作者：李永军1 ，刘涛 2 ，张辉 1 ，赵静 1 ，赵合保 1 ，李保卫 1

单位：

1.056000 河北省邯郸市，河北工程大学附属医院医学影像科；2.056000 河北省邯郸市，冀中能源峰峰集团有限公司总医院 CT 室；通信作者：李保卫，E-mail：hdmc_001@163.com

Units：

1.Department of Medical Imaging，the Affiliated Hospital of Hebei University of Engineering，Handan 056000，China；2.CT Room，General Hospital of Jizhong Energy Fengfeng Group Co.，LTD，Handan 056000，China；Corresponding author：LI Baowei，E-mail：hdmc_001@163.com

关键词：

非小细胞肺癌；体层摄影术，螺旋计算机；诊断显像；能谱 CT 成像；诊断

Keywords：

Non-small-cell lung carcinoma；Tomography，spiral computed；Diagnostic imaging；Energyspectrum CT imaging；Diagnosis

CLC：

R 730.26　R 814.42

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.013

Funds：

河北省财政厅 2018 年度政府专科能力建设科技研究项目

摘要：

目的　分析能谱 CT 成像对非小细胞肺癌（NSCLC）患者淋巴结转移的诊断价值。方法　选取 2016年 8 月—2018 年 8 月在河北工程大学附属医院就诊的 NSCLC 患者 58 例，均行能谱 CT 成像检查。比较所有患者转移病灶与非转移病灶淋巴结短径，并比较所有患者转移病灶与非转移病灶淋巴结、原发病灶能谱曲线斜率（λ Hu ）及其 λ Hu 比值、标准化碘（水）密度（NIC）及其 NIC 比值、标准化水（碘）密度（NWC）及其 NWC 比值、标化有效原子序数（Neff-Z）及其 Neff-Z 比值；以手术及病理学检查结果为“金标准”，绘制四格表以分析能谱 CT 成像对NSCLC 患者淋巴结转移的诊断价值，并绘制 ROC 曲线以分析淋巴结和原发病灶 λ Hu 比值、NIC 比值在判断 NSCLC 患者淋巴结转移中的价值。结果　（1）NSCLC 患者转移病灶淋巴结短径长于非转移病灶（P<0.01）；绘制四格表发现，能谱 CT 成像诊断 NSCLC 患者淋巴结转移的灵敏度为 90.00%，特异度为 60.00%，准确率为 69.47%。（2）NSCLC 患者转移病灶淋巴结 λ Hu 、淋巴结和原发病灶 λ Hu 比值低于非转移病灶，原发病灶 λ Hu 高于非转移病灶（P<0.05）；ROC曲线显示，淋巴结和原发病灶λ Hu 比值诊断NSCLC患者淋巴结转移的曲线下面积（AUC）为0.791〔95%CI（0.737，0.823）〕，最佳临界值为 1.35，灵敏度为 88.6%，特异度为 72.7%。（3）NSCLC 患者转移病灶淋巴结 NIC、淋巴结和原发病灶 NIC 比值低于非转移病灶，原发病灶 NIC 高于非转移病灶（P<0.05）；ROC 曲线显示，淋巴结和原发病灶 NIC 比值诊断 NSCLC 患者淋巴结转移的 AUC 为 0.751〔95%CI（0.717，0.811）〕，最佳临界值为 1.25，灵敏度为 85.1%，特异度为 73.4%。（4）NSCLC 患者转移病灶与非转移病灶淋巴结、原发病灶 NWC 及其 NWC 比值比较，差异无统计学意义（P>0.05）。（5）NSCLC 患者转移病灶与非转移病灶淋巴结、原发病灶 Neff-Z 比较，差异无统计学意义（P>0.05），而转移病灶淋巴结和原发病灶 Neff-Z 比值低于非转移病灶（P<0.05）。结论　能谱 CT 成像诊断NSCLC 患者淋巴结转移的灵敏度较高，而能谱 CT 参数淋巴结和原发病灶 λ Hu 比值、NIC 比值在判断 NSCLC 患者淋巴结转移中有一定参考、应用价值，有利于提高临床判断 NSCLC 患者淋巴结转移的准确性。

Abstract：

Objective　To analyze the diagnostic value of energy spectrum CT imaging on lymphatic metastasis inpatients with non-small cell lung cancer（NSCLC）.Methods　A total of 58 patients with NSCLC were selected in the AffiliatedHospital of Hebei University of Engineering from August 2016 to August 2018，all of them underwent the examination of energyspectrum CT imaging. Short diameter of lymph node，λ Hu ，NIC，NWC and Neff-Z of lymph node and primary focus，λ Huratio，NIC ratio，NWC ratio and Neff-Z ratio of lymph node to primary lesion were compared between metastatic lesion and non-metastatic lesion；taking surgical and pathological examination results as "gold standard"，four-fold table was drawn to analyzethe diagnostic value of energy spectrum CT imaging on lymphatic metastasis in patients with NSCLC，ROC curve was drawn toanalyze the diagnostic value of λ Hu ratio and NIC ratio of lymph node to primary lesion on lymphatic metastasis in patients withNSCLC，respectively. Results　（1）Short diameter of lymph node in metastatic lesion was statistically significantly longerthan that in non-metastatic lesion in patients with NSCLC（P<0.01）；four-fold table showed that，the sensitivity，specificityand accuracy rate of energy spectrum CT imaging in diagnosing lymphatic metastasis of patients with NSCLC was 90.00%，60.00% and 69.47%，respectively.（2）λ Hu of lymph node and λ Hu ratio of lymph node to primary lesion in metastatic lesionwere statistically significantly lower than those in non-metastatic lesion in patients with NSCLC，while λ Hu of primary focus inmetastatic lesion was statistically significantly higher than that in non-metastatic lesion in patients with NSCLC（P<0.05）；ROC curve showed that，AUC，optimum critical value，sensitivity and specificity of λ Hu ratio of lymph node to primarylesion in diagnosing lymphatic metastasis in patients with NSCLC was 0.791〔95%CI（0.737，0.823）〕，1.35，88.6% and72.7%，respectively.（3）NIC of lymph node and NIC ratio of lymph node to primary lesion in metastatic lesion were statisticallysignificantly lower than those in non-metastatic lesion in patients with NSCLC，while NIC of primary focus in metastatic lesionwas statistically significantly higher than that in non-metastatic lesion in patients with NSCLC（P<0.05）；ROC curve showedthat，AUC，optimum critical value，sensitivity and specificity of NIC ratio of lymph node to primary lesion in diagnosinglymphatic metastasis in patients with NSCLC was 0.751〔95%CI（0.717，0.811）〕，1.25，85.1% and 73.4%，respectively.（4）No statistically significant difference of NWC of lymph node or primary focus，or NWC ratio of lymph node to primary lesion wasfound between metastatic lesion and non-metastatic lesion in patients with NSCLC（P>0.05）.（5）No statistically significantdifference of Neff-Z of lymph node or primary focus was found between metastatic lesion and non-metastatic lesion in patientswith NSCLC（P>0.05），while Neff-Z ratio of lymph node to primary lesion in metastatic lesion was statistically significantlylower than that in non-metastatic lesion in patients with NSCLC（P<0.05）. Conclusion　Energy spectrum CT imaging hasrelatively high sensitivity in diagnosing lymphatic metastasis in patients with NSCLC，however λ Hu ratio and NIC ratio of lymphnode to primary lesion have relatively high reference and application value in the diagnosis of lymphatic metastasis，which arehelpful to improve the diagnostic accuracy on clinic.

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