能谱CT定量参数对非小细胞肺癌纵隔淋巴结转移中的应用价值
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摘要
目的探讨能谱CT定量参数对非小细胞肺癌(NSCLC)纵隔淋巴结转移的初步研究。方法前瞻性搜集60例NSCLC患者且均行能谱CT增强扫描,入组淋巴结共100枚,转移性65枚,未转移性35枚,测量并比较动、静双期转移组和未转移组淋巴结的碘浓度(IC)、标化碘浓度(NIC)、水浓度(WC)、标化水浓度(NWC)、能谱曲线斜率及有效原子序数。动、静脉期转移组与未转移组淋巴结能谱各参数对比采用独立样本t检验,P<0.05为有统计学意义。对具有统计学差异的能谱参数进行受试者工作特征曲线(ROC)分析,通过计算约登指数确定各参数的最佳临界值,并计算采用该临界值诊断肺癌类型的敏感度、特异度及曲线下面积(AUC)。结果动脉期转移组与未转移组淋巴结IC分别为20.66±2.255、18.87±0.879,差异有明显统计学意义(t=5.537,P<0.001);NIC分别为0.22±0.006、0.23±0.013,差异有明显统计学意义(t=6.760,P<0.001);能谱斜率分别为1.85±0.136、2.04±0.198,差异有明显统计学意义(t=5.536,P<0.001);有效原子序数分别为8.63±0.075、8.69±0.091,差异有明显统计学意义(t=3.543,P<0.001)。静脉期转移组与未转移组淋巴结IC分别为20.09±1.070、22.05±1.988,差异有明显统计学意义(t=5.318,P<0.001);NIC分别为0.43±0.010、0.45±0.013,差异有明显统计学意义(t=8.946,P<0.001);能谱斜率分别为2.33±0.050、2.44±0.102,差异有明显统计学意义(t=6.027,P<0.001);有效原子序数分别为8.66±0.066、8.75±0.117,差异有明显统计学意义(t=4.199,P<0.001)。动、静脉期WC及NWC均无明显统计学意义(P均>0.05)。ROC分析显示静脉期NIC的诊断效能最高,当NIC为0.44 mg/ml时,判断纵隔淋巴结转移的敏感度为84.8%,特异度为82.9%,AUC为0.881。结论能谱CT定量参数对术前评估NSCLC纵隔淋巴结转移具有一定的临床应用价值,有利于术前明确淋巴结的转移状态。
Objective To investigate the preliminary study of quantitative parameters of spectral CT in the mediastinal lymph node metastasis of NSCLC. Methods A prospective analysis of 60 non-small-cell lung cancers was performed with contrast-enhanced CT scan. A total of 100 lymph nodes were enrolled,65 metastatic,and 35 non-metastatic. We measured and compared dynamic and static dual-phase images with metastases and no metastases. The iodine concentration(IC),standardized iodine concentration(NIC),water concentration(WC),standardized water concentration(NWC),slope of the energy spectrum curve K,and effective atomic number of lymph nodes in the group was evaluated. The independent sample t-test was used to compare the parameters of the lymph node energy spectrum between the arterial and venous phase metastasis group and the non-metastatic group,P<0.05 was statistically significant. ROC curve analysis was performed on statistically significant energy spectrum parameters. The Youden index(YI) was used to determine the best critical value of each parameter,and the sensitivity and specificity of the diagnosis of lung cancer type using this critical value were calculated. Area under the curve(AUC) was determined. Results The rates of IC,NIC,effective atomic number and energy spectrum curve of lymph node in arterial phase metastasis group and non-metastasis group were 20.66±2.255 and 18.87±0.879,respectively. The difference was statistically significant(t=5.537,P<0.001); 0.22± 0.006,0.23 ± 0.013,the difference was statistically significant(t=6.760,P<0.001); 1.85 ± 0.136,2.04 ± 0.198,the difference was statistically significant(t=5.536,P<0.001); 8.63 ± 0.075,8.69 ± 0.091,the difference was statistically significant(t=3.543,P<0.001). WC and NWC no significant statistical significance(P> 0.05). The slopes of IC,NIC,effective atomic number and energy spectrum of lymph nodes in venous phase metastasis group and non-metastatic group were 20.09±1.070 and 22.05±1.988,respectively. The difference was statistically significant(t=5.318,P<0.001); 0.43±0.010. The difference between 0.45±0.013 was statistically significant(t=8.946,P<0.001); 2.33±0.050,2.44±0.102,and the difference was statistically significant(t=6.027,P<0.001); 8.66±0.066,8.75±0.117. The difference was statistically significant(t=4.199,P<0.001). No significant statistical significance was found in the WC and NWC of the arteriovenous phase(P=0.05,P<0.05,P=0.241,0.085,0.636,0.595,respectively).The ROC curve analysis showed that the diagnostic efficiency of venous phase NIC was the highest. When NIC was 0.44 mg/ml,the sensitivity of judging mediastinal lymph node metastasis was 84.8%,the specificity was 82.9%,and the area under the curve was 0.881. Conclusion Quantitative CT spectral parameters have certain clinical value in preoperative assessment of mediastinal lymph node metastasis of NSCLC,which is helpful for the definite lymph node metastasis before surgery.
