64排螺旋CT多层灌注成像对结直肠癌的临床应用

Application of 64MDCT multislice perfusion imaging in colorectal carcinoma

目的研究结直肠癌（CRC）的64排螺旋CT（64MDCT）灌注成像时间-密度曲线（TDC）及诸参数与肿瘤分期、浆膜浸润、淋巴结及远处转移和CEA等的关系。方法对33例CRC患者进行64MDCT多层灌注成像检查。绘制所选层面靶动脉、靶静脉及肿瘤感兴趣区（ROI）的TDC。CT灌注的参数包括：血流量（BF）、血容量（BV）、平均通过时间（MTT）和表面通透性（PS）。肿瘤按TNM分期，TDC根据形态进行分型。对CT灌注参数与TNM分期、浆膜浸润、淋巴结及远处转移和CEA等诸因素的相关性进行统计学分析。结果CRC的TDC分为5种类型，TNM分期中各期的TDC可表现为5型中的一种或多种。CRC的灌注参数在各期中的差异无统计学意义，BV、MTT与浆膜浸润有关（t=2．63和-2．24，P=0．0137和0．0331），Bv与肿瘤大小存在正相关（r=0．41，P=0．02），BF、MTT与肿瘤分期、浆膜浸润、淋巴结转移、远处转移和CEA等均无关（P〉0．05）。结论MDCT多层灌注成像可反映CRC的血流灌注状况．可能为临床治疗方案提供客观依据。

Objective To study the correlation of time-density curves （TDC）, parameters revealed by 64-multidetector-row CT（64MDCT） perfusion imaging with clinicopathological factors（staging, serosal invasion, lymph node metastasis, distant metastasis and CEA） in colorectal carcinoma （CRC）. Methods 64 MDCT perfusion imaging was performed in 33 patients with pathologically verified CRC. TDC was created from the region of interest （ROI） drawn over the tumor, target artery and vein by 64MDCT with perfusion functional software. The parameters of individual perfusion maps included blood flow （BF）, blood volume（BV）, mean transit time （MTF） and permeability-surface area product （PS）. Tumors were staged according to TMN classification. TDC was classified according to their shapes. The correlation between CT perfusion parameters and ctinieopathological factors was studied. Results TDC of 64MDCT perfusion imaging could be classified into five types. TDC in different stages could demonstrate one or more types of the five types. There was no significant difference of CT perfusion parameters among different stages. BV and MTF were significantly higher in the patients with serosal invasion than in those without serosal invasion（t=-2.63,-2.24, P=0.0137, 0.0331, respectively）. BV was significantly correlated with tumor size（r=0.41, P=0.02）. BF and PS were not correlated with staging, serosal invasion, lymph node metastasis, distant place metastasis and CEA （all P〉0.05）. Conclusions 64MDCT multisliee perfusion imaging can reveal the blood perfusion of CRC and has potential value of clinical application.