Abstract: Objective　To explore the value of 256-slice spectral CT imaging parameters in the diagnosis and treatment guidance of lung adenocarcinoma. Methods　A total of 120 patients with lung adenocarcinoma and 83 patients with lung squamous cell carcinoma who were admitted to Hubei Third People's Hospital Affiliated to Jianghan University from May 2018 to January 2022 were selected as the research subjects. All patients underwent 256-slice spectral CT imaging, and the spectral CT imaging parameters were compared between the two groups. The value of spectral CT imaging parameters in the diagnosis of lung adenocarcinoma and lung squamous cell carcinoma was analyzed. The patients with lung adenocarcinoma were grouped according to the curative effect of targeted therapy, and the spectral CT imaging parameters before and after treatment were compared between the effective group and the ineffective group. The relationship between spectral CT imaging parameters and curative effect was analyzed. t test, χ² test, receiver operating characteristic curve (ROC), and Spearman correlation analysis were used. Results　There were 76 males and 44 females in the lung adenocarcinoma group, with an age of (45.26±2.95) years old; there were 58 males and 25 females in the lung squamous cell carcinoma group, with an age of (45.11±2.07) years old. The calcium content, effective atomic number, iodine concentration, and slope of energy spectrum curve in the lung adenocarcinoma group were (3.16±0.86) mg/ml, (7.79±0.05), (6.76±0.96) g/L, and (0.94±0.24), respectively, which were lower than those in the lung squamous cell carcinoma group [(4.71±1.09) mg/ml, (7.84±0.06), (7.92±1.13) g/L, and (1.24±0.32)], with statistically significant differences (all P<0.05); there was no statistically significant difference in the water base value between the lung adenocarcinoma group and the lung squamous cell carcinoma group (P>0.05). The areas under the curve (AUC) of the above parameters to diagnose lung adenocarcinoma and lung squamous cell carcinoma were 0.832, 0.754, 0.792, and 0.722, respectively, and the AUC of combined diagnosis with these parameters was 0.932. After treatment, the calcium content, effective atomic number, iodine concentration, and slope of energy spectrum curve were significantly reduced in both groups (all P<0.05). The calcium content, effective atomic number, iodine concentration, and slope of energy spectrum curve in the effective group were lower than those in the ineffective group before and after treatment (all P<0.05); the difference values of these parameters before and after treatment in the effective group were higher than those in the ineffective group (all P<0.05). Spearman correlation analysis showed that calcium content, effective atomic number, iodine concentration, and slope of energy spectrum curve were negatively correlated with curative effect (r=-0.413, -0.628, -0.527, and -0.385; all P<0.05). Conclusion　256-slice spectral CT imaging parameters are helpful in the diagnosis of lung adenocarcinoma, which can reflect the curative effect, and provide references for condition and curative effect evaluation.

Key words: 256-slice spectral CT imaging parameters, Lung adenocarcinoma, Diagnosis, Treatment guidance

摘要： 目的　探究256排能谱CT成像参数在肺腺癌诊断及治疗指导中的价值。方法　选择2018年5月至2022年1月期间江汉大学附属湖北省第三人民医院收治120例肺腺癌患者及83例肺鳞癌患者作为研究对象，患者均行256排能谱CT成像获得CT成像参数，比较两组患者能谱CT成像参数，分析能谱CT成像参数对肺腺癌与肺鳞癌的诊断价值；肺腺癌患者依据靶向治疗疗效进行分组，比较有效与无效组患者治疗前后能谱CT成像参数差异，分析能谱CT成像参数与疗效之间的关系。采用t检验、χ²检验、受试者工作特征曲线（ROC）、Spearman相关性分析进行分析。结果　肺腺癌患者男76例、女44例，年龄（45.26±2.95）岁；肺鳞癌患者男58例、女25例，年龄（45.11±2.07）岁。肺腺癌患者钙含量、有效原子序数、碘基值以及能谱曲线斜率分别为（3.16±0.86）mg/ml、（7.79±0.05）、（6.76±0.96）g/L、（0.94±0.24），均低于肺鳞癌患者的（4.71±1.09）mg/ml、（7.84±0.06）、（7.92±1.13）g/L、（1.24±0.32），差异均有统计学意义（均P<0.05）；肺腺癌患者与肺鳞癌患者水基值比较，差异无统计学意义（P>0.05）。能谱CT成像参数钙含量、有效原子序数、碘基值、能谱曲线斜率用于肺腺癌与肺鳞癌诊断曲线下面积（AUC）分别为0.832、0.754、0.792、0.722，各指标联合AUC值则为0.932；两组患者治疗后钙含量、有效原子序数、碘基值以及能谱曲线斜率较治疗前明显下降（均P<0.05），有效组患者治疗前与治疗后钙含量、有效原子序数、碘基值以及能谱曲线斜率均低于无效组（均P<0.05），有效组患者钙含量、有效原子序数、碘基值以及能谱曲线斜率治疗前后差值均高于无效组（均P<0.05）；Spearman相关性分析显示，钙含量、有效原子序数、碘基值以及能谱曲线斜率与疗效均为负相关关系（r=-0.413、-0.628、-0.527、-0.385，均P<0.05）。结论　256排能谱CT成像参数用于肺腺癌诊断有一定价值，能够反映患者疗效，可以作为患者病情诊断以及疗效评估的参考依据。

关键词: 256排能谱CT成像参数, 肺腺癌, 病情诊断, 治疗指导