CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值

来源期刊：广州医药 | 547-552 发布时间：2025-05-07 收稿时间：2025/11/13 18:54:19 阅读量：36

作者：: 苏鹏飞,

董备,

李玉舟,

王兴龙,

袁方,

关键词：: CT增强扫描延迟扫描非小细胞肺癌病理特征诊断价值相关性; CT enhanced scanning delay scanning non-small cell lung cancer pathological features diagnostic value relevance

DOI：: 10.20223/j.cnki.1000-8535.2025.04.017

收稿时间：: 2024-07-02
修订日期：
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引用总数：: 0

目的探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析,将其分为观察组,另选取82例肺部良性肿瘤患者作为对照组,收集其术前CT增强延迟扫描结果,以术后病理诊断结果为金标准,分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值,采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ²=26.560、24.680,P<0.05）,观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ²=43.330、64.600,P<0.05）;82例非小细胞肺癌通过CT增强延迟扫描共确诊79例,CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82）,与病理诊断结果100.00%对比差异无统计学意义（χ²=3.060,P=0.080）;82例非小细胞肺癌平均CT增强值为（39.14±7.31）,不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P>0.05）,不同病理类型[腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）]、细胞分化程度[中、低分化（45.71±7.21）vs 高分化（32.81±5.11）]、临床分期[Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）]患者、淋巴结转移[是（42.75±4.21）vs 否（35.77±8.13）]CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378,P<0.05）;Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008,P<0.05）。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值,其诊断准确率与病理诊断并无显著差异,且可通过CT增强延迟扫描技术确定患者CT增强值,从而为非小细胞肺癌患者术后病理特征判断提供参考。

Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer（NSCLC）．Methods A retrospective analysis was conducted on 82 patients with NSCLC who underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into an observation group and another 82 patients with benign lung tumors were included in the control group．The preoperative CT enhanced delayed scanning results were collected,and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared,and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs 39.29%）in the observation group was significantly lower than that in the control group（χ²=26.560,24.680,P<0.05）,while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ²=43.330,64.600,P<0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan,and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82）,with no significant difference from the pathological diagnosis result of 100.00%（χ²=3.060,P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders,ages,maximum tumor diameter,and lymph node infiltration（P>0.05）．Patients with different pathological types [adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）],degree of cell differentiation [moderate,and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）],clinical stage [I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）] and lymph node metastasis [yes（42.75±4.21）,vs no（35.77±8.13）] CT enhancement had significant difference（t/F=5.243,8.804,84.828,4.378,P<0.05）．The Spearman correlation analysis results showed that pathological type,degree of cell differentiation,clinical stage,lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008）．Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis,and the CT enhanced value of patients can be determined through CT enhanced delayed scanning,providing reference for postoperative pathological feature judgment of NSCLC patients．

1、俞愈,李继会,章斌,等.18F-FDG PET/CT影像组学预测晚期非小细胞肺癌预后的价值[J].标记免疫分析与临床,2023,30(1):51-56,144.

2、夏露花,崇乐,李红玉,等.NM23表达对18F-FDG PET/CT在非小细胞肺癌患者放疗计划中的影响[J].分子影像学杂志,2023,46(6):978-982.

3、王勤奋,秦将均,许有忠,等.99Tcm-异腈氨基葡萄糖SPECT/CT诊断非小细胞肺癌区域淋巴结转移的价值[J].中国医学影像学杂志,2023,31(6):606-610.

4、李阳,杨昭,李淑华,等.基于非小细胞肺癌双能CT表现及影像组学列线图模型预测其血管生成拟态[J].中国医学影像技术,2023,39(5):684-689.

5、张盼,黄庆,汪扬,等.非小细胞肺癌动态增强CT扫描下临床表现特征与其病理类型的关系[J].西部医学,2023,35(4):584-587.

6、张桐睿,李军,申敏,等.CT影像组学结合肺癌血清肿瘤标志物预测非小细胞肺癌亚型的初步研究[J].中国CT和MRI杂志,2023,21(3):65-67.

7、李仕骞. CT增强延迟扫描技术在肝脏肿瘤鉴别诊断中的应用探究[J].影像研究与医学应用,2020,4(9):108-109.

8、刘玲玲,王喆,李超,等.18F-氟代脱氧葡萄糖正电子发射断层扫描成像/CT原发灶影像特征对非小细胞肺癌淋巴结转移的预测价值[J].山西医药杂志,2024,53(4):262-266.

9、徐刚,陈鹏,纪伟,等.基于CT影像组学列线图预测实性非小细胞肺癌组织PD-L1蛋白表达状态[J].现代肿瘤医学,2024,32(5):913-920.

10、 KORDE R,VELUSWAMY R,ALLAIRE J C,et al.Small cell lung cancer patients treated with immune checkpoint inhibitor:A systematic literature review of treatment efficacy,safety and quality of life[J].Curr Med Res Opin,2022,38(8):1361-1368.

11、 GENG Y,ZHANG Q,FENG S,et al.Safety and Efficacy of PD-1/PD-L1 inhibitors combined with radiotherapy in patients with non-small-cell lung cancer:A systematic review and meta-analysis[J].Cancer Med,2021,10(4):1222-1239.

12、 CHEN J,WANG J,XU H.Comparison of atezolizumab,durvalumab,pembrolizumab,and nivolumab as first-line treatment in patients with extensive-stage small cell lung cancer:A systematic review and network meta-analysis[J].Medicine(Baltimore),2021,100(15):e25180.

13、 ZHOU T,ZHANG Z,LUO F,et al.Comparison of first-line treatments for patients with extensive-stage small cell lung cancer:A systematic review and network meta-analysis[J].JAMA Netw Open,2020,3(10):e2015748.

14、冯浩洁,姚颐,耿庆.美国国家综合癌症网络临床实践指南:非小细胞肺癌(2021V1)更新解读[J].临床外科杂志,2021,29(1):25-28.

15、吕丹丹. CT增强延迟扫描技术在鉴别肝脏肿瘤类型中与病理检查结果符合率分析[J].罕少疾病杂志,2022,29(2):52-53,67.

16、杨扬,王健,杨光钊,等.术前CT在诊断非小细胞肺癌脏层胸膜浸润中的应用价值[J].中国中西医结合影像学杂志,2024,22(1):72-79.

17、周洁,郑燕婷,江舒琪,等.CT影像组学联合形态学特征模型评估非小细胞肺癌患者预后生存期的价值[J].中国医学物理学杂志,2024,41(1):18-26.

18、谢娟英,张凯云.SOSNet:一种非对称编码器-解码器结构的非小细胞肺癌CT图像分割模型[J].电子学报,2024,52(3):824-837.

19、张磊,米玉霞,王建业.术前多排螺旋CT三期增强扫描对非小细胞肺癌纵隔淋巴结转移的诊断价值[J].实用癌症杂志,2024,39(1):83-86.

20、 SICILIANO M A,CARIDà G,CILIBERTO D,et al.Efficacy and safety of first-line checkpoint inhibitors-based treatments for non-oncogene-addicted non-small-cell lung cancer:A systematic review and meta-analysis[J].ESMO Open,2022,7(3):100465.

21、 ZHANG M,FAN Y,NIE L,et al.Clinical outcomes of immune checkpoint inhibitor therapy in patients with advanced non-small cell lung cancer and preexisting interstitial lung diseases:A systematic review and meta-analysis[J].Chest,2022,161(6):1675-1686.