Objective To investigate the preliminary study of quantitative parameters of spectral CT in the mediastinal lymph node metastasis of NSCLC. Methods A prospective analysis of 60 non-small-cell lung cancers was performed with contrast-enhanced CT scan. A total of 100 lymph nodes were enrolled,65 metastatic,and 35 non-metastatic. We measured and compared dynamic and static dual-phase images with metastases and no metastases. The iodine concentration(IC),standardized iodine concentration(NIC),water concentration(WC),standardized water concentration(NWC),slope of the energy spectrum curve K,and effective atomic number of lymph nodes in the group was evaluated. The independent sample t-test was used to compare the parameters of the lymph node energy spectrum between the arterial and venous phase metastasis group and the non-metastatic group,P<0.05 was statistically significant. ROC curve analysis was performed on statistically significant energy spectrum parameters. The Youden index(YI) was used to determine the best critical value of each parameter,and the sensitivity and specificity of the diagnosis of lung cancer type using this critical value were calculated. Area under the curve(AUC) was determined. Results The rates of IC,NIC,effective atomic number and energy spectrum curve of lymph node in arterial phase metastasis group and non-metastasis group were 20.66±2.255 and 18.87±0.879,respectively. The difference was statistically significant(t=5.537,P<0.001); 0.22± 0.006,0.23 ± 0.013,the difference was statistically significant(t=6.760,P<0.001); 1.85 ± 0.136,2.04 ± 0.198,the difference was statistically significant(t=5.536,P<0.001); 8.63 ± 0.075,8.69 ± 0.091,the difference was statistically significant(t=3.543,P<0.001). WC and NWC no significant statistical significance(P> 0.05). The slopes of IC,NIC,effective atomic number and energy spectrum of lymph nodes in venous phase metastasis group and non-metastatic group were 20.09±1.070 and 22.05±1.988,respectively. The difference was statistically significant(t=5.318,P<0.001); 0.43±0.010. The difference between 0.45±0.013 was statistically significant(t=8.946,P<0.001); 2.33±0.050,2.44±0.102,and the difference was statistically significant(t=6.027,P<0.001); 8.66±0.066,8.75±0.117. The difference was statistically significant(t=4.199,P<0.001). No significant statistical significance was found in the WC and NWC of the arteriovenous phase(P=0.05,P<0.05,P=0.241,0.085,0.636,0.595,respectively).The ROC curve analysis showed that the diagnostic efficiency of venous phase NIC was the highest. When NIC was 0.44 mg/ml,the sensitivity of judging mediastinal lymph node metastasis was 84.8%,the specificity was 82.9%,and the area under the curve was 0.881. Conclusion Quantitative CT spectral parameters have certain clinical value in preoperative assessment of mediastinal lymph node metastasis of NSCLC,which is helpful for the definite lymph node metastasis before surgery.
引文
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2 Rami-Porta R,Crowley JJ,Goldstraw P.The revised TNM staging system for lung cancer[J].Ann Thorac Cardiovasc Surg,2009,15:4-9.
