摘要
目的:探讨多层螺旋CT灌注在孤立性肺结节(SPN)首过时血流特征及鉴别诊断中的应用价值.方法:对99例直径2~4 cm的SPN先行32层螺旋CT平扫,再行多层同层连续动态增强扫描,在时间-密度曲线(TDC)的基础上,测量SPN增强峰值(PESPN)、病灶同层主动脉的增强峰值(PEAA)、病灶达峰时间(TTP),并由此计算增强净增值(NE)、结节-主动脉强化峰值比(S/A)、灌注量(Pr),进行统计学分析.结果:恶性与炎性SPN的PESPN、NE、S/A和Pr均高于良性SPN(P均〈0.05),其TTP低于良性SPN(P〈0.05);恶性SPN的PESPN、NE、S/A高于炎性SPN(P均〈0.05);恶性结节的Pr高于炎性结节,但二者之间差异无显著性意义(P〉0.05).以NE≥25 HU作为恶性病变的阈值,其敏感度为98.2%,特异度为52.0%,准确度为86.9%,阳性预测值为85.6%,阴性预测值为92.9%.良性、恶性及炎性结节的TDC形态不同.结论:多层螺旋CT灌注成像技术是定量评价SPN血流模式的无创性技术,有助于SPN的鉴别诊断.
Objective: To evaluate the blood flow patterns for first time and the differential diagnostic ability with multi-slice spiral CT perfusion imaging in solitary pulmonary nodules (SPNs). Methods: A study was undertaken in 99 patients with SPNs of 2-4 cm in diameter using 32-slice spiral CT perfusion. The parameters of CT perfusion, including peak enhancement of SPN (PESPN) ,and aorta(PEAA), net enhancement (NE), ratio of peak height of the SPN , and aorta(S/A) and perfusion(Pr), were measured on time-density curve (TDC). The data gathered from average values were analyzed statistically. Results: PESPN, NE, S/A , and Pr of malignant and inflammatory SPNs were significantly higher than those of benign SPNs (all P〈 0.05). PESPN, NE, S/A of malignant SPNs were significantly higher than those of inflammatory SPNs (all P 〈0.05). Pr of malignant SPNs was higher than that of inflammatory SPNs,with no statistic significant differences( P 〉0.05). When NE≥ 25HU was set as the diagnostic threshold, the sensitivity, specificity, accuracy, positive predict value, negative predict value were 98.2%, 52%, 86.9%, 85.6%,92.9%, respectively. The TDC appeared different among the three groups. Conclusion: Multi-slice spiral CT perfusion imaging is a kind of non-invasive method for quantitative evaluation of the blood flow patterns for first time in solitary pulmonary nodules, and is helpful for differential diagnosis of SPNs.
出处
《中国中西医结合影像学杂志》
2010年第4期305-308,315,F0003,共6页
Chinese Imaging Journal of Integrated Traditional and Western Medicine
基金
上海市卫生局重点专科项目(编号:05II025)
关键词
硬币病变
肺
体层摄影术
X线计算机
灌流
Coin lesion, Pulmonary
Tomography, X-ray computed
Perfusion