| Objective: To explore the value of multi-parameter analysis in the evaluation of efficacy of non-small cell lung cancer by dual-source CT in patients after radiotherapy and chemotherapy.Methods: A total of 61 non-small cell lung cancer patients were enrolled in our hospital from October 2015 to December 2016.Among them,43 males and 18 females,the age was between 43 and 77 years old,mean age 59.1 years ±8.7[standard deviation].All patients underwent bronchoscopic biopsy or local puncture were diagnosed as non-small cell lung cancer,including squamous cell carcinoma in 41 cases,adenocarcinoma in 20 cases.Clinical stage: ⅢA 14 cases,ⅢB in 35 cases,Ⅳin 12 cases.All patients underwent complete sequential chemoradiotherapy or concurrent chemoradiotherapy,and within 1 week before and after treatment,the Germany Siemens SOMATOM DEFINITION FLASH dual-source CT scanner was used for dual energy scanning.The dose of contrast medium was 1 ml per kg body weight in iodine content of 350 mgI/ml iohexol of non-ionic contrast medium.For vessel enhancement,the contrast medium was used at the flow rates of 4.0 ml/S using dual-barrel power injector via a cubital vein.The injection was followed by 30 ml of saline at the same flow rate using a dual-barrel power injector.Using Lung Nodules sequence,dual-phase dual-energy scanning was obtained 30 s and 60 s after the start of injection of the contrast medium.Scanning parameters: Tube A at a voltage of 140 Sn kV and tube B at a voltage of 80 kV,reference tube current 56 mAs,133 mAs,collimator width 64 x 0.6 mm,rotation time 0.28 s,helical pitch 0.55.Dual-source CT was performed from the thoracic inlet to the middle portion of the kidneys scan during a single breath hold following deep inspiration with the patients in supine position.Three types of data sets were generated from the dual-energy CT scanning: the 80 kV,Sn140 kV,and enhanced weighted-average images.The scan can obtain three sets of images,namely 80 kV image,Sn140 kV image and linear fusion image with high and low tube voltage according to certain weighting coefficient,linear fusion coefficient M is 0.4.The longest diameter of the cross section of the lesion in the fusion image was measured by the pulmonary nodule segmentation technique in the MM Oncology post-processing software of the Syngo-via workstation.80 kV and Sn 140 kV images were transferred to Siemens dual source CT dual energy software.The virtual non-enhanced images and iodine-enhanced images were made by using the Liver VNC application mode of dedicated dual-energy postprocessing software.The data of the two groups were measured before and after treatment: in the arterial phase mean CT value of virtual noncontrast and mean CT value of mixed images,overlay value and iodine concentration and normalized iodine concentration in the arteriovenous phase,and calculate the longest diameter change rate [the longest diameter of the lesion after treatment-the longest diameter before treatment)/ the longest Diameter before treatment × 100%],the mean CT value of the lesion(the mean CT value of the mixed image-the mean CT value of the virtual noncontrast),and the mean CT value of the rate of change [(after treatment to strengthen the mean CT value-before treatment to strengthen the mean CT value)/ before treatment to strengthen the mean CT value × 100%],lesions of arterial enhancement fraction AEF[(absolute iodine content in arterial phase/ absolut iodine content in venous phase)×100%].According to Choi criteria,patients were divided into treatment remission group(including complete response CR and partial response PR,A decrease in size ≥ 10% or a decrease in tumor attenuation(HU)decreased ≥ 15%)And no-remission group(including stable disease SD and progressive disease PD,A decrease in size <10%,and a decrease in tumor attenuation(HU)decreased <15%),according to NSCLC efficacy evaluation results were grouped.All statistical analyses were performed using the SPSS 21.0 statistical analysis software.The data were expressed as x? ±s,The correlation between the mean CT value of the lesion and the iodine coverage value of the iodine volume was analyzed by Pearson test,Before and after treatment the two groups were compared with t test,Statistical significance was confirmed if the P value was less than an alpha(α)level of 0.05.Results: 61 patients with non-small cell lung cancer underwent dual-source CT scans with one week before and after treatment,and 66 pulmonary nodules were found(the longest diameter ≥ 10 mm).The results showed that the mean CT value of lesions was consistent with iodine overlay value(r=0.996,P<0.05).According to the Choi criteria,patients were divided into treatment remission group and no-remission group,with 27 patients(29 pulmonary nodules)in the remission group and 34 patients(37 pulmonary nodules)in the no-remission group.Analysis of two groups : In the remission group the change rate of the longest diameter of the lesion was(-17.96± 5.94)%,and the change rate of the mean CT value was(-22.79±10.31)%.The change of the longest diameter of the lesion in no-remission group was(10.39±7.42)%,and the change rate of mean CT value was(-9.59±3.65)%.The change rate of longest diameter and the mean CT value of the remission group were significantly reduced and decreased(P<0.05)compared with the no-remission group.The remission group before treatment,the arterial phase normalized iodine concentration and iodine overlay value were(13.09+5.99)% and 29.48+10.54 HU,respectively after treatment(8.77+2.21)% and 22.23+6.91 HU,after treatment than before treatment significantly decreased(P<0.05),the no-remission group before treatment,the arterial phase normalized iodine concentration and iodine overlay value were(12.98+6.27)% and 26.93+10.61 HU,respectively after treatment(17.01+10.07)% and 31.01+10.85 HU,after treatment was significantly higher than before treatment(P<0.05).After treatment the remission group were significantly lower than those in the no-remission group(P<0.05).There was no significant difference between the two groups in the normalized iodine concentration and iodine overlay value in the venous phase(P>0.05).The remission group before treatment for tumor AEF(104.84+ 34.17)%,after treatment for(73.68+19.44)%,after treatment of tumor AEF was significantly lower than that before treatment(P<0.05),and no-remission group before treatment(107.45+32.49)%,after treatment for(125.79+30.19)%,after treatment of tumor AEF was significantly higher than that before treatment(P<0.05),remission group after treatment tumor AEF compared with no-remission group decreased(P<0.05).Conclusion: Dual-source CT can not only display the morphological features of the lesion.The multiple parameters in the dual energy image can also quantitatively analyze the enhancement features of the lesion,evaluate the degree of vascularization,and make the CT diagnosis from the single morphological judgment into the multi-parameter quantitative analysis and functional diagnosis.Dual-source CT can be used as a useful method for the evaluation of the efficacy of non-small cell lung cancer,especially for early evaluation of efficacy,for patients to improve the follow-up treatment to provide a reference. |
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