320排CT双入口灌注参数预测肺癌纵隔淋巴结转移的应用价值

The value of CT dual-input perfusion imaging to predict the mediastinal lymph node metastasis of the lung cancer

目的:探讨肺癌原发灶的双入口技术灌注成像参数与纵隔淋巴结转移的关系及其诊断效能。方法:对61例经术后病理证实的肺癌患者行320排CT灌注成像(CTPI)检查,运用双入口(dual-input,DI)模式对图像进行后处理,采用两独立样本t检验分析纵隔淋巴结转移与肺癌原发灶的DI-CTPI参数的关系,并运用ROC曲线分析DI-CTP参数对肺癌合纵隔淋巴结转移的诊断效能。结果:有淋巴结转移组(27例)支气管动脉血流量(BAF)高于无淋巴结转移组(34例),差异有统计学意义(t=4.173,P<0.001);有淋巴结转移组的灌注指数(PI)低于无淋巴结转移组,差异有统计学意义(t=-3.378,P=0.001);两组肺动脉血流量(PAF)间的差异无统计学意义(P>0.05)。三个参数中,BAF的ROC曲线下面积(AUC)最大(0.773),以BAF>56.42mL/(min·100mL)作为预测肺癌纵隔淋巴结转移的临界值时,敏感度为74.1%,特异度为76.5%;PI的AUC为0.739,以PI<41.57%作为预测纵隔淋巴结转移的临界值时,敏感度为82.4%,特异度为66.7%。结论:肺癌DI-CTPI参数对术前预测肺癌是否发生纵隔淋巴结转移有重要参考价值,从而可为肺癌的术前分期及治疗方案的制定等提供参考。

Objective.. To analyze the relationship between the CT perfusion parameters of lung cancer and the pre- sence of mediastinal lymph node metastasis. Methods..Sixty-one patients with lung cancer confirmed by postoperative patho- logical diagnosis were included in the study. All patients underwent 320-row multidetector CT perfusion imaging of lung, then use the dual-input CT perfusion analysis model was used to calculate the perfusion parameters. The difference of perfu- sion parameters between the group with lymph node metastasis and the group without lymph node metastasis was analyze u- sing independent simple t-test,and receiver-operating characteristic （ROC） curve was used to determine the diagnosis eff- ciency of dual-input perfusion parameters. Results.. Bronchial artery flow （BAF） was higher in the group with lymph node metastasis （27 cases） than that in the group without lymph node metastasis （34 cases）, and the difference was statistically significant （t=4. 173 ,P〈0. 001） ;perfusion index （PI） was lower in the group with lymph node metastasis than that in the group without lymph node metastasis,and the difference was statistically significant （t=-3. 378, P= 0. 001）;and there was no significant difference in the pulmonary artery flow （PAF） between the two groups （P〉0.05）. If setting BAF〉 56.42mL/（min · 100mL） as the critical value of predicting lung cancer with mediastinal lymph node metastasis, the sensi- tivity was 74.1% ,specificity was 76.5% ,and the area under the ROC curve was 0. 773. If setting PI〈41.57% as the criti- cal value of predicting lung cancer with mediastinal lymph node metastasis, the sensitivity was 82. 4%, specificity was 66.7 %, and the area under the ROC curve was 0. 739. Conclusion ： Dual-input CT perfusion imaging can be used as an impor- tant reference index for preoperative diagnosis of lymph node metastasis.