SPECT肺灌注与CT异机融合图像评价非小细胞肺癌肺功能的价值

Value of fusion SPECT lung perfusion and CT images in the evaluation of lung function for patients with non-small cell lung cancer

目的探讨SPECT肺灌注与CT异机融合图像评价Ⅲ期非小细胞肺癌（NSCLC）患者区域肺功能的意义。方法选择Ⅲ期NSCLC患者32例，治疗前行肺功能测试和胸部CT扫描，并在相同体位下行SPECT肺灌注显像，两套图像均传至Philips Pinnacle^3放射治疗计划系统，依据外标记点进行手动异机图像融合。参考CT与SPECT肺灌注融合图像，按灌注缺损区与肿瘤病灶的大小关系分为4级：0级为无灌注受损；1级为肿瘤及其周围局部肺灌注受损；2级为1叶肺灌注受损；3级为超过1叶肺灌注受损。采用SPSS13．0软件，行Pearson χ^2检验。结果32例Ⅲ期NSCLC患者中，31例有程度不等的肺灌注缺损，其中1级13例，2级8例，3级10例。中央型NSCLC患者肺灌注缺损较周围型NSCLC患者严重，差异有统计学意（χ^2=10．495，P〈0．05）。8例患者肺功能测试有不同程度的异常。CT与SPECT肺灌注融合图像阳性率96．9％（31／32），较肺功能测试阳性率25．0％（8／32）高，差异有统计学意义（χ^2=34．724，P〈0．05）。结论SPECT肺灌注与CT异机融合图像能更好显示Ⅲ期NSCLC患者区域肺组织的功能状况，为此类患者制订手术方案、预测术后肺功能、优化放疗计划等提供更多的信息。

Objective The aim of this study was to assess the value of fusion SPECT perfusion and CT images acquired separately at 2 time-points in evaluating regional lung function of patients with stage m non-small cell lung cancer （NSCLC）. Methods Thirty-two patients with untreated stage Ⅲ NSCLC underwent pulmonary function test （PFT）, CT and SPECT imaging. Two series of images were registered by software fusion based on external markers by Philips Pinnacle^3 planning treatment system. The SPECT/CT fusion images were graded by comparing lung perfusion defect with the area of radiological abnormality. Grade 0 ： no lung perfusion defect in the area of radiological abnormality. Grade 1 ： the area of lung perfusion defect was similar to the size of radiological abnormality. Grade 2 ： the area of lung perfusion defect was bigger than that of radiological abnormality, and extended to 1 pulmonary lobe. Grade 3 ： the area of lung perfusion defect exceeded 1 pulmonary lobe. Statistically significant difference was evaluated by Pearson χ^2-test using SPSS 13.0 software. Results In 32 patients with stage Ⅲ NSCLC, 31 patients had lung perfusion defects. There were 13 patients with grade 1, 8 with grade 2, 10 with grade 3. There was statistically significant difference between central lung cancer and peripheral lung cancer （χ^2 = 10. 495, P 〈 0.05 ） ; 8 patients had PFT abnormality. There was also statistically significant difference between the positive rate of SPECT/CT fusion images and PFT [96.9%（31/32） vs25.0%（8/32）,χ^2 =34.724, P〈0.05]. Conclusion The fusion of SPECT lung perfusion and CT images acquired separately at 2 different time-points is a feasible technique for assessing the regional lung function of patients with stage Ⅲ NSCLC, thereby offering more in- formation for surgical planning, prediction of postoperative lung function and optimization of radiation treatment plans.