全器官CT灌注成像评价胰腺癌微循环的价值

Evaluation of Microcirculation of Pancreatic Carcinoma Using Whole Organ CT Perfusion Imaging

目的应用低剂量全器官动态容积CT对胰腺组织进行灌注成像,并分析不同疾病的灌注差异,为全器官CT灌注成像的临床应用提供依据。资料与方法采用640层容积CT对28例拟诊为胰腺疾病的患者行胰腺CT灌注成像。在团注对比剂时同步采集数据,应用灌注软件对所得容积数据进行空间对位配准及灌注分析,采用最大斜率法获取感兴趣区的时间-密度曲线、血流灌注图、组织动脉血流量等。结果 28例患者中,胰腺癌10例;急性胰腺炎6例,其中1例伴胰头坏死灶形成;慢性胰腺炎3例,其中1例伴假囊肿形成;正常胰腺9例。正常胰腺组织动脉血流量为(117.04±12.05)ml(/min100ml),胰腺炎症组织为(118.67±37.18)ml(/min100ml),胰腺癌组织为(67.16±18.94)ml/(min100ml),三组差异有统计学意义(F=8.59,P<0.001);胰腺癌组与正常胰腺组及胰腺炎组间差异有统计学意义(q=3.70,P<0.05),且血流灌注图中可以明确显示该差异;正常胰腺组与胰腺炎组间差异无统计学意义(q=2.91,P>0.05)。扫描全过程X线总剂量为21.5～23.9mSv。结论低剂量胰腺全器官CT灌注扫描可以定量分析胰腺疾病的血流动力学改变,对评价胰腺癌诊疗过程中微循环的改变具有重要价值。

To analyze the perfusion differences of different pancreatic diseases using the low-dose whole organ dynamic volume CT perfusion imaging, and to provide the evidence tbr the clinical application. Materials and Methods Twenty-eight patients suspected as pancreatic disease were applied by 640 layer volume CT perfusion imaging for the pancreas. Data were collected at the same time of bolus injection of contrast agent, then were analyzed by spatial alignment and perfusion calculation using the perfusion software. The time-density curve, blood perfusion flow diagram and tissue artery blood flow were obtained using the maximum slope method. Results Normal pancreatic tissue （n=9） blood flow was （117.04±12.05） ml/（min-100 ml）, pancreatitis organizations （6 cases with acute pancreatitis and 3 cases with chronic pancreatitis） （118.67±37.18） ml/ （rain.100 ml）, pancreatic carcinoma tissue （n=10） was （67.16±18.94） ml/（min.100 ml）. There was significant difference among three groups （F=8.59, P〈0.001）; the difference was demonstrated in pancreatic cancer vs. normal pancreas and pancreatic cancer vs. pancreatitis group （q=3.70, P〈0.05）, which could be clearly demonstrated by blood perfusion flow diagram. The difference was not statistically revealed pancreatitis and normal pancreas group （q=2.91, P〉0.05）. The total dose of X-rays in the whole scanning process was 21.5-23.9 mSv. Conclusion Low-dose whole pancreas organ CT perfusion scan can quantitatively analyze the hemodynamic changes in pancreatic disease, which be of great value for evaluating changes in microcirculation during the treatment of pancreatic cancer.