影像技术

目的：评价能谱CT多参数成像联合γ-干扰素释放试验(IGRAs)在肺结核中的诊断效能。方法：纳入2022年1月至2023年6月收集的63例肺结核、36例肺炎及61例肺部肿瘤患者，分析其IGRAs结果及胸部能谱CT增强扫描图像及参数(双期CT值、碘浓度、水浓度、有效原子序数、能谱曲线斜率等)；绘制受试者工作特征(ROC)曲线，比较各种方法在肺结核中的鉴别诊断效能。结果：动脉期三组间比较：CT 40 ke V、CT 70 ke V、NIC、λ_HU、Zeff、IC炎性病变组>肿瘤组>结核组(P<0.05)。静脉期三组间比较：CT 40ke V、CT 70ke V、NIC、λ_HU、Zeff、IC炎性病变组>肿瘤组>结核组(P<0.05)。三组水基值比较：结核组双期水基值低于炎性病变组与肿瘤组(均P<0.05)，炎性病变组与肿瘤组之间双期数据无统计学差异(P>0.05)。能谱CT双期联合参数联合IGRAs的AUC值最高，可达0.95，诊断敏感度和特异度分别为91%和82%，优于单一应用能谱CT或γ-干扰素释放试验诊断效能(P<0.05)。结论：能谱CT联合IGRAs可显著提高肺结核的诊断准确性，为临床诊断提供有价值的补充手段。

Objective:To investigate the efficacy of spectral CT multi-parameter imaging and inter‐feron-γ release assays(IGRAs) in distinguishing between pulmonary tuberculosis,lung tumors,and pul‐monary inflammatory lesions.Methods:To determine the result of interferon-γ release assays and effec‐tiveness of energy spectrum CT parameters in diagnosing bacillus-negative tuberculosis,analyze chest en‐ergy spectrum CT enhancement scan images of 63 patients with tuberculosis,36 patients with inflamma‐tory lesions,and 61 patients with lung tumors.Measure CT values of the lesions,concentration of iodine and water,and effective atomic sequence number.Calculate the slope of the energy spectrum curve,com‐pare differences between groups,create ROC curves for parameters with significant differences,calculate AUC,and evaluate the results.Results:The group with inflammatory lesions had higher CT 40 ke V,CT70 ke V,NIC,λ_HU,Zeff,and IC values compared to the tumor and tuberculosis groups in both the arterial and intravenous phases (P<0.05).The tuberculosis group had lower two-phase water-based values com‐pared to the other two groups (P<0.05).No significant difference was found in the two-phase data be‐tween the inflammatory lesion group and the tumor group (P>0.05).The diagnostic spectral CT combined with IGRAs was the highest,with an AUC value of 0.95,sensitivity of 91%,and specificity of 82%,which was higher than spectral CT and IGRAs (P<0.05).Conclusion:Energy spectrum CT combined with IGRAs can improve the diagnosis and differential diagnosis efficiency of pulmonary tuberculosis and has high clinical application value.