多层CT灌注技术在鉴别肺占位病变的临床价值

The Clinical Value of Multi-slice CT Perfusion in the Differentiation of Lung Lesions

目的探讨多层CT灌注技术在鉴别肺占位病变中的应用价值。方法前瞻性分析我院自2013年2月-2015年2月收治的92例肺部占位病变患者,其中肺癌58例,病灶直径2-7cm,34例为良性,其中肺结核14例,肺脓肿6例,炎性假瘤2例,非特异性炎症6例,错构瘤4例,曲菌球2例,病灶直径2-5cm,所有病例均行多层CT灌注扫描,图像传输至工作站,应用肿瘤软件包分析,记录病变BV(血容积)、BF(血流量)、PS(表面渗透性)、MTT(平均通过时间),分析多层CT灌注成像在鉴别肺肿瘤病变中的应用价值。结果本组92例肺部占位患者,恶性病变患者灌注参数BF、BV、MTT、PS参数均较良性组高,两组间BV、MTT及PS参数差异有统计学意义(P<0.05),以BV值≥6mg/100g作为恶性病变阈值,则多层CT灌注成像诊断良性组符合率为64.71%,恶性组符合率则达100.00%。若以PS值≥30ml/min·100g作为恶性病变阈值,34例良性肺病变中,30例确诊,符合率为88.24%,4例误诊(肺结核2例,肺脓肿2例),58例恶性病变中,50例确诊,8例误诊,符合率为86.21%。结论恶性肺肿瘤CT灌注参数BV、PS值均高于良性组。多层螺旋CT灌注成像检查,可反映不同性质肺肿瘤病变微血管特征,有利于良恶性肿瘤的鉴别。

Objective To investigate the application value of multi-slice CT perfusion in the differentiation of lung lesions. Methods A total of 92 cases lung lesions patients which admitted into the hospital during February 2013 to February 2015 were prospectively analyzed. Among the objects, 58 cases were lung cancer with the diameter of 2-7cm,34 cases were benign lesions, including pulmonary tuberculosis（14 cases）, lung abscess（6 cases）, inflammatory pseudotumor in（2 cases）, nonspecific inflammation（6 cases）, hamartoma in（4 cases）, and Aspergillus in（2 cases）. The diameters of the lesions were 2 to 5cm. All cases underwent multi-slice CT perfusion scanning and the images were transmitted to the workstation and were analyzed by software package. The BV（blood volume）, BF（blood flow）, PS（surface permeability） and MTT（mean through time） of the lesions were recorded. The application value of multi-slice CT perfusion in the differentiation of lung lesions was analyzed. Results The perfusion parameters like BF, BV, MTT and PS in patients with malignant lesions were significantly higher than those in the benign group, the differences of BV, MTT and PS between the two groups were statistically significant（P〈0.05）. BV value which was equal to or larger than 6mg/100 g was defined as the threshold of malignant lesions. Therefore, the coincidence rate of multi-slice CT perfusion imaging diagnosis in the benign group was 64.71% while in the malignant group was 100.00%. If the PS value which was equal to or more than 30 m L/min·100g was defined as the threshold of malignant lesions, there were 34 30 cases of benign pulmonary lesions which were confirmed as correct,the coincidence rate was 88.24%（30/34）. There were 4 cases misdiagnosed（2 cases of pulmonary tuberculosis and 2 cases of lung abscess）. In the 58 cases of malignant lesions, there were 50 cases diagnosed, 8 cases misdiagnosed and the coincidence rate was 86.21%. Conclusion The BV and PS values in patients with malignant lung tumors were higher than those in the benign group. CT perfusion imaging can reflect the microvascular characteristics of different types of lung tumors, which is helpful to the differentiation of benign and malignant lung tumors, and is worth of promotion.