Department of Imaging and Nuclear Medicine, Harbin Medical University, Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150086, China.
Department of Radiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
Clin Radiol. 2018 Dec;73(12):1033-1040. doi: 10.1016/j.crad.2018.07.104. Epub 2018 Aug 14.
To evaluate lung cancer histology type using computed tomography (CT) spectral quantitative parameters combining with serum tumour markers.
Patients with suspicious lung cancer underwent CT spectral imaging and serum tumour markers. CT spectral quantitative parameters including attenuation value, the slope of spectral curve (λ), iodine concentration, water concentration, and effective atomic number (Zeff) were acquired. Serum levels of tumour markers including carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), squamous cell carcinoma antigen (SCC-Ag), and cytokeratin fragment CYFRA21-1 were also obtained. All the values were compared among different histological types of lung cancer. The diagnostic efficiencies of serum tumour markers, CT spectral parameters, and a combination of them were computed by statistical analysis.
CEA and NSE levels were higher in adenocarcinoma and neuroendocrine tumour, respectively, while SCC-Ag and CYFRA21-1 levels were higher in squamous cell cancer. There was no significant difference in attenuation among the groups (p>0.05), whereas λ in the arterial phase, and Zeff and IC in both the arterial and venous phases were significantly different among groups (p<0.05). According to the area under the receiver operating characteristic (ROC) curve (AUC) and Youden's index, the diagnostic efficiency of serum tumour markers were higher than that of CT spectral parameters. Moreover, AUCs of combined serum and CT indicators were larger than that of combined serum markers and combined CT spectral parameters between squamous cell cancer and adenocarcinoma as well as between squamous cell cancer and neuroendocrine tumour.
CT spectral quantitative parameters and serum tumour markers are valuable in evaluating histological types of lung cancer. In combination they can significantly improve diagnostic efficiency.
利用 CT 能谱定量参数联合血清肿瘤标志物评估肺癌组织学分型。
对可疑肺癌患者行 CT 能谱成像及血清肿瘤标志物检查，获取能谱定量参数包括衰减值、斜率（λ）、碘浓度、水浓度、有效原子序数（Zeff），以及血清肿瘤标志物包括癌胚抗原（CEA）、神经元特异性烯醇化酶（NSE）、鳞状细胞癌抗原（SCC-Ag）、细胞角蛋白 19 片段（CYFRA21-1）的水平。比较不同组织学分型肺癌之间各参数值的差异，统计分析血清肿瘤标志物、CT 能谱参数及两者联合对肺癌组织学分型的诊断效能。
腺癌中 CEA、NSE 水平较高，神经内分泌肿瘤中 NSE 水平较高，鳞癌中 SCC-Ag、CYFRA21-1 水平较高。各组间动脉期的衰减值差异无统计学意义（p＞0.05），而 λ、Zeff、IC 在动脉期及静脉期差异均有统计学意义（p＜0.05）。根据受试者工作特征（ROC）曲线下面积（AUC）和约登指数，血清肿瘤标志物的诊断效能高于 CT 能谱参数，且鳞癌与腺癌、鳞癌与神经内分泌肿瘤之间联合血清和 CT 指标的 AUC 均大于联合血清标志物和联合 CT 能谱参数。
CT 能谱定量参数和血清肿瘤标志物在评估肺癌组织学分型方面有一定价值，联合应用可显著提高诊断效能。
