目的 探究正电子发射计算机体层摄影术(PET)/CT联合胸部能谱CT对肺癌及其分型的诊断价值。方法 选择2022年7月至2023年8月在皖北煤电集团总医院收治的疑似肺癌患者70例，其中男性55例，女性15例;年龄37～85岁，平均年龄66。34岁;经病理诊断肺癌60例，存在淋巴结转移或远处转移19例，无淋巴结转移或远处转移41例。全部病例均接受PET/CT、能谱CT检查，对比两种检查方式单独及联合对肺癌的诊断效能，对比不同肺癌分型的PET/CT、能谱CT检查特征参数，分析两种检查中各参数单独及联合对腺癌、鳞癌的诊断价值。结果 经病理诊断10例非肺癌，60例肺癌，其中非小细胞肺癌54例(腺癌31例、鳞癌21例、鳞腺癌2例)、小细胞肺癌6例。PET/CT检查诊断54例肺癌，16例非肺癌;能谱CT诊断51例肺癌，19例非肺癌。PET/CT+能谱CT诊断出62例肺癌，8例非肺癌。PET/CT+能谱CT诊断肺癌的灵敏度、准确度及阴性预测值高于二者单独诊断，漏诊率低于二者单独诊断(P＜0。05)。不同肺癌分型PET/CT检查的最大标准化摄取值(SUVmax)差异明显，非小细胞肺癌PET/CT检查的SUVmax比较，腺癌＞鳞癌＞鳞腺癌(21。61±1。52＞13。60±1。39＞6。65±1。27)(P＜0。05);小细胞肺癌与非小细胞肺癌 SUVmax(14。17±1。82 vs 17。94±1。65)比较，差异有显著统计学意义(P＜0。001);不同非小细胞肺癌分型能谱CT检查的有效原子系数、钙含量、碘基值、斜率K比较，差异有统计学意义(P＜0。05);小细胞肺癌有效原子系数、钙含量、碘基值、斜率K[7。91±0。08、(6。89±1。68)mg/mL、(11。43±0。79)g/L、2。23±0。24]与非小细胞肺癌比较[7。77±0。12、(3。73±1。36)mg/mL、(7。02±1。18)g/L、1。69±0。30]，差异有统计学意义(P＜0。05);PET/CT、能谱CT检查各参数联合诊断腺癌、鳞癌的曲线下面积分别为0。923、0。939(P＜0。05)。结论 PET/CT、胸部能谱CT联合应用可提高对肺癌的诊断效能，且PET/CT、能谱CT检查各参数对不同肺癌分型的有较高诊断价值。
Diagnostic value of PET/CT combined with chest energy spectral CT for lung cancer and its classification
Objective To explore the value of positron emission tomography(PET)/CT combined with chest spectral CT in diag-nosis and classification of lung cancer.Methods From July 2022 to August 2023,a total of 70 patients with suspected lung cancer were enrolled,which included 55 males and 15 females,aged 37-85 years old with mean age of 66.34 years old;pathological diagnosis of lung cancer in 60 cases,lymph node metastasis or distant metastasis in 19 cases,non-lymph node metastasis or distant metastasis in 41.All of them performed PET/CT and spectral CT,and the diagnostic efficacy of 2 exami-nations in individually and jointly for lung cancer was compared;the characteristic parameters of PET/CT and spectral CT in different types of lung cancer were compared.The diagnostic value of each parameter between 2 examinations alone and jointly for adenocarcinoma and squamous cell carcinoma was analyzed.Results There were 10 cases of non-lung cancer and 60 of lung cancer after diagnosing by pathology,which included 54 cases of non-small cell lung cancer(31 of adenocarcinoma,21 of squamous cell carcinoma,2 of squamous adenocarcinoma)and 6 cases of small cell lung cancer.Fifty-four cases of lung cancer and 16 of non-lung cancer were diagnosed by PET/CT;51 cases of lung cancer and 19 of non-lung cancer were diagnosed by spectral CT.Notably,PET/CT+spectral CT diagnosed 62 cases of lung cancer and 8 of non-lung cancer.The sensitivity,accuracy and negative predictive value of PET/CT+spectral CT in diagnosis of lung cancer were significantly higher than those of diagnosis in individually,and the missed diagnosis rate was significantly lower than that of single diagnosis(P＜0.05).The maximum standardized uptake value(SUVmax)of PET/CT examination in different lung cancer types was significantly different,the SUVmax of PET/CT examination in non-small cell lung cancer was adenocarcinoma＞squamous cell carcinoma＞squamous adenocarcino-ma(21.61±1.52＞13.60±1.39＞6.65±1.27)(P＜0.05);the difference of SUVmax between small cell lung cancer(14.17±1.82)and non-small cell lung cancer(17.94±1.65)was statistically significant(P＜0.001);there were statistically significant differences in effective atomic coefficient,calcium content,iodine base value and slope K among different types of non-small cell lung cancer(P＜0.05);the effective atomic coefficient,calcium content,iodine value and slope K of small cell lung cancer[7.91±0.08,(6.89±1.68)mg/mL,(11.43±0.79)g/L,2.23±0.24]compared with non-small cell lung cancer[7.77±0.12,(3.73±1.36)mg/mL,(7.02±1.18)g/L,1.69±0.30],the difference was statistically significant(P＜0.05).The area under the curve of PET/CT and spectral CT in jointly diagnosis of adenocarcinoma and squamous cell carcinoma was 0.923 and 0.939,respectively(P＜0.05).Conclusion It is demonstrated that the combined application of PET/CT and chest energy spectral CT could improve the diag-nostic efficiency of lung cancer,and the parameters of PET/CT and spectral CT examination showed high diagnostic value for classification of different subtypes of lung cancer.
lung cancerenergy spectrum CTPET/CTSUVmaxslope of energy spectrum curve
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