CT灌注成像在肺部肿物诊断及鉴别诊断中的应用研究

Diagnostic Values of CT Perfusion Imaging in Pulmonary Masses

背景与目的:良、恶性肿瘤的血流供应与代谢在质、量上有着明显的差异,目前正在开发使用新的影像学技术来鉴别恶性、良性结节的血供情况,灌注成像技术是其中一种。本文采用多层螺旋CT灌注成像技术,定量评价肺内块状病灶的血流特点及其对良、恶性肿瘤进行鉴别诊断的价值。方法:52例初诊为肺部肿物的患者(37例恶性、7例良性、8例活动性炎性),行16排螺旋CT灌注扫描。利用功能软件包自动获取动、静脉、病灶的时间-密度曲线及病变的灌注参数,包括灌注量(perfusionvolume,PV)、血容量(bloodvolume,BV)、对比剂平均通过时间(meantransittimeMTT)、增强峰值(peakheight,PH)。结果:恶性、活动性炎性、良性病变PV值分为(27.63±15.06)ml·min-1·ml-1、(30.80±20.33)ml·min-1·ml-1、(11.81±3.74)ml·min-1·ml-1,PH值分别为(28.46±12.07)Hu、(32.15±15.89)Hu、(10.41±3.77)Hu,BV分别为(21.64±10.97)ml/100g、(28.38±14.55)ml/100g、(10.61±5.33)ml/100g,恶性及活动性炎性病变这3值均显著高于良性病变。恶性、活动性炎性、良性病变的MTT值分别为(28.39±21.66)s、(25.91±14.57)s、(29.86±13.57)s,三者差异没有统计学意义。恶性、活动性炎性病变间4个灌注参数均没有统计学差异。若以PV值>20ml·min-1·ml-1,且PH>15Hu作为鉴别恶性、良性病变(除外活动炎性病变)的阈值,其灵敏度、特异度、准确性分为91.9%、100%、84.1%。结论:多层螺旋CT灌注成像能定量评价肺部肿物血流模式,可用于无创性诊断和鉴别诊断肺部病变。

BACKGROUND ＆ OBJECTIVE： Blood flow patterns with CT perfusion imaging （CTPI） had been innovated to delineate abnormal hemodynamic lesions in the liver, brain, and kidney. This study was to evaluate the blood flow patterns of pulmonary masses by CTPI, and determine the value of CTPI in differential diagnosis among benign, malignant, and inflammatory masses. METHODS： Fifty-two patients with previously diagnosed pulmonary masses （37 with malignant masses, 7 with benign masses, and 8 with inflammatory masses） underwent dynamic CTPI. Time-density curves （TDC） of artery, vein, and pulmonary masses as well as mass perfusion images and parameters including perfusion volume （PV）, peak height （PH）, mean transit time （MTT） and blood volume （BV） were obtained by Phlips CT-perfusion software. RESULTS.. The values of PV, PH, and BV were significantly higher in malignant masses and active inflammatory masses than in benign masses [（27.63±15.06） ml·min^-1·ml^-1 and （30.80±20.33）ml·min^-1·ml^-1 vs. （ 11.81±3.74）ml·min^-1·ml^-1, （28.46±12.07） Hu and （32.15±15.89） Hu vs. （10.41±3.77） Hu, （21.64±10.97） ml/100 g and （28.38±14.55） ml/100 g vs. （10.61±5.33） ml/100 g, P〈0.01]. However, the differences of MTT among malignant, inflammatory, and benign masses were not significant [（28.39±21.66） s, （25.91±14.57） s, and （29.86±13.57） s, P=0.928]. No significant differences in the 4 parameters were found between malignant and inflammatory masses. When PV 〉20 ml·min^-1·ml^-1 and pH 〉15 Hu were set as a diagnostic threshold （excluded active inflammatory masses）, the sensitivity, specificity, and accuracy were 91.9%, 100%, and 84.1%, respectively. CONCLUSION： CT perfusion imaging provides quantitative information about blood flow patterns of pulmonary masses and is an applicable diagnostic method for differentiating pulmonary masses.