多层螺旋CT灌注成像与直肠癌TNM分期关系的研究

A study on the relation between 64-Slice spiral CT perfusion imaging and the TNM stage of the patients with rectal cancer

目的探讨直肠癌患者CT灌注成像的各项参数对直肠癌术前评估的价值。方法选择施行根治性手术治疗且病理证实的直肠癌病人30例为研究对象,所有病人于术前行CT灌注成像扫描,准确记录血容量(blood volume,BV)、强化峰值(peak enhancement image,PEI)、强化峰值达到时间即达峰时间(time to peak enhancement image,TTP)、血流量(perfusion,PF),并在术后准确确定TNM分期,并对TNM分期中各CT灌注参数值进行统计学分析。结果在T分期中,各组PF、TTP、BV的参数值的差别有统计学意义(P<0.01),而PEI的差别无统计学意义(P>0.05)。并且在各分组中,PF有逐渐减少的趋势,TTP、BV有逐渐增加的趋势;在淋巴结转移分组中,无淋巴结转移组的PF、BV要多于有淋巴结转移组的PF、BV,并且差异有统计学意义(P<0.05),TTP、PEI无意义(P>0.05),在远处转移组中,同时肝转移组的PEI、PF要少于无远处转移组,差异有显著性(P<0.05),TTP、BV则无统计学差异(P>0.05);肿瘤的分化程度分组中,分化程度越高的肿瘤,其血流量越多于分化差的肿瘤,参数表现为PF、TTP渐次升高,差异有统计学意义(P<0.05);靶淋巴结灌注的表现为转移淋巴结的PF要多于反应性增生的淋巴结,数据上有统计学的差异(P=0.0001),TTP、BV、PEI无意义(P>0.01),证明被转移的淋巴结其血流量要多于反应性增生的淋巴结。结论直肠癌患者CT灌注成像中的各项参数对直肠癌进行术前分期有一定的应用价值,可以使术前分期更加准确,从而采取更合理的治疗策略。

Objective To explore the value of 64-Slice spiral CT perfusion imaging parameters in the preoperative assessment of rectal cancer. Methods 64 MDCT perfusion imaging wag performed in 30 patients with pathologically verified rectal cancer, all patients underwent preoperative CTPI successfully, and the parameters of individual perfusion imaging were recorded accurately,such as BV PEI PF TTP, determined the ifnal pTNM after surgery and then used for statistical analysis. Results CT perfusion images in 30 patients with rectal cancer were satisifed , in T stage ,the difference was statistically signiifcant among perfusion ,TTP BV(P<0.01), but not PEI(P>0.05), and as stage increased, TTP,BV increased, perfusion decreased ,in lymph node metastasis group, in without lymph node metastasis group ,perfusion and BV were more than these in group with lymph node metastasis,and the difference was statistically signiifcant(P<0.05), but TTP,PEI made no sense(P> 0.05), in distant metastasis group ,PEI and Perfusion in liver metastasis group at the&nbsp;same time less than without distant metastases group, and it made sense(P<0.05),not TTP,BV(P<0.05), in differentiation of the cancer group,of higher degree of differentiation of the tumor, its blood flow more than poorly differentiated tumor, from poor degree to high degree , parameters of Perfusion, TTP gradually increased, and the difference was statistically signiifcant(P<0.05),in lymph node group,Characterized target Perfusion of lymph node metastasis of lymph node had more blood flow than reactive hyperplasia of lymph nodes, the data was statistically difference(P=0.0001), it proved that metastasis have support of blood flow .Conclusions The parameters in cancer patients with CTPI in the preoperative evaluation of rectal cancer has a certain value,make more accurate preoperative evaluation,and thus be able to take a more rational treatment strategies.