目的 探讨能谱CT在肺癌诊断及 病理分型中的应用价值。方法 以2015年1 月至2017年6月我院收治的80例疑似肺癌 患者为研究对象，患者入院后均行能谱CT 扫描检查，参照术后组织病理学结果评估 能谱CT诊断肺癌效能，依据术后病理结果 将肺癌患者分为鳞癌组、腺癌组和小细 胞癌组，比较三组平扫和增强扫描后能 谱特征参数和能谱曲线。结果 以术后组 织病理结果为金标准，能谱CT诊断肺癌 的灵敏度、特异度、准确度、阳性预测 值、阴性预测值各为83.33%、65.00%、 87.72%、56.52%；小细胞癌组钙含量、 有效原子系数最高，鳞癌组次之，腺癌 组最低，三组之间两两相较差异有统计 学意义(P＜0.05)；三组之间△Ct值相比 较，仅腺癌组△Ct值较小细胞癌组明显高 (P＜0.05)；三组斜率K、NIC由高至低排 序：小细胞癌组＞鳞癌组＞腺癌组，三组 之间两两相较差异显著(P＜0.05)；斜率K 对鳞癌和腺癌鉴别诊断有较高灵敏度和特 异度，各为85%、89%，并且曲线下面积为 0.92。结论 能谱CT可作为肺癌诊断及其 病理分型鉴别诊断的一种有效辅助手段， 有临床推广应用价值。

Objective To investigate the application value of energy spectrum CT in the diagnosis and pathological typing of lung cancer. Methods 80 patients with suspected lung cancer treated in our hospital from January 2015 to June 2017 were selected as study subjects. They were examined by energy spectrum CT scan after admission, and according to histopathological findings, the effectiveness of energy spectrum CT in the diagnosis of lung cancer was evaluated. Patients with lung cancer were divided into squamous cell carcinoma group, adenocarcinoma group and small cell carcinoma group according to postoperative pathological findings. The spectral characteristic parameters and spectrum curves were compared among the three groups after plain scan and enhanced scan. Results With histopathological findings as the golden standard, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of energy spectrum CT in the diagnosis of lung cancer were 83.33%, 65.00%, 87.72% and 56.52% respectively. The calcium content and effective atomic coefficient of small cell carcinoma group were the highest, followed by squamous cell carcinoma group and they were the lowest in adenocarcinoma group. There were statistically significant differences between any two groups (P<0.05). For comparison of △Ct value among the three groups, only △Ct value in adenocarcinoma group was significantly higher than that in small cell carcinoma group (P<0.05). K and NIC slopes in the three groups ranking from high to low showed small cell carcinoma group > squamous cell carcinoma group > adenocarcinoma group, and there were statistically significant differences between any two groups (P<0.05). The sensitivity and specificity of slope K in differential diagnosis of squamous cell carcinoma and adenocarcinoma were 85% and 89% respectively, and the area under the curve was 0.92. Conclusion Energy spectrum CT can be used as an effective assistant method for the diagnosis of lung cancer and differential diagnosis of pathological type.