64排螺旋CT灌注成像技术在直肠癌术前评估中的应用价值

The value of 64-slice spiral CT perfusion imaging in the preoperative assessment of rectal cancer

目的探讨CT灌注成像的各项参数对直肠癌的术前评估价值。方法选经根治性手术治疗且病理证实的30例直肠癌患者为研究对象,所有患者于术前行CT灌注成像扫描,准确记录血容量(blood volume,BV)、强化峰值(peak enhancement image,PEI)、强化峰值达到时间即达峰时间(time to peak,TTP)、血流量(perfusion,PF),并在术后确定pTNM分期,并对TNM分期中各CT灌注参数值进行统计学比较。结果直肠癌组织中的PF、BV明显高于正常组织,差异有统计学意义(均P<0.01),而PEI、TTP的差异无统计学意义(均P>0.05)。在T分期的各组中,PF、TTP、BV的差别有统计学意义(均P<0.01),而PEI的差异无统计学意义(P>0.05);在淋巴结是否转移的分组中,无淋巴结转移组的PF、BV要高于有淋巴结转移组,差异有统计学意义(均P<0.05),TTP及PEI则无统计学差异(均P>0.05)。在是否远处转移各分组中,同时肝转移组的PEI、PF要低于无远处转移组,差异有统计学意义(均P<0.05),TTP、BV则无统计学差异(均P>0.05);肿瘤的分化程度分组中,分化程度越高,其PF、TTP渐次升高,差异有统计学意义(均P<0.05);靶淋巴结灌注的表现为转移淋巴结的PF要多于反应性增生的淋巴结(P=0.000 1),而TTP、BV、PEI无统计学意义(均P>0.05)。结论直肠癌患者CT灌注成像中的各项参数对直肠癌进行术前分期有一定的应用价值,可以使术前分期更加准确,进而采取更合理的治疗策略。

Objective To study the value of 64-slice spiral CT perfusion imaging （CTPI） parameters in the preoperative assessment of rectal cancer. Methods 64-slice spiral CT perfusion imaging was performed in 30 patients with pathologically verified rectal cancer, all patients underwent preoperative CTPI successfully, and the parameters of individual perfusion imaging were recorded accurately, such as blood volume（BV） , peak en- hancement image（ PEI）, time to peak（TIP） and perfusion（ PF）, determined the final pTNM after surgery and then used for statistical analysis. Results PF, BV in rectal cancer tissue were significantly higher than these in normal tissue, and the difference was significant（ P 〈 0.01 ）, but PEI, TIP hadn＇t significant differences（ P 〉 0.05 ）. In T stage, the differences were statistically significant among PF, TTP and BV （ P 〈 0.01 ） , but not PEI（ P 〉 0. 05 ） ; as stage increased, TrP and BV increased, PF decreased; in lymph node metastasis group, PF and BV of lymph node non-metastasis group were more than these in group with lymph node metastasis（P 〈O. 05）, but TIP, PEI made no sense（P 〉 O. 05） ; in distant metastasis group, PEI and PF in liver metastasis group at the same time less than without distant metastases group（P 〈0.05）, not TIP and BV（P 〈0.05 ） ; in group of higher degree of differentiation, PF was more than poorly differentiated tumor, from poor degree to high degree, parameters of PF, TTP gradually increased （P 〈 0.05 ） ;metastasis of lymph nodes had more PF than re- active hyperplasia of lymph nodes, the data was statistically difference （P = 0. 000 1 ）. Conclusions The pa- rameters in cancer patients with CTPI in the preoperative evaluation of rectal cancer has a certain value, make more accurate preoperative evaluation and thus be able to take a more rational treatment strategies.