The Differential Diagnosis Study Of Primary Pulmonary Squamous-cell Carcinoma And Adenocarcinoma With Gemstone Spectral CT

Objective: To explore the differential diagnosis value of the primary pulmonary squamous-cell carcinoma and adenocarcinoma by Gemstone Spectral CT, and the value of it in clinical application.Methods: Selected the cases which were tested by GSI enhanced scan and diagnosed as primary pulmonary adenocarcinoma or squamous cell carcinoma by pathology for 30 patients respectively. Determined the Iodine value and spectral curve with monochromatic imaging by GSI viewer. Calculated the CT value,the Iodine value,spectral curve,normalized iodine concent rations(NIC),and the slope rate of spectral curve(K) by monochromatic energy in pulmonary arterial phase and aortic phase with GSI viewer. Using SPSS19.0 to statistical analysis: Data were analyzed between two groups, different groups of same differentiation levels with t test, one group of different differentiation levels with ANOVE, and using Spearman test the correlation of NIC and K with differentiation levels. Using ROC to calculate the area under the ROC curve(AUC).Results: The pulmonary arterial phase: the CT value of adenocarcinoma was significantly higher than squamous-cell carcinoma on 40~140ke V(P<0.01); NIC and the K of adenocarcinoma group were higher compared with squamous-cell carcinoma group(P<0.05). The aortic phase: the CT value of adenocarcinoma was significantly higher than squamous-cell carcinoma on 40~140ke V(P<0.01); NIC and the K of adenocarcinoma group were higher than squamous-cell carcinoma group(P<0.05). Adenocarcinoma group is higher than squamous-cell carcinoma group in the level I aortic phase NIC, K and the level II aortic phase K and the level III aortic phase K(P<0.05). The level III aortic phase K was higher than level I in adenocarcinoma group(P < 0.05), The level III pulmonary arterial phase K was higher than level II in squamous-cell carcinoma group(P < 0.05). NIC and K were positively related with differentiation levels(P < 0.05). The area under the ROC curve for the aortic phase NIC was 0.717, the value of critical diagnosis was 0.132, sensitivity was 0.733 and specificity was 0.633; The area under the ROC curve for pulmonary arterial phase K was 0.733, the value of critical diagnosis was1.355, sensitivity was 0.533 and specificity was 0.933; The area under the ROC curve for the arterial phase K was 0.745, the value of critical diagnosis was 1.020, sensitivity was 0.900 and specificity was 0.533.Conclusion: Using gemstone spectral CT with monochromatic imaging, spectral curve, material separation and quantity are helpful in differential diagnosis of the primary squamous-cell carcinoma and adenocarcinoma.