收稿日期: 2024-03-27
网络出版日期: 2024-07-15
基金资助
广东省医学科研基金项目(A2024521);广州医科大学本科生创新创业培育项目;广东省钟南山医学基金会(ZNSXS-20230001)
Differential diagnostic value of wide⁃body spectral CT parameters in mediastinal metastatic， non⁃metastatic lymph nodes of lung cancer patients and reactive hyperplastic lymph nodes
Received date: 2024-03-27
Online published: 2024-07-15
目的 探讨宽体能谱CT在肺癌纵隔转移淋巴结、非转移淋巴结与反应性增生淋巴结的鉴别诊断价值。 方法 回顾性分析64例肺癌患者和28例肺部炎性病变患者临床及影像资料，所有患者均行平扫、增强双期能谱CT扫描，分别在70 keV单能量图像及碘基图像上测量转移、非转移、炎性反应性增生三组淋巴结大小、密度、三期IC、NIC、λHU，并用单因素方差、Kruskal- Wallis H秩和检验方法分析比较其差异。 结果 转移淋巴结短径比非转移淋巴结及反应性增生淋巴结大（P < 0.001）。反应性增生淋巴结平扫密度比转移淋巴结高（P < 0.001），而与非转移淋巴结差异无统计学意义（P = 0.325）；增强扫描反应性增生淋巴结动脉期、静脉期CT值均比转移、非转移淋巴结高（P < 0.05）。除了动脉期NIC，反应性增生淋巴结与转移淋巴结在平扫IC、NIC、λHU，动脉期IC、λHU，静脉期IC、NIC、λHU均有统计学意义（P < 0.05），而反应性增生淋巴结与非转移淋巴结在平扫、动脉期及静脉期的IC、NIC、λHU差异均无统计学意义（P > 0.05）。 结论 肺癌纵隔转移淋巴结碘的定量及能谱曲线斜率基本低于反应性增生淋巴结，能谱CT定量参数鉴别两者有一定诊断效能，而非转移淋巴结与反应性增生淋巴结能谱参数无差异。
郑思捷 , 向佳 , 陈茜彤 , 卢颖欣 , 刘韵 , 陈淮 , 黄绥丹 . 宽体能谱CT参数在鉴别诊断肺癌纵隔转移、非转移淋巴结与反应性增生淋巴结中的价值[J]. 实用医学杂志, 2024 , 40(14) : 2003 -2008 . DOI: 10.3969/j.issn.1006-5725.2024.14.017
Objective The evaluation of lymph node properties before lung cancer surgery has a great impact with the choice of surgical methods. Although there are various examination methods， many methods have invasive or accuracy problems. In order to improve the accuracy of diagnosis， we mainly discuss the value of wide?body spectral CT in the differential diagnosis of mediastinal metastatic lymph nodes， non?metastatic lymph nodes in lung cancer patients and reactive hyperplastic lymph nodes. Methods The clinical and imaging data of 64 patients with lung cancer and 28 patients with pulmonary inflammatory lesions were retrospectively analyzed. All patients underwent plain scan and enhanced dual?phase spectral CT scan. The size， density， three?phase IC， NIC， and λHU of lymph nodes in metastatic， non?metastatic and inflammatory reactive hyperplasia groups were measured on 70 keV single?energy images and iodine?based images， respectively. The single?factor variance and Kruskal?Wallis H rank sum test were used to analyze and compare the differences. Results The short diameter of metastatic lymph nodes was larger than that of non?metastatic lymph nodes and reactive hyperplastic lymph nodes （P < 0.001）. The plain scan density of reactive hyperplastic lymph nodes was higher than that of metastatic lymph nodes （P < 0.001）， but there was no significant difference between non?metastatic lymph nodes （P = 0.325）. The CT values of reactive hyperplastic lymph nodes in arterial phase and venous phase were higher than those of metastatic and non?metastatic lymph nodes （P < 0.05）. Except for NIC in arterial phase， IC， NIC and λHU in plain scan， IC and λHU in arterial phase， IC， NIC and λHU in venous phase of reactive hyperplastic lymph nodes and metastatic lymph nodes were statistically significant （all P < 0.05）. There was no significant difference in IC， NIC and λHU between reactive hyperplastic lymph nodes and non?metastatic lymph nodes in plain scan， arterial phase and venous phase （all P > 0.05）. Conclusion The quantitative and spectral curve slope of iodine in mediastinal metastatic lymph nodes of lung cancer were basically lower than those in reactive hyperplastic lymph nodes. The quantitative parameters of spectral CT had certain diagnostic efficacy in differentiating metastatic lymph nodes and reactive hyperplastic lymph nodes， while the spectral parameters of non?metastatic lymph nodes and reactive hyperplastic lymph nodes were not statistically significant.
Key words： lung cancer; mediastinal lymph nodes; spectral CT; efficiency
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