光谱参数在非增强型胸部 CT 中鉴别诊断良性和恶性乳腺结节中的价值。

IF 2.9 2区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Quantitative Imaging in Medicine and Surgery Pub Date : 2024-10-01 Epub Date: 2024-09-26 DOI:10.21037/qims-24-575
Xin He, Siqian Gu, Yuyang Xie, Ling Yang
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引用次数: 0

摘要

背景:双层光谱计算机断层扫描(Dual-layer spectral computed tomography,DSCT)能够在一次常规扫描中同时获取常规图像和光谱图像,被广泛用于物质的定量和定性分析、鉴别诊断和疾病分期。然而,有关其在使用非增强扫描进行乳腺结节良性和恶性鉴别诊断方面性能的研究还很有限。本研究旨在评估非增强 DSCT 得出的多个定量参数在区分良性和恶性乳腺结节方面的诊断性能:这项回顾性横断面研究对苏州大学附属第一医院 2023 年 3 月至 2023 年 12 月期间在胸部体检或常规入院治疗乳腺疾病时发现的 114 名患者(恶性组:n=68;良性组:n=53)的 121 个乳腺结节进行了检查。所有患者均接受了 DSCT 扫描和病理诊断。测量了非增强图像中的 DSCT 定量参数,包括有效原子序数(Zeff)、40-70 keV 的计算机断层扫描(CT)衰减值和光谱 Hounsfield 单位曲线斜率(λHU)。λHU 的计算公式如下:λHU = CT70 keV - CT40 keV/30 HU。此外,还分析了典型的放射学特征。使用接收者操作特征曲线(ROC)对 DSCT 参数诊断模型和传统 CT 诊断模型进行了评估。德隆检验用于评估和比较每个模型的诊断性能:结果:DSCT参数,包括Zeff(PConclusions:从非增强 DSCT 图像中得出的 DSCT 参数,如 Zeff 值和λHU,可用于区分良性和恶性乳腺结节,而且 DSCT 参数的鉴别诊断效力高于传统 CT 参数。
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Value of spectral parameters in the differential diagnosis of benign and malignant breast nodules in non-enhanced chest CT.

Background: Dual-layer spectral computed tomography (DSCT) is capable of acquiring both conventional and spectral images during one routine scan, and is widely used for the quantitative and qualitative analyses of substances, differential diagnosis, and disease staging. However, limited research has been conducted on its performance in the differential diagnosis of benign and malignant breast nodules using non-enhanced scans. This study aimed to assess the diagnostic performance of multiple quantitative parameters derived from non-enhanced DSCT in differentiating benign from malignant breast nodules.

Methods: This retrospective cross-sectional study examined a total of 121 breast nodules from 114 patients (malignant group: n=68; benign group: n=53) identified during chest physical examination or routine admission for the treatment of breast diseases at The First Affiliated Hospital of Soochow University from March 2023 to December 2023. All the patients underwent DSCT scanning and pathological diagnosis. The DSCT quantitative parameters, including the effective atomic number (Zeff), computed tomography (CT) attenuation values at 40-70 keV, and the slope of the spectral Hounsfield unit curve (λHU), in non-enhanced images were measured. The λHU was calculated as follows: λHU = CT70 keV - CT40 keV/30 HU. Additionally, typical radiological features were analyzed. A DSCT parameter diagnostic model and a conventional CT diagnostic model were assessed using receiver operating characteristic (ROC) curves. The Delong test was used to assess and compare the diagnostic performance of each model.

Results: The DSCT parameters, including the Zeff (P<0.001), λHU (P<0.001), and CT attenuation values at 40 keV (P<0.001) and 50 keV (P=0.001), as well as the presence of the lobular sign (P<0.001) and spicule sign (P<0.001), exhibited statistically significant differences between the benign and malignant groups. The logistic regression analysis revealed that the Zeff [odds ratio (OR): 9.22; 95% confidence interval (CI): 2.11-40.35; P=0.003], λHU (OR: 0.64; 95% CI: 0.52-0.79; P<0.001), 40 keV CT attenuation value (OR: 8.69; 95% CI: 3.28-23.06; P<0.001), 50 keV CT attenuation value (OR: 0.01; 95% CI: 0.001-0.07; P<0.001), and lobular sign (OR: 3.95; 95% CI: 1.52-10.31; P=0.005) were independent predictors of malignancy. Compared to the benign group, the malignant group had a higher likelihood of presenting with the lobular sign and higher Zeff values but lower λHU values. The ROC curve indicated that the Zeff had the highest diagnostic efficacy [area under the curve (AUC) of the ROC =0.792, 95% CI: 0.71-0.87]. Further, the DSCT parameter diagnostic model had improved diagnostic efficacy with an AUC of 0.899 (95% CI: 0.84-0.96), which was higher than the AUC of the conventional CT diagnostic model (AUC =0.796, 95% CI: 0.72-0.87). The Delong test revealed a statistically significant difference between these two models (P=0.04).

Conclusions: DSCT parameters derived from non-enhanced DSCT images, such as the Zeff value and λHU, can be used to differentiate benign and malignant breast nodules, and the differential diagnosis efficacy of the DSCT parameters is higher than that of conventional CT parameters.

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Quantitative Imaging in Medicine and Surgery
Quantitative Imaging in Medicine and Surgery Medicine-Radiology, Nuclear Medicine and Imaging
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4.20
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17.90%
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252
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