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Title: [Comparative imaging study of mediastinal lymph node from pre-surgery dual energy CT versus post-surgeron verifications in non-small cell lung cancer patients].
Author: Zhu Q, Ren C, Zhang Y, Li MJ, Wang XH.
Journal: Beijing Da Xue Xue Bao Yi Xue Ban; 2020 Aug 18; 52(4):730-737. PubMed ID: 32773811.
Abstract:
OBJECTIVE: To validate the value of dual energy CT (DECT) in the differentiation of mediastinal metastatic lymph nodes from non-metastatic lymph nodes in non-small cell lung cancer (NSCLC). METHODS: In the study, 57 surgically confirmed NSCLC patients who underwent enhanced DECT scan within 2 weeks before operation were enrolled. Two radiologists analyzed the CT images before operation. All mediastinal lymph nodes with short diameter≥5 mm on axial images were included in this study. The morphological parameters [long-axis diameter (L), short-axis diameter (S) and S/L of lymph nodes] and the DECT parameters [iodine concentration (IC), normalized iodine concentration (NIC), slope of spectral hounsfield unit curve (λHU) and effective atomic number (Zeff) in arterial and venous phase] were measured. The differences of morphological parameters and DECT parameters between metastatic and non-metastatic lymph nodes were compared. The parameters with significant difference were analyzed by the Logistic regression model, then a new predictive variable was established. Receiver operator characteristic (ROC) analyses were performed for S, NIC in venous phase and the new predictive variable. RESULTS: In 57 patients, 49 metastatic lymph nodes and 938 non-metastatic lymph nodes were confirmed by surgical pathology. A total of 163 mediastinal lymph nodes (49 metastatic, 114 non-metastatic) with S≥5 mm were detected on axial CT images. The S, L and S/L of metastatic lymph nodes were significantly higher than those of non-metastatic lymph nodes (P < 0.05). The DECT parameters of metastatic lymph nodes were significantly lower than those of non-metastatic lymph nodes (P < 0.05). The best single morphological parameter for differentiation between metastatic and nonmetastatic lymph nodes was S (AUC, 0.752; threshold, 8.5 mm; sensitivity, 67.4%; specificity, 73.7%; accuracy, 71.8%). The best single DECT parameter for differentiation between metastatic and nonmetastatic lymph nodes was NIC in venous phase (AUC, 0.861; threshold, 0.53; sensitivity, 95.9%; specificity, 70.2%; accuracy, 77.9%). Multivariate analysis showed that S and NIC were independent predictors of lymph node metastasis. The AUC of combined S and NIC in the venous phase was 0.895(sensitivity, 79.6%; specificity, 87.7%; accuracy, 85.3%), which were significantly higher than that of S (P < 0.001) and NIC (P=0.037). CONCLUSIONS: The ability of quantitative DECT parameters to distinguish mediastinal lymph node metastasis in NSCLC patients is better than that of morphological parameters. Combined S and NIC in venous phase can be used to improve preoperative diagnostic accuracy of metastatic lymph nodes. 目的: 探讨能谱CT (dual energy CT, DECT)诊断非小细胞肺癌(non-small cell lung cancer, NSCLC)纵隔淋巴结转移的应用价值。方法: 选择2018年4月至2019年10月在北京大学第三医院接受胸部DECT检查且经术后病理诊断证实的NSCLC患者病例资料进行回顾性分析，共收集到病例57例，两名放射科医师共同分析患者术前CT图像，将轴位图像上所有短径(short-axis diameter, S)≥5 mm的纵隔淋巴结纳入本研究。测量淋巴结形态学参数长径(long-axis diameter, L)、S、短径与长径比值(ratio of short-axis diameter to long-axis diameter, S/L)以及能谱参数动脉期及静脉期碘浓度(iodine concentration, IC)、标准化碘浓度(normalized iodine concentration, NIC)、能谱曲线斜率及有效原子序数。比较转移与非转移淋巴结形态学指标及其能谱参数的差异，将有统计学差异的参数纳入Logistic回归方程筛选出有诊断价值的参数，并生成诊断淋巴结转移的联合变量，对淋巴结S、静脉期NIC及联合变量进行受试者工作特征(receiver operating characteristic, ROC)曲线分析。结果: 57例患者中，术后病理诊断证实转移淋巴结49枚，非转移淋巴结938枚。CT轴位上共检出S≥5 mm纵隔淋巴结163枚(转移淋巴结49枚，非转移淋巴结114枚)。转移淋巴结的S、L及S/L均显著大于非转移淋巴结(P＜0.05)，转移淋巴结的能谱参数均显著低于非转移性淋巴结(P＜0.05)。S是诊断淋巴结转移的最佳单一形态学指标，ROC曲线下面积(area under curve, AUC)为0.752，阈值8.5 mm，灵敏度67.4%，特异度73.7%，准确率71.8%。静脉期NIC为最佳单一能谱参数，AUC为0.861，阈值0.53，灵敏度95.9%，特异度70.2%，准确率77.9%。多因素分析显示S、静脉期NIC是转移淋巴结的独立预测因子。联合S、静脉期NIC诊断淋巴结转移的AUC为0.895，灵敏度79.6%，特异度87.7%，准确率85.3%，明显高于S (P＜0.001)、静脉期NIC (P=0.037)。结论: DECT定量参数鉴别NSCLC患者纵隔淋巴结转移的价值优于形态学参数，联合S和静脉期NIC可提高术前诊断淋巴结转移的准确率。

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