CT能谱成像在良恶性纵隔淋巴结鉴别中的应用

毕正宏; 任庆国; 李铭; 王鸣鹏; 殷士蒙; 李克

doi:10.3760/cma.j.issn.1005-1201.2015.08.005

高级检索

IP登录

登录IP

切换

退出

中华放射学杂志

• 胸部放射学 •

ENGLISH ABSTRACT

CT能谱成像在良恶性纵隔淋巴结鉴别中的应用

作者及单位信息

出版日期： 2015 -08 -10 ·

DOI： 10.3760/cma.j.issn.1005-1201.2015.08.005

Application of spectral CT in the differential diagnosis of benign and malignant mediastinal lymph nodes

Authors Info & Affiliations

Bi Zhenghong

Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, China

Ren Qingguo

Li Ming

Wang Mingpeng

Yin Shimeng

Li Ke

Published： 2015 -08 -10 ·

DOI： 10.3760/cma.j.issn.1005-1201.2015.08.005

498

APP内阅读

摘要

目的分析良恶性淋巴结CT能谱成像参数的差异，探讨CT能谱成像在纵隔良恶性淋巴结鉴别诊断中的应用价值。

方法根据随访和病理结果，筛选出73例进行纵隔淋巴结CT能谱成像患者。1名有10年以上CT工作经验的医师与手术和相关医师一起将手术病理淋巴结所示位置与CT图像中淋巴结位置进行认真配对，共纳入47枚恶性淋巴结（恶性组）和65枚良性淋巴结（良性组）。在纵隔窗上测量淋巴结的最长径及最短径，并获取淋巴结及正常周围肺组织和胸壁肌肉组织在40、70、140 keV虚拟单能量图像的CT值以及CT变化值（vHU）、碘含量（IC）、水含量（WC）及有效原子序数（Z _eff）等能谱参数，采用独立样本组 t检验对两组间测量结果进行比较，并绘制能谱曲线图。

结果恶性组淋巴结长径及短径分别为（28.8±10.5）、（20.3±9.1) cm，良性组对应长短径分别为（14.0±4.6）、（7.5±1.8) cm，恶性组明显大于良性组，差异有统计学意义（ t值分别为6.54、7.13， P值均<0.05）。两组正常肺组织、胸壁肌肉组织和淋巴结在40、70、140 keV虚拟单能量的CT值和vHU、IC、WC、Z _eff值间差异均无统计学意义（ P值均> 0.05）。恶性及良性组淋巴结能谱曲线斜率分别为1.86、1.73，两者近似。

结论单期增强CT能谱成像难以对纵隔淋巴结进行良恶性鉴别诊断。

关键词：纵隔;淋巴结;体层摄影术，X线计算机;诊断，鉴别

ABSTRACT

ObjectiveTo compare the differences of the spectral CT parameters between benign and malignant mediastina lymph nodes and to investigate the value of spectral imaging in the differential diagnosis.

MethodsAccording to the follow-up and pathology results, a total of 73 patients were enrolled in this study. One experienced radiologist determined the locations of lymph nodes on CT images corresponding to the surgical pathological ones. A total of 47 malignant nodes and 65 benign nodes were found. The longest and shortest diameters of lymph nodes in mediastina window were measured .The vHU, IC, WC, Z _eff and the CT values of normal lung, normal muscle and lymph nodes at 40, 70 and 140 keV were measured. The indices were compared between the benign nodes and malignant nodes by independent-samples t test. The Spectral HU curves were drawn.

ResultsThe long and short diameter of malignant lymph nodes were (28.8±10.5), (20.3±9.1)cm , while they were were (14.0±4.6),(7.5±1.8)cm for benign lymph nodes. Malignant nodes were significantly larger than benign nodes ( t=6.54, 7.13, respectively, P<0.05), The differences of the CT values at 40, 70 and 140 keV and the vHU, IC, WC, Z _eff for the normal lung, normal muscle and lymph nodes between the two groups had no statistical significance ( P> 0.05). The two groups showed similar spectral HU curve slopes (1.86 values 1.73).

