Department of ECT, Tangshan People's Hospital, Tangshan, Hebei Province, China.
Department of Neurosurgery, Tangshan People's Hospital, Tangshan, Hebei Province, China.
Medicine (Baltimore). 2022 Nov 25;101(47):e31502. doi: 10.1097/MD.0000000000031502.
To investigate the imaging characteristics of sarcoidosis and Hodgkin's lymphoma based on mediastinal enlarged lymph node using spectral CT and evaluate whether the quantitative information can improve the differential diagnosis of these diseases. This retrospective study was approved by the institutional review board, and written informed consent was obtained from all patients. Overall, 21 patients with sarcoidosis and 39 patients with Hodgkin's lymphoma were examined with CT spectral imaging during the arterial phase (AP) and venous phase (VP). The CT values on 40 to 140 keV monochromatic images and iodine (water) concentrations of enlarged lymph nodes were obtained in AP and VP. Iodine concentrations (ICs) were normalized to the iodine concentration in the aorta. The differences in normalized iodine concentrations (NICs) and hounsfield units (HU) curve slop (λHU) were calculated. Anatomical distribution of mediastinal lymph nodes and morphologic features were also compared. Receiver operating characteristic curves were generated to help establish threshold values for the parameters required for the significant differentiation of sarcoidosis from lymphomas. The CT values on 40 to 100 keV monochromatic images in AP and 40 to 50 keV in VP were higher in sarcoidosis than those in Hodgkin's lymphoma, the differences were statistically significant (P < .05); NICs during the AP and λHU during the AP (VP) in patients with sarcoidosis differed significantly from those in patients with Hodgkin's lymphoma. Receiver operating characteristic curves analysis showed that the monochromatic CT value on 40 keV in AP had the highest sensitivity (71.4%) and specificity (100%) in differentiating sarcoidosis from Hodgkin's lymphoma. The anatomic distribution, coalescence, calcification, compression, enhancement pattern and enhancement degree of the mediastinal enlarged lymph node differed significantly between the groups (P < .05). The combination of monochromatic CT value, NICs and λHU had higher sensitivity and specificity than did those of conventional qualitative CT image analysis during the combined phases. CT spectral imaging has promising potential for the diagnostic differentiation of Hodgkin's lymphomas and sarcoidosis. The monochromatic CT value, iodine content and λHU could be valuable parameters for differentiating Hodgkin's lymphomas and sarcoidosis based on mediastinal enlarged lymph node.
利用能谱 CT 研究基于纵隔肿大淋巴结的结节病和霍奇金淋巴瘤的影像学特征，并评估定量信息是否能提高这些疾病的鉴别诊断能力。
本回顾性研究经机构审查委员会批准，并获得所有患者的书面知情同意。共对 21 例结节病和 39 例霍奇金淋巴瘤患者进行 CT 能谱成像检查，检查时包括动脉期（AP）和静脉期（VP）。分别在 AP 和 VP 时获得 40140keV 单能量图像的 CT 值和肿大淋巴结的碘（水）浓度。碘浓度（IC）标准化为主动脉碘浓度。计算标准化碘浓度（NIC）和 HU 曲线斜率（λHU）的差异。比较纵隔淋巴结的解剖分布和形态学特征。生成受试者工作特征曲线，帮助确定用于区分结节病和淋巴瘤的参数的阈值。AP 时 40100keV 单能量图像和 VP 时 40~50keV 的 CT 值在结节病中高于霍奇金淋巴瘤，差异有统计学意义（P<0.05）；AP 时的 NIC 和 AP（VP）时的 λHU 在结节病患者中与霍奇金淋巴瘤患者显著不同。受试者工作特征曲线分析显示，AP 时 40keV 单能量 CT 值在区分结节病和霍奇金淋巴瘤方面具有最高的灵敏度（71.4%）和特异性（100%）。纵隔肿大淋巴结的解剖分布、融合、钙化、压迫、增强模式和增强程度在两组之间差异有统计学意义（P<0.05）。联合相的单能量 CT 值、NICs 和 λHU 的组合比传统定性 CT 图像分析具有更高的灵敏度和特异性。
CT 能谱成像在诊断鉴别霍奇金淋巴瘤和结节病方面具有很大的潜力。基于纵隔肿大淋巴结的单能量 CT 值、碘含量和 λHU 可能是鉴别霍奇金淋巴瘤和结节病的有价值的参数。
