64排螺旋CT多期增强扫描联合血管成像对肺内肿块的诊断价值

The value of 64-row helical CT multi-phase enhancement scan combined with angiography in the diagnosis of pulmonary mass

目的探讨64排螺旋CT多期增强扫描联合血管成像(CTA)对肺内肿块的诊断价值。方法对265例经病理检查确诊的肺内肿块患者行64排螺旋CT多期增强扫描及CT血管成像,分析CT各个扫描期征象特点和CTA对肺内肿块血供的显示。结果肺癌主要由支气管动脉(BA)供血,部分可由体动脉供血,肺癌组供血动脉显示率显著高于良性病变组(P<0.05)。肺癌组CT增强峰值显著大于结核球组、炎性假瘤组及错构瘤组(P<0.05),但与血管瘤组比较差异无统计学意义(P>0.05)。肺癌组与良性病变各组的增强动态曲线不同:肺癌组增强扫描后在肺动脉期无明显强化,主动脉期CT值迅速升高,120s形成强化高峰,延迟期缓慢下降;结核球组增强扫描后CT值缓慢上升,无明显峰值出现;炎性假瘤组增强扫描后在肺动脉期CT值逐渐升高,90s左右出现高峰;错构瘤组强化不明显;血管瘤增强扫描后在肺动脉期迅速强化,在15s左右达高峰,然后缓慢下降。结论64排螺旋CT多期增强扫描联合血管成像能有效鉴别肺内肿块的良、恶性,具有重要的临床价值。

Objective To explore the value of 64-row helical CT multi-phase enhancement scan combined with angiography （CTA） in the diagnosis of pulmonary mass. Methods Two hundred and sixty-five patients with pulmonary mass confirmed by pa- thology were checked,analyzed the CT sign of multi-phase enhancement scan and the blood supply of pulmonary mass displayed by CTA. Results Lung cancer was mainly supplied by bronchial arteries, some by body arteries,the feeding arteries display rate of lung cancer group was significantly higher than that of benign disease group（P〈0.05）. CT enhancement peak value of lung cancer group was significantly higher than that of tuberculoma group,inflammatory pseudotumor group and hamartoma group（P〈0.05）, but no significant difference between hemanginoma group（P〉0.05）. Enhancement dynamic curves of lung cancer group was differ- ent from benign lesion groups：Lung cancer without obvious enhancement in pulmonary artery phase,CT value increased rapidly in aorta phase, 120 s reached peak,and declined slowly in delay phase;CT value of tuberculoma was increased slowly without obvious peak;CT value of inflammatory increased gradually in pulmonary artery phase, 90 s reached the peak; hamartoma was no obvious enhancement; Hemangioma enhanced rapidly after strengthening in the pulmonary artery phase, reached the peak at about 15 s,and then decreased slowly. Conclusion 64-row helical CT multi-phase enhancement scan combined with angiography have important clinical value, which can differentiate malignant mass from benign ones.