64层螺旋CT灌注成像在食管癌放疗中的应用

Application of perfusion 64-slice spiral CT in esophageal carcinoma radiotherapy

目的：探讨64层螺旋CT灌注成像在食管癌放疗方面的价值。方法：38例经病理学证实的食管癌患者在放疗前后分别行64层螺旋CT灌注扫描，将放疗前、后的灌注参数进行配对设计t检验。放疗后随访12～18个月，中位时间15个月，再以是否局部复发和（或）转移为标准进行分组，并对各组病例放疗前肿瘤灌注参数进行独立样本t检验。结果：38例放疗前组织血流量、血容量、表面通透性、平均通过时间、强化峰值分别为（341．2±137．5）ml·100g^-1·min^-1，（10．4±6．8）ml·100g^-1，（28．3±17．1）ml·100g^-1·min^-1，（4．3±1．8）s，（55．9±14．7）Hu，放疗灌注后参数分另4为（331．4±121．0）ml·100g^-1·min^-1，（8．8±5．1）ml·100g^-1，（9．6±8．9）ml·100g^-1·min^-1，（3．5±2．0）s，（46．6±13．5）Hu。肿瘤表面通透性，强化峰值差异有统计学意义。其余各参数之间比较差异无统计学意义。复发／转移组与无复发／转移组灌注参数差异无统计学意义。结论：灌注参数可以定量反映食管癌的微循环特征。放疗前和放疗后肿瘤表面通透性、强化峰值表现为明显减低。灌注参数难以预测肿瘤放疗后复发及转移。

Objective ： To assess the value of 64-slice spiral CT in diagnosis of esophageal carcinoma and prediction. Methods： thirty-eight cases of esophageal carcinoma proved by nasopharyngoscopy biopsy underwent 64-slice CT perfusion imaging before radiotherapy, paired samples t-test was used to analys the per- fusion parameters of pre-radiation and post-radiation, 38 cases were followed up for 12 - 18 months, with median of 15 months. The cases were divided into groups according to whether they had local recurrence or/ and metastasis. The parameters of those groups before radiotherapy were assessed with independent-sample t-test. Results： Before radiotherapy, the tissue blood flow（BF）, blood volume（BV） ,surface permeability （PS）, mean transit time（MTT） ,peak height（PH） of 38 cases were（341.2 ± 137.5） ml · 100 g^-1 min^-1, （10.4±6.8）ml · 100 g^-1, （28.3 ±17.1）ml · 100 g^-1 ·min^-1, （4.3 ±1.8） s, （55.9 ± 14.7） Hu. After radiation of 60 - 64 Gy, these parameters were （ 331.4 ± 121.0 ） ml · 100 g^- 1 · min^- 1, （ 8.8 ± 5.1）ml · 100 g^-1, （9.6 ±8.9）ml · 100 g^-1 · min^-1,（3.5 ±2.0） s, （46.6 ± 13.5） Hu respectively on paired-samples t-test. There was significant difference in PH, PS between per and post-radiation data,while there was no statistic significant difference in other parameters. Between the group with recurrence or/and metastasis and other groups, there was no statistic difference in parameters of perfusion before radiotherapy.Conclusion： Perfusion CT can reflect the microcirculation features of esophageal carcinoma quantitatively. Peak height decreased significantly compared with that of per-radiation. It is difficult to predict recurrence or metastasis of esophageal carcinoma after radiotherapy with the perfusion parameters.