多层CT灌注成像在肺内肿块诊断及鉴别诊断中的应用

Multi-slice CT perfusion imaging for differentiating pulmonary masses

目的 探讨多层CT灌注成像在评价肺内肿块性质及良恶性鉴别中的应用价值。方法 3 4例肺内肿块患者(恶性 2 1例 ,良性 8例 ,炎性 5例 )行多层CT同层动态扫描 (欧乃派克 3 5 0mgI/ml、总量 5 0ml、速率 5ml/s ,延迟 11s扫描 ,扫描速度 4层 /0 .5s、周期 1.5s、共扫 3 0s)。利用FUNCTIONALCT软件对图像进行后处理 ,获得主动脉和肿块的时间 密度曲线、肿块血流灌注参数值 ,对结果进行分析比较。结果 肺内恶性和炎性肿块的时间 密度曲线有明显的上升支 ,达峰值后走行平缓 (恶性 16例 /2 1例 ,76.2 % ;炎性 4例 /5例 ,80 .0 % ) ;良性肿块曲线走行平坦 ,无明显上升 ( 8例 /8例 ,10 0 .0 % )。恶性肿块的灌注值、峰值高、峰值高比值和平均通过时间均明显大于良性肿块 (P <0 .0 1) ,此四个参数间呈两两正相关 ;灌注值与到达峰值时间呈负相关。结论 CT灌注成像可为肺内肿块的诊断提供定量的功能信息 。

Objective To evaluate the clinical efficacy of multi-slice CT perfusion imaging in differentiating pulmonary masses. Methods Thirty-four patients with proved pulmonary masses (21 malignant, 8 benign, 5 inflammatory) underwent dynamic CT scan in the same slice (with Omnipaque 350 mgI/ml, 50 ml, 5 ml/s, delay 11 s, cycle time 1.5 s, duration time 30 s). Time-density curves of aorta and mass as well as mass perfusion parameters including perfusion value (PV), peak enhancement (PE), time to peak (TTP) and mean transit time (MTT) were created by FUNCTIONAL CT software. Mass-to-aorta peak enhancement ratio (RATIO) was also determined. The differences of perfusion parameters among groups and the relationships among these groups were assessed. Results Time-density curves of malignant and inflammatory pulmonary masses increased rapidly and maintained a plateau when they reached the peak enhancement, whereas it was flat with no evident increase in benign ones. PV, PE, RATIO and MTT of malignant masses were significantly higher than those of benign masses ( P <0.01), the four parameters were correlated with each other significantly. The correlation between PV and TTP was significantly negative. Conclusion CT perfusion imaging provides quantitative functional information about pulmonary masses and offers an effective method for differentiating pulmonary masses.