3 Takamochi K,Nagai K,Yoshida J,et al.The role of computed tomographic scanning in diagnosing mediastinal node involvement in non-small cell 1ung cancer[J].J Thorac Cardiovasc Surg,2000,119:1135-1140.
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7 Kubota K,Murakami K,Inoue T,et al.Additional value of FDG-PET to contrast enhanced-computed tomography (CT) for the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer:a Japanese multicenter clinical study [J].Ann Nucl Med,2011,25:777-786.
8 杨金华,李文献,赵天增.肺癌纵隔淋巴结转移58例的临床分析[J].第四军医大学学报,2007,28:1631-1631.
9 杜祥颖,李倩文,王艳,等.CT能谱成像中利用能谱曲线进行碘定量分析[J].放射学实践,2013,28:616-618.
10 沈静娴,谢传淼,习勉,等.能谱CT定量指标在鉴别诊断非小细胞肺癌转移淋巴结与非转移淋巴结中的价值[J].中山大学学报:医学科学版,2014,35:738-743.
11 恩藏戈·杰西,詹文华,汪建平,等.进展期胃癌的淋巴结转移特点及其临床意义[J].中华胃肠外科杂志,2006,9:506-509.
12 Offersen BV,Pfeiffer P,Hamilton-Dutoit S,et al.Patterns of angiogenesis in nonsmall-cell lung carcinoma[J].Cancer,2001,91:1500-1509.
13 林晓珠,沈云,陈克敏.CT能谱成像的基本原理与临床应用研究进展 [J].中华放射学杂志,2011,45:798-800.
14 王玉婕,黄遥,唐威等.宝石能谱CT在提高非小细胞肺癌术前淋巴结转移状态准确性中的初步研究[J].癌症进展,2015,13:188-193.
2 Rami-Porta R,Crowley JJ,Goldstraw P.The revised TNM staging system for lung cancer[J].Ann Thorac Cardiovasc Surg,2009,15:4-9.
3 Takamochi K,Nagai K,Yoshida J,et al.The role of computed tomographic scanning in diagnosing mediastinal node involvement in non-small cell 1ung cancer[J].J Thorac Cardiovasc Surg,2000,119:1135-1140.
4 Lau CL,Harpole DJ.Noninvasive clinical staging modalities for lung cancer[J].Semin SurgOncol,2000,18:116-123.
5 Dwamena BA,Sonnad SS,Angobaldo JO,et al.Metastases form non-small cell lung cancer:mediastinal staging in the 1990s:meta-analytic comparison of PET and CT[J].Radiology,1999,213:530-536.
6 Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline version 1.1[J].Eue J Cancer,2009,45:228-247.
7 Kubota K,Murakami K,Inoue T,et al.Additional value of FDG-PET to contrast enhanced-computed tomography (CT) for the diagnosis of mediastinal lymph node metastasis in non-small cell lung cancer:a Japanese multicenter clinical study [J].Ann Nucl Med,2011,25:777-786.
8 杨金华,李文献,赵天增.肺癌纵隔淋巴结转移58例的临床分析[J].第四军医大学学报,2007,28:1631-1631.
9 杜祥颖,李倩文,王艳,等.CT能谱成像中利用能谱曲线进行碘定量分析[J].放射学实践,2013,28:616-618.
10 沈静娴,谢传淼,习勉,等.能谱CT定量指标在鉴别诊断非小细胞肺癌转移淋巴结与非转移淋巴结中的价值[J].中山大学学报:医学科学版,2014,35:738-743.
11 恩藏戈·杰西,詹文华,汪建平,等.进展期胃癌的淋巴结转移特点及其临床意义[J].中华胃肠外科杂志,2006,9:506-509.
12 Offersen BV,Pfeiffer P,Hamilton-Dutoit S,et al.Patterns of angiogenesis in nonsmall-cell lung carcinoma[J].Cancer,2001,91:1500-1509.
13 林晓珠,沈云,陈克敏.CT能谱成像的基本原理与临床应用研究进展 [J].中华放射学杂志,2011,45:798-800.
14 王玉婕,黄遥,唐威等.宝石能谱CT在提高非小细胞肺癌术前淋巴结转移状态准确性中的初步研究[J].癌症进展,2015,13:188-193.