Zhong Li-Juan, Yu Na, Zhou Xin-Jie, Fu Lang-Zhou, Zhou Dai-Quan, Wang Yi, Yan Min
Department of Radiology, the People's Hospital of Leshan, Leshan, China.
Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing, China.
J Thorac Dis. 2023 Feb 28;15(2):679-689. doi: 10.21037/jtd-23-115. Epub 2023 Feb 22.
Unlike the conventional spectral analyses of spectral computed tomography (CT) that cannot fully represent the whole lesion, the volumetric quantitative analysis reveals the information of the whole lesion and is of more accurate. So this study sought to evaluate the value of volumetric quantitative analysis in the differential diagnosis of pulmonary adenocarcinoma (ADC) and squamous cell carcinoma (SQCC).
Fifty-seven patients with lung cancer confirmed by pathology, including 35 ADC and 22 SQCC patients, were retrospectively analyzed. Calcium concentration and effective-Z (Eff-Z) in plain scan (PS), iodine concentration, and water concentration in the arterial phase (AP) were measured. The Student -test or rank-sum test was used to determine the statistically significant parameters. Receiver operating characteristic (ROC) curve was used, and the corresponding area under the curve (AUC), sensitivity and specificity was calculated to evaluate the diagnostic efficacy in differential diagnosis of ADC and SQCC.
In the volumetric quantitative analysis of spectral CT, the concentration of calcium [(6.97±2.83) mg/cm], Eff-Z (7.90±0.14), and iodine [1.42 (0.84) mg/cm] was significantly higher in ADC than SQCC [(5.14±2.39) mg/cm, (7.80±0.10), 1.16 (0.65) mg/cm, =2.513, 2.860, Z=-2.246, P=0.015, 0.006, 0.025], but the concentration of water was significantly lower in ADC [995.00 (38.70) mg/cm] than SQCC [1,007.00 (14.38) mg/cm, Z=-2.082, P=0.037]. Moreover, whether it's ADC or SQCC, the concentrations of calcium [(8.51±4.28) mg/cm, (5.96±2.50) mg/cm], Eff-Z (7.97±0.20, 7.86±0.13), and water [1,007.00 (14.38) mg/cm, 1,029.28 (10.49) mg/cm] were lower in the volumetric spectral analysis than the conventional spectral analysis, while the concentration of iodine [1.33 (0.80) mg/cm, 0.94 (0.63) mg/cm] was significantly higher in the volumetric spectral analysis than the conventional spectral analysis. The ROC curve analysis showed that the areas under the curves (AUC) (0.76, 0.76, 0.75, 0.71), sensitivity (66.7%, 66.7%, 66.7%, 85.2%), and specificity (92.3%, 84.6%, 86.9%, 69.2%) of the volumetric spectral analysis parameters for the differential diagnosis of ADC and SQCC were higher than those of the conventional spectral analysis [(0.65, 0.66, 0.73, 0.63), (44.4%, 48.1%, 59.3%, 66.7%), (69.2%, 69.2%, 84.6%, 53.8%)] parameters.
The volumetric quantitative analysis has a promising advantage in the observation range of whole lesions, it may be invaluable in the differential diagnosis of ADC and SQCC, and is worthy of clinical recommendation.
与传统的光谱计算机断层扫描（CT）光谱分析不同，传统光谱分析无法完全呈现整个病变的信息，而容积定量分析可揭示整个病变的信息，且更为准确。因此，本研究旨在评估容积定量分析在肺腺癌（ADC）和鳞状细胞癌（SQCC）鉴别诊断中的价值。
回顾性分析57例经病理确诊的肺癌患者，其中包括35例ADC患者和22例SQCC患者。测量平扫（PS）时的钙浓度和有效原子序数（Eff-Z）、动脉期（AP）的碘浓度和水浓度。采用Student检验或秩和检验确定具有统计学意义的参数。使用受试者操作特征（ROC）曲线，并计算相应的曲线下面积（AUC）、敏感度和特异度，以评估在ADC和SQCC鉴别诊断中的诊断效能。
在光谱CT的容积定量分析中，ADC的钙浓度[（6.97±2.83）mg/cm]、Eff-Z（7.90±0.14）和碘浓度[1.42（0.84）mg/cm]显著高于SQCC[（5.14±2.39）mg/cm，（7.80±0.10），1.16（0.65）mg/cm，t=2.513，2.860，Z=-2.246，P=0.015，0.006，0.025]，但ADC的水浓度[995.00（38.70）mg/cm]显著低于SQCC[1,007.00（14.38）mg/cm，Z=-2.082，P=0.037]。此外，无论是ADC还是SQCC，容积光谱分析中的钙浓度[（8.51±4.28）mg/cm，（5.96±2.50）mg/cm]、Eff-Z（7.97±0.20，7.86±0.13）和水浓度[1,007.00（14.38）mg/cm，1,029.28（10.49）mg/cm]均低于传统光谱分析，而容积光谱分析中的碘浓度[1.33（0.80）mg/cm，0.94（0.63）mg/cm]显著高于传统光谱分析。ROC曲线分析表明，容积光谱分析参数用于ADC和SQCC鉴别诊断的曲线下面积（AUC）（0.76，0.76，0.75，0.71）、敏感度（66.7%，66.7%，66.7%，85.2%）和特异度（92.3%，84.6%，86.9%，69.2%）均高于传统光谱分析参数[（0.65，0.66，0.73，0.63），（44.4%，48.1%，59.3%，66.7%），（69.2%，69.2%，84.6%，53.8%）]。
容积定量分析在整个病变的观察范围方面具有显著优势，在ADC和SQCC的鉴别诊断中可能具有重要价值，值得临床推荐。
