CT灌注成像在乳腺良、恶性病变诊断中的应用

CT perfusion : the clinical application in the diagnosis of breast diseases

目的对乳腺病变CT灌注进行初步评价。方法22例乳腺疾病女性行乳腺CT灌注。其中纤维腺瘤1例(合并乳腺囊肿);其他良性病变5例;乳腺癌16例。采用电影模式(0.5s/r),120kV,60mA,5mm×4;注射流率4.0ml/s,延迟5s,扫描时间50s。利用GE公司Perfusion3体部灌注软件,分别测量血流量(BF)、血容量(BV)、平均通过时间(MTT)和表面通透性(PS),并进行统计学分析。结果乳腺癌组BF、BV、MTT、PS均值分别为(33.55±28.40)ml.min-1.100g-1、(5.60±3.08)ml/100g、(15.37±6.41)s和(18.71±10.42)ml.min-1.100g-1,对侧正常乳腺组BF、BV、MTT、PS均值分别为(10.36±9.44)ml.min-1.100g-1、(0.70±0.22)ml/100g、(13.55±7.27)s和(1.54±1.74)ml.min-1.100g-1,2组间BF、BV、PS均值差异有统计学意义(P<0.05),MTT均值差异无统计学意义(P>0.05)。纤维腺瘤BF、BV、MTT、PS均值分别为(62.57±19.62)ml.min-1.100g-1、(7.37±1.30)ml/100g、(11.24±3.34)s和(27.63±3.87)ml.min-1.100g-1,与乳腺癌组之间PS均值差异有统计学意义(P<0.05),BF、BV、MTT均值差异无统计学意义(P>0.05)。其他良性病变BF、BV、MTT、PS均值分别为(7.65±10.24)ml.min-1.100g-1、(1.23±0.97)ml/100g、(14.94±10.68)s和(1.81±1.72)ml.min-1.100g-1,与乳腺癌组之间BF、BV、PS均值差异有统计学意义(P<0.05),MTT均值差异无统计学意义(P>0.05)。结论CT灌注成像能反映乳腺病变的血液灌注特点,提供有价值的血流动力学信息,有助于乳腺良、恶性病变的鉴别诊断。

Objective To assess the CT perfusion characteristics of breast diseases. Methods Twenty-two patients with fibroadenoma accompanied with cyst （ n = 1 ） , other benign diseases （ n = 5 ） , and carcinomas （n = 16） underwent breast CT scan. CT perfusion was performed for breast with cine mode （0. 5 s .per rotation ） on a muhislice CT scanner ,120 kV, 60 mA, 4 ×5 mm collimation. Contrast injection was done by using 50 ml nonionic contrast agent （ 300 mg L/ml ） , at a flow rate of 4 ml/s with a power injector, 5 seconds delay, and data acquisition lasted for 50 seconds. These data were processed on a GE AW 4. 1 workstation using perfusion 3 software package, and the mean BF, BV, MTF and PS were measured and statistically analyzed. Results The mean BF, BV, MTF and PS in carcinoma were （33.55 ± 28.40） ml·min^-1 · 100g^-1, （5.60±3.08） ml/100 g, （15.37 ±6.41） s, （18.71 ±10.42） ml · min^-1· 100 g^-1. The mean BF, BV, MTF and PS in contralateral normal breast of carcinoma were （ 10. 36 ± 9.44） ml· min^-1· 100g^-1, （0.70±0.22） ml/100 g, （13.55±7.27） s, （1.54±1.74） ml· min^-1 · 100 g^-1. The mean BF, BV, and PS between carcinoma and normal breast were statistically significant （ P 〈 0. 05 ） , and the mean MTF was not statistically significant （ P 〉 0. 05 ）. The mean BF, BV, MTF and PSinfibroadenomawere （62. 57 ±19.62） ml · min^-1· 100 g^-1, （7.37 ±1.30） ml/100 g, （11.24± 3.34） s, （27. 63 ±3.87） ml · min^-1· 100 g^-1. The mean PS between carcinoma and fibroadenoma was statistically significant （ P 〈 0. 05 ） , and the mean BF, BV, and MTF were not statistically significant （ P 〉 0. 05）. The mean BF, BV, MTF and PS in benign lesion were （7.65 ± 10. 24） ml · min^-1 · 100 g^-1, （1.23±0.97） ml/100g, （14.94±10.68） s, （1.81±1.72） ml· min^-1· 100g^-1. The meanBF, BV, and PS between carcinoma and benign lesion were statistically significant （ P 〈 0. 05 ） , and the mean MTT was not statistically significant （ P 〉 0. 05 ）. Conclusion MSCT perfusion may reflect the features of breast diseases, and provide valuable hemodynamic message. These parameters have a value in diagnosis of breast diseases and are helpful for differential diagnosis.