肺部肿瘤首过期CT灌注成像及其临床应用价值研究

The Clinical Application of Pulmonary Tumors in First Pass Phase by Dynamic CT Perfusion

目的通过多层螺旋CT动态增强首过期灌注值和强化峰值来描述周围型肺癌、中央型肺癌和肺部转移瘤的灌注特征。资料与方法92例肺部肿瘤患者(包括48例周围型肺癌,31例中央型肺癌,13例单侧肺转移瘤)接受检查。注射对比剂同时屏气,在固定层面连续扫描30层(1层/s)。分别以整个肿瘤、肿瘤富强化区、肿瘤少强化区取感兴趣区来评价其时间密度曲线。通过Miles最大斜率法计算灌注值和强化峰值,依据肿瘤大小、位置(中央型/周围型或转移瘤)及病理类型的不同进行比较。结果大的肿瘤(直径>4cm)的灌注值及强化峰值明显低于小的肿瘤(直径≤4cm),其差异有统计学意义(P<0.0001)。不考虑大小因素,中央型肺癌的灌注值与周围型肺癌的灌注值差异有统计学意义。另外,两者的强化峰值差异亦有统计学意义;中央型肺癌与转移瘤灌注值及强化值差异有统计学意义,周围型肺癌与转移瘤灌注值及强化值差异则无统计学意义。非小细胞肺癌与小细胞肺癌的上述参数的差异均无统计学意义。结论肿瘤灌注值及强化峰值与肿瘤大小位置有关,但与病理类型无关,可以对不同大小、位置的肿瘤预后进行评估。

Objective To discuss perfusion features of peripheral/central bronchial carcinomas and unilateral lung metastasis with dynamic CT perfusion. Materials and Methods 92 cases included 48 peripheral bronchial carcinomas,31 central bronchial carcinomas and 13 unilateral lung metastasis tumors were collected. During breath hold,after injection of contrast medium,30 slices scan were performed （lscan/s） at a fixed table position. Density time curves were evaluated from regions of interest of the whole tumor and high enhancing and low enhancing tumor areas. Perfusion （P） and peak en- hancement value （EPV） were calculated using the maximum slope method of miles and compared with size, localization （ central or peripheral） and histology. Results Perfusion and peak enhancement value of large tumors （ diameter 〉 4 cm） was significantly lower than that of smaller ones （diameter ≤4 cm）. Independent of size, central carcinomas had a signifi- cantly （ P 〈 0.05 ） lower perfusion （ mean 0.39 ml ·min - 1· ml - 1 ） than that of peripheral ones （ mean 0.73 ml· min -1 · ml-1 ） , in contrast, peak enhancement of central and peripheral carcinomas was also significantly different; central carcino- mas had a significantly （ P 〈 0.05 ） lower perfusion and peak enhancement value than that of unilateral lung metastasis tumors （ mean 0.76 ml ·min - 1 · ml -1 ） , and peripheral ones did not. There was no significant difference in both parameters between non small cell lung cancers （NSCLC） and small cell lung cancers （SCLC）. Conclusion Tumor perfusion and peak enhancement value depend on tumor size and localization, but not on histology, which can be used to evaluate the prog- nosis of pulmonary tumors.