ConclusionSpectral imaging may not be helpful in the differential diagnosis of malignant and benign lymph nodes.

KEYWORDS： Mediastinum;Lymph nodes;Tomography, X-ray computed;Diagnosis, differential

Corresponding author: Li Ke, Email: mocdef.3ab612036kl

COPYRIGHTS:

No content published by the journals of Chinese Medical Association may be reproduced or abridged without authorization. Please do not use or copy the layout and design of the journals without permission.

All articles published represent the opinions of the authors, and do not reflect the official policy of the Chinese Medical Association or the Editorial Board, unless this is clearly specified.

引用本文

毕正宏,任庆国,李铭,等. CT能谱成像在良恶性纵隔淋巴结鉴别中的应用[J]. 中华放射学杂志,2015,49(8)：582-585.

DOI:10.3760/cma.j.issn.1005-1201.2015.08.005

PERMISSIONS

Request permissions for this article from CCC.

评价本文

*以上评分为匿名评价

版权归中华医学会所有。

未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。

除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

纵隔及肺门淋巴结转移是肺癌转移的重要途径，直接决定肿瘤分期。临床工作中常以淋巴结短径是否>10 mm作为鉴别淋巴结良恶性的指标 ^{[
1
]}，但是其敏感度和特异度不高。目前有关淋巴结的CT研究报道主要见于颈部淋巴结 ^{[
2
,

3
]}，纵隔淋巴结CT研究报道比较少见 ^{[
3
]}，而且主要为PET或PET-CT的研究报道 ^{[
4
,

5
]}。近年CT能谱成像（gemstone spectral imaging, GSI）技术吸引了众多研究者的兴趣 ^{[
6
,

7
,

8
]}，其利用两种电压瞬间切换技术获取数据，生成虚拟单能量图像（virtual monochromatic images, VMIs）和物质密度图像 ^{[
7
]}。本研究通过对纵隔良恶性淋巴结能谱成像参数的初步比较，旨在探讨CT能谱成像在纵隔转移性淋巴结和良性淋巴结鉴别诊断中的应用价值。

试读结束，您可以通过登录机构账户或个人账户后获取全文阅读权限。

已是订阅账户? 登录

摘要
参考文献

参考文献

[1]

罗为展，钟长镐，陈愉，等．灰阶超声声像特征对肺门纵隔恶性淋巴结的预测价值[J]．中华结核和呼吸杂志， 2014，37（12）：924-927．

返回引文位置Google Scholar

百度学术

万方数据

[2]

钟进，刘筠，华锐，等．颈部淋巴结病变的CT灌注成像研究[J]．中华放射学杂志， 2011，45（1）：46-46．

返回引文位置Google Scholar

百度学术

万方数据

[3]

Morita S , Mizoguchi K , Suzuki M ,et al. The accuracy of (18) [F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography, ultrasonography, and enhanced computed tomography alone in the preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma[J]. World J Surg, 2010,34(11):2564-2569.

返回引文位置Google Scholar

百度学术

万方数据

[4]

Lee SM , Park CM , Paeng JC ,et al. Accuracy and predictive features of FDG-PET/CT and CT for diagnosis of lymph node metastasis of T1 non-small-cell lung cancer manifesting as a subsolid nodule[J]. Eur Radiol, 2012,22(7):1556-1563.

返回引文位置Google Scholar

百度学术

万方数据

[5]

Kasai T , Motoori K , Horikoshi T ,et al. Dual-time point scanning of integrated FDG PET/CT for the evaluation of mediastinal and hilar lymph nodes in non-small cell lung cancer diagnosed as operable by contrast-enhanced CT[J]. Eur J Radiol, 2010,75(2):143-146.

返回引文位置Google Scholar

百度学术

万方数据

[6]