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

doi:10.3969/j.issn.1006-5725.2024.14.017

Abstract

Abstract:

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

CLC Number:

R816.4

Sijie ZHENG,Jia XIANG,Qiantong CHEN,Yingxin LU,Yun LIU,Huai CHEN,Suidan. HUANG. 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[J]. The Journal of Practical Medicine, 2024, 40(14): 2003-2008.

Figures/Tables 4

References 27

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类别	肺癌组（n = 64）	炎症组（n = 28）
性别
男	41	19
女	23	9
年龄（x ± s，岁）	61.3 ± 10.3	62.3 ± 12.6
确诊方式
手术切除	55	0
穿刺活检	9	12
临床确诊	0	16
淋巴结（枚）
转移	74	0
非转移	152	0
反应性增生	0	222

参数	转移淋巴结	非转移淋巴结	反应性增生淋巴结	F/H值	P值
短径（mm）	14.35 ± 7.73^*	8.18 ± 1.77^*	10.33 ± 3.15	91.749	< 0.001
平扫CT（HU）	39.00 ± 9.33^*	45.20 ± 12.83	48.77 ± 15.37	21.755	< 0.001
动脉期CT（HU）	63.30 ± 19.42^*	67.71 ± 19.30^*	76.86 ± 18.17	36.642	< 0.001
静脉期CT（HU）	77.17 ± 15.99^*	81.59 ± 20.29^*	88.54 ± 14.36	30.185	< 0.001

参数	转移淋巴结	非转移淋巴结	反应性增生淋巴结	F/H值	P值
平扫IC（x ± s）	7.07 ± 2.36	8.85 ± 2.54^*	8.77 ± 2.64	26.236	< 0.001
平扫NIC	1.56（1.19，2.01）	1.81（1.37，2.42）^*	1.89（1.47，2.50）	14.409	0.001
平扫λHU	0.80（0.63，1.08）	1.05（0.86，1.29）^*	1.06（0.85，1.31）	27.897	< 0.001
动脉期IC（x ± s）	18.84 ± 8.03	23.51 ± 7.66^*	22.87 ± 6.66	21.529	< 0.001
动脉期NIC	0.19（0.13，0.24）	0.20（0.14，0.27）	0.19（0.16，0.24）	2.958	0.228
动脉期λHU	2.22（1.54，2.76）	2.70（2.22，3.29）^*	2.68（2.18，3.25）	22.788	< 0.001
静脉期IC（x ± s）	22.61 ± 5.89	25.47 ± 5.44^*	25.30 ± 4.63	10.799	0.005
静脉期NIC	0.51（0.43，0.56）	0.53（0.46，0.62）^*	0.56（0.48，0.64）	14.495	0.001
静脉期λHU	2.80（2.22，3.20）	3.00（2.62，3.47）^*	3.03（2.64，3.43）	11.562	0.003

参数	AUC	95%CI	临界值	灵敏度（%）	特异度（%）
平扫IC	0.682	0.612 ~ 0.752	6.46	50.0	81.1
平扫NIC	0.645	0.574 ~ 0.717	1.69	64.9	61.7
平扫λHU	0.689	0.619 ~ 0.759	0.795	50.0	82.9
动脉期IC	0.669	0.596 ~ 0.743	23.44	79.7	46.4
动脉期λHU	0.671	0.598 ~ 0.744	2.095	47.3	78.4
静脉期IC	0.623	0.546 ~ 0.699	19.18	28.4	93.2
静脉期NIC	0.647	0.578 ~ 0.716	0.585	85.1	42.3
静脉期λHU	0.627	0.551 ~ 0.704	2.335	31.1	93.2

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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

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