腮腺肿瘤血液流变学特点与肿瘤性质的关系

Clinical value of CT perfusion imaging in differential diagnosis of parotid gland tumors

目的:探讨采用多层螺旋CT灌注成像技术研究腮腺良、恶性肿瘤的血液流变学特点及其鉴别腮腺肿瘤良恶性的价值。方法:56例患者共60个病灶,其中良性肿瘤38例(42个病灶),恶性肿瘤18例(18个病灶),全部经术后病理证实。术前行CT灌注检查。采用Philips perfusion功能软件包获取组织的时间密度曲线(time density curve T-DC)及CT灌注参数,包括灌注量(perfusion)、增强峰值(peak height,PH)、达峰时间(time topeak,TTP)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)。采用Wilcoxon符号秩和检验进行统计学处理。结果:腮腺良性肿瘤的CT灌注参数的中位数M及四分位间距25%CI75%(Q1,Q2)分别为perfu-sion:73.50mL.100g-1.min-1(18.70,113.30),PH:34.50HU(17.70,53.05),TTP:20.00s(13.60,34.40),BV:38.50mL.100g-1(29.10,63.30),MTT:7.55s(4.50,28.70)。腮腺恶性肿瘤的CT灌注参数分别为:perfusion:135.93mL.100g-1.min-1(101.35,195.18),PH:49.06HU(32.65,59.40),TTP:12.85s(11.27,14.60),BV:67.50mL.100g-1(52.35,109.50),MTT:6.02s(5.05,7.60)。统计结果显示:CT灌注参数BF、BV、TTP的中位数M及四分位间距25%CI75%(Q1,Q2)在腮腺良恶性肿瘤之间差异具有统计学意义(P<0.05),而PH及MTT之间差异无统计学意义(P>0.05);腺淋巴瘤、其它良性肿瘤、恶性肿瘤的TDC的差异也有统计学意义。结论:CT灌注扫描技术检测腮腺肿瘤血液流变学特点对腮腺良恶性肿瘤的鉴别诊断具有一定价值。

AIM ： To explore the usefulness of CT perfusion imaging in quantitatively judging the blood patterns of the benign tumors and the malignancies of the parotid, and to evaluate its clinical value in differentiating benign tumors from malignant tumors of the parotid. METHODS： Fifty - three patients were included in this study （35 with benign tumors and 18 with malignant tumors）. All the tumors were confirmed histopathologically and examined with CT perfusion before operations. The parameters of CT perfusion were obtained by using Philips perfusion software, including time - density curve （ TDC ）, perfusion （ mL · 100 g ^-1 · min ^-1 ）, peak height （ PH ： HU ）, time to peak （ TTP ： s ）, blood volume （BV： mL · 100 g^-1） and mean transit time （MTT：s）. Wilcoxon signed -rank test for paired data was used to determine the statistical differences of parameters between the benign and malignant tumors. RESULTS： The median and quartile range of perfusion, PH, TTP, BV, MTT were 73.50 mL · 100 g^-1 · min^-1 （18.70,113.30） , 34. 50 HU （ 17.70, 53.05 ） ,20. 00 s （ 13.60,34. 40 ）, 38.50 mL · 100 g^-1（ 29. 10,63.30 ）, 7.55 s （ 4. 50,28.70 ） respectively in benign tumors, versus 135.93 mL· 100 g^-1 · min^-1 （101.35,195.18）,49.06 HU（32.65,59.40）,12.85 s（11.27,14.60）, 67.50 mL · 100 g^-1 （52.35,109.50） ,6. 02 s（5.05,7.60） in malignant tumors. Except for PH and MTT, the differences of perfusion,TrP and BV between benign and malignant tumors were statistically significant （P 〈 0. 05 ）. The difference of TDC among the Warthin＇s tumor, other benign tumors and malignant tumors was also statistically significant （P 〈 0. 05）. CONCLUSION： On the basis of this study, the parameters of CT perfusion, BF,BV,TTP and TDC were valuable in differential diagnosis for benign and malignant tumors of the parotid gland.