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目的:探讨宝石能谱CT成像(gemstone spectral imaging,GSI)在乳腺浸润性导管癌诊疗中的价值。方法:手术及病理证实的乳腺浸润性导管癌患者32例,共有病灶47个。由两位从事乳腺影像工作的副主任医师对图像进行盲评,分析乳腺浸润性导管癌病灶的影像特点及能谱特征。以软件自动生成的KeV-CT值曲线作为观察指标,分析浸润性导管癌病灶同正常腺体的差异。按病理结果将淋巴结分为转移组和非转移组;以淋巴结的KeV-CT值曲线斜率、碘基值以及淋巴结CT值与主动脉CT值的比值为评价指标,比较转移组淋巴结和非转移组淋巴结上述数值的差异。结果:GSI共检出44个病灶,病灶的最佳单能量图像KeV值在66~68KeV之间。碘/水(Iodine/Water)基物质图、水/脂(Water/Fat)基物质图对病灶范围、毛刺(40/44)、分叶(36/44)、钙化(11/44)、胸壁侵犯(7/44)有更清晰的显示。增强后病灶轻中度强化,CT值增加(20±6)HU。最佳单能量40KeV CTA能清晰显示肿瘤血管,以胸廓内动脉及胸外侧动脉为主(29/44)。浸润性导管癌病灶KeV-CT值曲线,与正常腺体差异明显。腋窝转移淋巴结同非转移淋巴结KeV-CT值曲线斜率在40~70KeV间差异明显,P<0.01(t=-5.5),差异有统计学意义。不同KeV下转移组同非转移组HU_(淋巴结)/HU_(主动脉)差异无统计学意义。转移组与非转移组淋巴结碘基值平均值,差异有统计学意义,P<0.05(t=-2.1)。结论:GSI能提高小病灶及多发病灶的检出率。可以较准确地评估乳腺浸润性导管癌位置、范围、胸壁侵犯、腋窝淋巴结转移及血供情况,对乳腺浸润性导管癌的诊疗有较大的指导价值。
Objective: To investigate the value of gemstone spectral imaging (GSI) in the diagnosis and treatment of breast invasive ductal carcinoma. Methods: Thirty-two cases of invasive ductal carcinoma of the breast were confirmed by operation and pathology. There were 47 common lesions. Two of the chief physicians engaged in breast imaging work blindly evaluated the images and analyzed the imaging features and spectral features of invasive ductal carcinoma of the breast. The value of KeV-CT curve generated automatically by software was taken as the observation index to analyze the difference between the lesions of invasive ductal carcinoma and the normal gland. According to the pathological results, lymph nodes were divided into metastasis group and non-metastasis group. The slope of KeV-CT curve, the iodine value and the ratio of lymph node CT value and aorta CT value were used as evaluation indexes. Lymph node differences in the above values. RESULTS: Forty-four lesions were detected in the GSI, and the best single-energy images KeV of lesions were between 66 and 68 KeV. Iodine / Water base material profile, Water / Fat base material profile on lesion extent, burr (40/44), lobulation (36/44), calcification (11/44) Violations (7/44) have a clearer display. After the lesion was enhanced mild to moderate enhancement, CT value increased (20 ± 6) HU. The best single energy 40KeV CTA can clearly show the tumor vessels, with the internal thoracic artery and the thoracic artery (29/44). Invasive ductal carcinoma lesions KeV-CT value curve, significant difference with the normal gland. The slope of keV-CT curve between axillary lymph node metastasis and non-metastatic lymph node was significantly different between 40 ~ 70 KeV, P <0.01 (t = -5.5), the difference was statistically significant. There was no significant difference in HU_ (lymph node) / HU_ (aorta) between the different KeV metastasis group and non-metastasis group. The mean value of iodine value of lymph node between metastasis group and non-metastasis group was statistically significant, P <0.05 (t = -2.1). Conclusion: GSI can improve the detection rate of small lesions and multiple lesions. The location, range, chest wall invasion, axillary lymph node metastasis and blood supply of breast invasive ductal carcinoma can be accurately evaluated. It has great guiding value for the diagnosis and treatment of invasive ductal breast cancer.