双入口CT灌注评价肺腺癌和肺鳞癌血供特征

Assessment of bronchial and pulmonary blood supply in lung adenocarcinoma and squamous cell carcinoma using dual-input perfusion CT

目的探讨双入口CT灌注成像技术分析肺腺癌和肺鳞癌血供特征的价值。方法对40例原发性肺癌患者行胸部容积CT灌注扫描,进行双入口灌注图像后处理分析,由2名高年资医师单独测量记录肺部癌性肿块的支气管动脉灌注血流量(BF)、肺动脉灌注血流量(PF)、肺动脉灌注指数[PI;PI=PF/(PF+BF)]及肿块体积、位置。比较肺腺癌与肺鳞癌、中央型肺癌和周围型肺癌各灌注参数值之间的差异。分析肿瘤体积与各CT灌注参数值之间的相关性。采用组内相关系数(ICC)分析观察者间一致性。结果 40例肺癌患者的PF为(54.26±21.07)ml/(min·100ml),BF为(64.41±22.06)ml/(min·100ml),PI为(43.38±16.07)%。其中肺腺癌23例、肺鳞癌17例,腺癌的PI小于鳞癌(t=-2.196,P=0.034)。周围型肺癌17例,中央型23例。周围型肺癌的PI高于中央型肺癌(t=2.305,P=0.027)。肺腺癌与肺鳞癌、中央型肺癌和周围型肺癌之间PF与BF的差异均无统计学意义(P均>0.05)。肿瘤体积与肺癌的PI呈负相关(r=-0.39,P=0.01)。2名医师测量病灶的PF、BF、PI的一致性良好,ICC分别为0.97、0.93、0.91。结论双入口CT灌注技术可用于评价不同组织类型和位置肺癌的血供特征,肺癌的PI与肿瘤的大小及位置有关。

Objective To evaluate the dual blood supply of lung adenocarcinoma and squamous cell carcinoma using dualinput perfusion CT.Methods A total of 40 patients confirmed with lung cancer pathologically underwent CT perfusion（CTP）scanning.The pulmonary flow（PF）,bronchial flow（BF）,perfusion index（PI,PI=PF/[PF＋BF]）and tumor volume,location were measured and recorded by 2 experienced radiologists.The differences in CTP parameters between lung adenocarcinomas and squamous cell carcinomas,the central lung cancers and peripheral lung cancers were analyzed.The correlation between the tumor volume and CTP parameters was analyzed.Interobserver agreements were assessed with intraclass correlation coefficient（ICC）.Results The average of PF,BF and PI of all 40 cases was（54.26±21.07）ml/（min·100ml）,（64.41±22.06）ml/（min·100ml）and（43.38±16.07）%,respectively.Tumor histology was consistent with adenocarcinomas in 23 cases and squamous cell carcinomas in 17 cases,lung adenocarcinomas showed lower PI than that of squamous cell carcinomas（t=-2.196,P=0.034）.There were 17 peripheral lung cancers and 23 central lung cancers,and the PI of the peripheral lung cancers was higher than that of the central lung cancer（t=2.305,P=0.027）.No statistically significant differences were found for BF and PF between two types of lung cancers and central lung cancers and the peripheral cancers（all P〉0.05）.Tumor volume was negatively associated with PI（r=-0.39,P=0.01）.Good agreement was found between the two observers,the ICC for BF,PF and PI was 0.97,0.93 and 0.91,respectively.Conclusion Dual-input CTP technique can be used to evaluate the differences of blood supply between different pathological types and locations of lung cancer,with PI depending both on tumor size and location.