多层螺旋CT在肺癌诊断中的临床应用

Application of multi-slice spiral CT in lung cancer

目的：探讨多层螺旋CT与肺癌早期诊断及预后的关系。方法：对我院2007年4月～2008年7月拟诊肺癌的152例患者行多层螺旋CT扫描，评价CT对肺癌早期诊断的作用，比较肺癌CT灌注参数与肌肉组织灌注参数的差异。接受化疗、放疗或同步放化疗且符合疗效评价标准患者中观察治疗前后CT灌注参数是否有变化，评价CT灌注参数的变化在监测化放疗疗效，评价预后中有无价值。结果：CT检查鉴别诊断肺部肿物良、恶性的灵敏度、特异性、阳性预测值、阴性预测值和准确性分别为90．5％、86．7％、98．4％、50．0％、90．1％。肺癌患者肿瘤组织和肌肉组织的BF、BV、MTT、PS（均P〈0．01）。在NSCLC中，缓解组的BF、BV值高于未缓解组，（P〈0．05）；缓解组的MTT值较低、PS值略高（P〉0．05）。PS值升高组的无进展生存期和总生存期均低于PS值降低组（均P〈0．01）。结论：CT在肺癌早期诊断中具有一定临床意义，肺癌的BF、BV和PS值明显高于肌肉组织，MTT明显低于肌肉组织。PS值升高，提示预后不良。对于化疗后早期灌注值明显升高、PS值升高的患者，可望提示临床在出现肿瘤进展前考虑提早联合放疗或靶向治疗。

Objective： To study the application of the multi-slice spiral CT in primary lung cancer. Methods： Multi-slice spiral CT were performed in 152 patients suspected lung cancer. The role of CT on early diagnosis of lung cancer was evaluated. The parameters including BF, BV, MTT and PS were calculated before and after chemotherapy and/or radiotherapy were compared, and the relationship between perfusion parameters with progression-free survival and overall survival was also assessed. Results： The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT were 90.5%, 86.7%, 98.4%, 50.0%, 90.1%. The BF, BV, MTT, PS were significant different between lung cancer tumor tissue and muscle tissue （all P 〈 0.01）. In NSCLC, BF, BV in the remission group were higher than that in the non-remission group, （ P 〈 0.05） ; PS values increased progression-free survival group and the overall survival period were lower than the PS value of reducing group （all P 〈 0.01）. Conclusion： Multi-slice spiral CT has a certain clinical significance in early diagnosis. BF, BV and PS of tumors are higher than that of nuseles, and MTT of tumors are lower than that of mulscles. PS is probable helpful parameter for predicting the prognosis of lung cancer.