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目的 探讨能谱CT在乳腺癌评估中的应用价值,为临床提供影像学辅助信息。资料与方法 回顾性分析2016年5月-2017年2月兰州总医院经手术病理证实并行术前能谱CT双期增强扫描的乳腺癌患者12例,其中6例伴有淋巴结转移。以对侧正常腺体为对照,测量双期乳腺癌病灶及对侧正常腺体40～140 keV下的平均CT值、能谱曲线斜率、碘(水)浓度及相对碘浓度。绘制原发灶及转移性淋巴结的能谱曲线、直方图及散点图。以12例胸部常规CT双期增强扫描的女性患者为对照进行辐射剂量对比评估,评估参数包括CT容积剂量指数、剂量长度乘积、有效辐射剂量。结果 乳腺癌动、静脉期的各项能谱参数均明显高于正常腺体,差异有统计学意义(P<0.05)。能谱CT胸部双期增强扫描的平均有效辐射剂量明显低于常规CT,差异有统计学意义(P<0.05)。6例伴淋巴结转移的乳腺癌,原发灶与转移性淋巴结的能谱曲线、直方图及散点图均表现为在静脉期一致性较高。结论 乳腺癌能谱参数的特征性表现有利于病变的进一步诊断。原发灶与转移淋巴结在能谱曲线、直方图及散点图等方面的一致性有助于淋巴结的定性诊断。能谱CT胸部双期增强扫描具有较低的辐射剂量,弥补了传统CT因辐射剂量问题在乳腺病变定性诊断方面的应用局限。因此,能谱CT在诊断乳腺癌方面具有一定的应用价值。
Objective To explore the application value of spectral-spectrum CT in the evaluation of breast cancer, and to provide clinical auxiliary information for imaging. Materials and Methods We retrospectively analyzed 12 patients with breast cancer who underwent double-phase CT scan with pre-operative spectral analysis and confirmed by surgical pathology from May 2016 to February 2017 in Lanzhou General Hospital. Among them, 6 patients had lymph node metastasis. The contralateral normal glands were used as controls to measure the average CT value, slope of energy spectrum curve, iodine (water) concentration and relative iodine concentration of dual-phase breast cancer lesions and contralateral normal glands at 40-140 keV. Plot the energy spectrum, histograms, and scatter plots of primary and metastatic lymph nodes. The radiation dose was assessed in 12 women with conventional double-contrast CT scans. The parameters included CT volume dose index, dose length product, and effective radiation dose. Results The parameters of energy spectrum of the breast and venous phases of breast cancer were significantly higher than those of normal glands, and the difference was statistically significant (P<0.05). The mean effective radiation dose of dual-phase enhanced chest CT scanning was significantly lower than that of conventional CT, and the difference was statistically significant (P<0.05). In 6 breast cancer patients with lymph node metastases, the energy spectrum, histogram, and scatter plots of the primary and metastatic lymph nodes all showed higher consistency in the venous phase. Conclusion The characteristic performance of breast cancer spectral parameters is conducive to the further diagnosis of lesions. The consistency of primary lesions and metastatic lymph nodes in the energy spectrum, histograms, and scatter plots is helpful for the qualitative diagnosis of lymph nodes. The spectral CT double-phase enhanced chest scan has a lower radiation dose, which makes up for the limitations of conventional CT in the qualitative diagnosis of breast lesions due to radiation dose problems. Therefore, spectral CT has a certain application value in the diagnosis of breast cancer.