Application of Gemstone Spectral Computed Tomography Imaging in the Characterization of Solitary Pulmonary Nodules

This study aimed to observe the value of computed tomography (CT) spectral imaging parameters in the diagnosis of solitary pulmonary nodules, during the contrast-enhanced early phase and late phase.This study was approved by the institutional review board and written informed consent was obtained from all patients. One hundred thirty-nine patients with solitary pulmonary nodules proved by pathology underwent double-phase enhanced CT scan using gemstone spectral imaging mode on a Discovery CT750 HD, and were divided into an active inflammatory group (43 cases), a malignant group (65 cases), and a tuberculosis group (31 cases). The slope rate was calculated from the spectral curve. Iodine concentrations (ICs) were derived from iodine-based material decomposition CT images and normalized to the IC in the aorta. The Kruskal-Wallis test and Nemenyi test were performed to compare quantitative parameters among the 3 groups or between each of the 2 groups.There were significant differences in the slope rate, IC, and normalized IC (NIC) among the 3 groups. In the active inflammatory group, malignant group, and tuberculosis group, the mean slope rate were 3.03 ± 0.71 (SD), 1.96 ± 0.91, and 1.37 ± 0.43, respectively, during the early phase and 3.28 ± 0.67, 2.24 ± 0.82, and 1.67 ± 0.64, respectively, during the late phase. The ICs were 2.68 mg/mL ± 0.56, 1.65 mg/mL ± 0.76, and 1.10 mg/mL ± 0.34, respectively, during the early phase and 2.79 mg/mL ± 0.57, 1.90 mg/mL ± 0.71, and 1.29 mg/mL ± 0.44, respectively, during the late phase. The NIC were 0.24 ± 0.06, 0.16 ± 0.04, and 0.10 ± 0.04, respectively, during the early phase and 0.57 ± 0.10, 0.43 ± 0.11, and 0.25 ± 0.09, respectively, during the late phase. The mean slope rate, IC, and NIC for the active inflammatory group were significantly higher than these parameters for the malignant group (P < 0.05), and the parameters for malignant group were significantly higher than the tuberculosis group (P < 0.05).Dual-energy CT gemstone spectral imaging provides a novel method to better characterize pulmonary nodules in double-phase contrast-enhanced scanning.