非小细胞肺癌靶向治疗前后CT动态增强扫描定量参数的变化特点及临床价值

The changes of quantitative indices and clinical value of dynamic enhanced CT in non-small cell lung cancer before and after targeted therapy

目的 研究非小细胞肺癌靶向治疗前后MSCT动态增强扫描定量参数的变化特点,与传统评价标准进行比较,找出能及时、客观评价靶向治疗效果的参数.方法 搜集21例行靶向治疗的非小细胞肺癌患者,并在治疗前后行CT动态增强扫描,观察病灶动态增强各时相的CT值,根据CT值绘出动态增强曲线,记录强化峰值（PH）、肿块强化达到峰值时间（Tp）,计算肿块与主动脉强化峰值之比（M/A）、灌注值.分别以治疗后PH减小、Tp延长、M/A值减小、灌注值减小为好转标准评价疗效,与病灶最大径变化评价疗效结果进行比较.复查前后参数值的变化采用自身配对t检验,不同参数评价疗效结果的比较采用Kappa检验.结果 21例患者靶向治疗后共CT复查33次,以灌注值变化评价疗效结果（17例次好转,6例次稳定,10例次进展）与以病灶最大径变化评价疗效结果（19例次好转,7例次稳定,7例次进展）一致（U=8.761,P＜0.01）；靶向治疗后好转患者灌注值有降低趋势[治疗前（0.28 ±0.11） ml·min-1·m1-1,治疗后（0.18 ±0.09） ml· min-1·ml-1,t=-3.2722,P=0.0042],进展患者灌注值有增大趋势[治疗前（0.21±0.08） ml·min-1·rnl-1,治疗后（0.34±0.11） ml·min-1·ml-1,t =2.6064,P=0.0403],其变化差异有统计学意义.结论 非小细胞肺癌靶向治疗后,动态增强扫描灌注值的变化与肿瘤最大径的变化一致；通过灌注值的变化可以评价靶向治疗效果.

Objective To investigate the changes of quantitative parameters of dynamic enhanced CT in non-small cell lung cancer before and after targeted therapy,and compare them with the traditional evaluation criteria,in order to find the parameters which can be exploited for timely,objective evaluation of the effect of targeted therapy.Methods The study included 21 patients with targeted therapy who had received dynamic enhanced CT before and after treatment.Enhancement time-density curves were obtained based on the CT values of the lesion at individual time points,and the functional indices：peak height （PH）,the time to peak height （Tp）,the ratio of PH of the mass to aorta （M/A） and perfusion value were calculated.The effects of the treatment on these indices were evaluated and compared with the effect of the treatment on lesion diameter. Results Twenty-one patients had 33 rechecking results. There was a statistically significant agreement between lesion diameter-based treatment evaluation and perfusion-based treatment evaluation （ U =8.761,P 〈 0.01 ）. The perfusion value decreased in patients with disease regression[before treatment：（0.28 ±0.11 ） ml · min-1 · ml-1,after targeted therapy（0.18 ±0.09） ml ·min-1 · ml-1,t =- 3.2722,P =0.0042],but increased in patients with disease progression[before treatment（0.21 ±0.08） ml · min-1 · ml-1,after targeted therapy：（0.34 ±0.11 ） ml · min-1 · ml-1,t =2.6064,P =0.0403].Conclusions On dynamic enhanced CT in non-small cell lung cancer patients after targeted therapy,perfusion value changed in the same trend as the diameter of tumor.The effectiveness of targeted therapy may be evaluated by perfusion value changes.