CT灌注参数变化对肺癌化疗早期疗效的观察与评估

Perfusion CT in assessing the early efficacy of the chemotherapy of lung cancer

目的:探索肺癌患者化疗前、化疗后早期CT灌注参数的变化与疗效的相关性。方法:收集病理证实的初治肺癌常规化疗患者25例。化疗前1周内CT检查与化疗后90～100 d的CT平扫结果进行比较,根据RECIST标准分成缓解组与未缓解组。化疗前1周内及化疗后21 d行两次CT灌注扫描,比较化疗前、化疗后早期CT灌注参数的变化与化疗疗效的关系。结果:25例患者中缓解组15例,非缓解组10例。在25例患者中,化疗前与化疗后早期病灶大小进行比较,均未见明显变化;化疗前及化疗后早期CT各灌注参数在两组中均有变化。缓解组血容量(BV)参数值化疗前后分别为(71.0±20.4)mL/1 000 mL和(49.8±31.4)mL/1 000 mL,t值2.558,P值0.023;Patlak血容量(PBV)参数值化疗前后分别为(73.1±34.1)mL/1 000 mL和(45.2±19.0)mL/1 000 mL,t值3.325;P值0.005,两者均具有统计学意义,并可见两种参数呈下降趋势。未缓解组BV参数值化疗前后分别为(50.4±61.0)mL/1 000 mL和(120.5±15.7)mL/1 000 mL,t值-3.062,P值0.016;PBV参数值治疗前后分别为(38.0±9.3)mL/1 000 mL和(62.0±38.3)mL/1 000 mL;t值-2.471;P值0.036,差异同样具有统计学意义,并呈上升趋势。进行分组对照BV和PBV缓解率的χ2检验后验证BV升高组和降低组缓解率差异无统计学意义,PBV升高组与下降组缓解率差异有统计学意义,PBV降低组缓解率高于PBV升高组。结论:化疗后早期病变大小较化疗前均无明显变化;CT灌注参数在化疗后早期的变化,对肺癌化疗后早期疗效的评估有一定的价值。

Objective： To observe the changes of parameters in perfusion CT before and after chemotherapy for patients with lung cancer and its relationship with the efficacy of treatment. Methods： Twenty-five patients were enrolled into the study who were pathologically diagnosed as lung cancer and would undergo conventional chemotherapy for lung cancer. According to RECIST criteria, the patients were divided into remission group and no-remission group. Each patient underwent two perfusion CT scans respectively within a week before and about 90±100 days after chemotherapy. The relationship of parameters changes before and after earlier chemotherapy and the efficacy of chemotherapy was studied. Results： Among the 25 cases, 15 cases had remission and the other 10 cases without remission. For all the 25 patients, the changes of tumor size in the two groups were not significant before and after chemotherapy（with an average interval of 21 days）, but the changes of BV and PBV was statistically significant（in the remission group, BV and PBV before and after treatment were （71.0±20.4）mL/1 000 mL, （49.8±31.4） mL/1 000 mL; （73.1±34.1） mL/1 000 mL, （45.2±19.0） mL/1 000 mL; t values of 2.558 and 3.325; P values of 0.023 and 0.005, and the two parameters showed a downward trend. In the group without remission, BV and PBV before and after treatment were （50.4±61.0） mL/1 000 mL, （120.5±15.7） mL/1 000 mL; （38.0±9.3） mL/1 000 mL, （62.0±38.3） mL/1 000 mL; t value of -3.062, -2.471; P value 0.016, 0.036, upward trend）. The relativity of the remission rate and the parameters of BV or PBV group X^2 test revealed： regardless of whether the parameter values increased or decreased, the changes of BV and effica- cy of chemotherapy were not statistically significant. The changes of PBV correlated well with the effects of chemotherapy. The remission rate of group with reduced PBV was higher than that of the elevated one. Conclusion： No obvious change of size is observed between the lesions before and after chemotherapy in early stage. The changes of the perfusion CT parameters in the early stage after chemotherapy have potential application in predicting the efficacy of chemotherapy in the treatment for lung cancer.