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目的：通过对肺部良性和恶性占位病变进行能谱CT扫描，讨论宝石CT能谱成像分析在诊断与鉴别肺良恶性占位病变的影像学价值。方法回顾性选取经病理确诊的肺部良性占位12例，肺部恶性占位18例，均用宝石能谱CT进行能谱扫描（GSI），分别得到动脉期和静脉期能谱曲线含碘图40～140 keV能量水平的CT值和斜率值对照，以及碘基图像，然后进行数据分析。结果增强扫描中动脉期和静脉期40～140 keV能量水平的CT值中，40～80 keV能量水平的CT值良性占位组均低于恶性占位组，单能量越低时CT值差别越大；动脉期良性占位组与恶性占位组40～70 keV区间能谱曲线斜率分别为2.57±0.21、3.22±0.23，2组间斜率差异有统计学意义（P＜0.05）；动脉期和静脉期碘基图像上良性占位组的碘浓度均低于恶性占位组，其差异具有统计学意义（P均＜0.05）。结论宝石能谱CT对肺部占位性病变的诊断具有重要价值，良性与恶性占位病变能谱成像上碘含量不同的特征，可以初步区分肺部良性与恶性占位病变。“,”Objective To discuss the diagnosis value of imaging in distinguishing between benign lung occupying lesions and malignant lung occupying lesions by the gem energy spectrum CT scan. Methods 12 patients with benign lung occupying lesions and 18 patients with malignant lung occupying lesions confirmed by pathology were collected. All the cases underwent GSI imaging of Gem energy spectrum CT, the CT values, slope value and iodine based images on 40~140 keV in arterial phase and venous phase were got. Then data were analyzed and compared. Results In the CT values on 40~140 keV of gem energy spectrum CT enhancement imaging in arterial phase and venous phase, the CT values on 40~80 keV in benign lung lesion group were lower than that in malignant lung lesion group, and the lower single energy, the greater difference between CT values;Slope value within the tumor region of interest on 40~70 keV in arterial phase was (2.57±0.21) vs (3.22±0.23), statistical significant difference of slope value was found between the two groups (P<0.05);In arterial phase and venous phase, iodine concentration on iodine based image of benign group were lower than that of malignant group, statistical significant difference was found (P<0.05). Conclusion Gem energy spectrum CT is of great value in diagnosis of lung occupying lesions, the characteristics of iodine content can initially distinguish between benign lung lesions and malignant lung lesions in energy spectrum imaging.