| Part Ⅰ The value of spectral CT imaging in identifying pulmonaryinflammatory nodules and lung cancers with a diameter≤ 2cmObjectives:The study was designed to evaluate the role of spectral computed CT in identifying pulmonary inflammatory nodules and lung cancers with a diameter of or less than 2cm.Methods:The clinical data were collected and analyzed from 41 cases of solitary pulmonary nodules with diameters of or less than 2cm,of which,13 cases were pathologically confirmed as inflammatory nodules and the remaining 28 cases were pathologically diagnosed as lung cancer.Gemstone Spectral Imaging(GSI)scanning was performed on all patients.The iodine concentration(IC)in arterial and venous phases,the CT values of 40 Ke V as well as 90 Ke V were detected in two groups of pulmonary nodules.Based on these results,we calculated the normalized iodine concentration(NIC)in arterial and venous phases,the normalized iodine concentration difference(ICD)between arterial and venous phases and slope of spectral curve(from 40 Ke V to 90 Ke V)in arterial and venous phases.Then,these above-described indicators were analyzed by Independent Sample T test and receiver operating characteristic(ROC)curves.Results :The NIC in arterial phase of pulmonary inflammatory nodules(0.12±0.02)was significantly smaller than that of lung cancers(0.18±0.04)(p < 0.01),while The NIC in venous phase、ICD and the slope of spectral curve in venous phasesλVP(0.49±0.07;0.37±0.07;2.92±0.89)of pulmonary inflammatory nodules was significantly larger than that of lung cancers(0.38±0.09;0.20±0.08;2.15±0.64)(P<0.05).The slope of spectral curve in arterial phases was not statistically significant between the two groups(p =0.384).Therefore,ICD was the optimal quantitative parameter for identification,with a threshold of 0.333,and the sensitivity and specificity were 85.7% and 96.4%;respectively,NIC in arterial phase was the second best parameter for identification,with a threshold of 0.152,and the sensitivity and specificity were 71.4% and 100%.Conclusions:The multiple parameters of IC in spectral CT presented with diagnostic values in identifying pulmonary inflammatory nodules and lung cancers with a diameter of or less than 2cm,among which,ICD and NIC in arterial phase may have relatively high sensitivity and specificity.Part Ⅱ The Correlation Study of spectral CT imaging,Ki-67 andinvasiveness of lung adenocarcinomaObjective: To explore the correlation of the spectral CT imaging,Ki-67 and invasiveness of lung adenocarcinoma.Methods: A total of 60 cases of lung adenocarcinoma confirmed by pathology were collected from March 2016 to July 2017 in our hospital,and all cases have immunohistochemical indexes(Ki-67).Gemstone Spectral Imaging(GSI)enhanced scanning(including arterial phase and venous phase)was performed on all patients.The iodine concentration(IC)in arterial and venous phases were detected in all cases.According to the solid content of tumors,all the cases were divided into three groups: 15 cases of p GGN group,15 cases of m GGN group,and 30 cases of solid nodules group.Spearman’s rank correlation analysis was used to estimate the correlation of Ki-67 and the iodine concentration in arterial and venous phases.Thirty glass-ground nodules were divided into two groups according to 2011 LASLC/ATS/ERS classification.Group A(16cases)included preinvasive lesions(2 cases)and minimally invasive adenocarcinoma(14 cases),group B(14cases)was invasive pulmonary adenocarcinoma.The difference between Ki-67 and IC in arterial and venous phases of the two groups were compared.Results:In all cases,there was a negative correlation between Ki-67 and iodine concentration in arterial and venous phases(r1=-0.749,P1=0.000;r2=-0.624,P2=0.000);Also,a negative correlation between the two was found in m GGN group and solid nodules group(r1=-0.754、-0.617,P1<0.05;r2=-6.09、-0.460,P2=<0.05),expect p GGN group.The expression of Ki-67 antigen in group was smaller than that of group B(P=0.001),but there was no significant difference of iodine concentration in arterial and venous phases between the two groups.Conclusion: There is a significant negative correlation between the multiple parameters of IC in spectral CT and Ki-67 in lung adenocarcinoma,which has a potential value to evaluate tumor proliferation capacity,but its role in diagnosing GGN infiltration level remains to be further exploited. |
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