CT灌注成像评价骨肿瘤新辅助化疗疗效的价值

CT perfusion imaging for evaluating neoadjuvant chemotherapy in bone neoplasms

目的：利用CT灌注成像（CTperfusion imaging，CTPI）研究新辅助化疗治疗原发性恶性骨肿瘤前后血流动力学变化。方法：经病理学检查确诊为恶性骨肿瘤患者13例接受常规化疗，其中骨肉瘤6例，上皮样肉瘤1例，原始神经外胚叶肿瘤4例，滑膜肉瘤1例，软骨肉瘤1例，每组患者均在化疗前1～5d及化疗后1～3周行CTPI，计算出血流量（BF）、血容量（BV）、达峰时间（TTP）、表面通透性（PS）等灌注参数，数据分析采用Wilcoxon符号秩检验。结果：化疗前后各参数的中位数BF分别为52．800mL／（100g·min）和53．000mL／（100g·min），BV分别为65．300mL／100g和67．600mL／100g，TTP分别为120．300S和114．900S，PS分别为40．100mL／（100g·min）和48．500mL／（100g·min）。化疗前后BF、BV和TTP差异均无统计学意义，P值分别为0．382、0．075和0．701；化疗后PS明显升高，差异有统计学意义，P=0．046。结论：PS能够评价化疗前后肿瘤血管灌注情况的变化，而BF、BV和TTP则相反。

OBJECTIVE： To investigate the hemodynamic changes of primary malignant bone tumors before and after neoadjuvant chemotherapy using CT perfusion imaging （CTPI）. METHODS： Thirteen patients with malignant bone tumors confirmed by pathology were enrolled in the study in which systemic chemotherapy was used to assess the tumor response. The pathological types of bone tumors were as follows： osteosarcoma in 6 cases, epithelioide sarcoma in 1 case, primitive neuroectodermal tumor （PNET） in 4 cases, synovial sarcoma in 1 case and chondrosarcoma in 1 case. All the patients underwent CTPI 1--5 days before and 1- 3 weeks after chemotherapy for the perfusion parameters including blood flow（BF）, blood volume （BV）, time to peak （TTP） and permeability surface（PS）. Perfusion parameters before and after chemotherapy were compared. Statistical analysis was performed with Wilcoxon signed-rank test. RESULTS： The following changes in median（M） pre- and post-induction chemotherapy values were noted as follows： BF 52. 800 mL/（100 g · min） and 53. 000 mL/（100 g· min） ;BV 65. 300 mL/100 g and 67. 600 mL/100 g; TTP 120. 300 s and 114. 900 st PS 40. 100 mL/（100 g ·min）to 48. 500 mL/（100 g · min）. There was no significant difference in BF, BV and TTP between pre- and posvinduction chemotherapy （P were 0. 382, 0. 075 and 0. 701 respectively）. After chemotherapy, tumors showed a significant increase in PS（P= 0. 046）. CONCLUSION： PS may be useful for assessing the changes in blood perfusion of primary malignant bone tumors after neoadjuvant chemotherapy, while BF, BV or TTP not.