CT灌注参数变化预测局部晚期非小细胞肺癌同步放化疗敏感性的价值

A preliminary study on the prediction value of CT perfusion indexes in predicting concurrent chemoradiotherapy sensitivity in patients with non-small cell lung cancer

目的探讨CT灌注成像在预测非小细胞肺癌同步放化疗疗效中的应用价值。方法选取接受同步放化疗的非小细胞肺癌患者31例,分别于治疗同步放化疗前对患者进行CT增强扫描,并对局部病灶进行CT灌注,记录CT灌注相关参数,依据实体瘤疗效评价标准,患者分为敏感组(n=22)和不敏感组(n=9)。分析2组患者治疗前血流量(blood flow,BF)、血容量(blood volume,BV)、表面透过性(permeability surface,PS)的变化,探讨影响同步放化疗疗效的因素。结果根据CT灌注成像评价同步放化疗疗效,同步放化疗敏感组的BF为(82.5±1.8)ml·min^(-1)·100 g^(-1),而同步放化疗不敏感组的BF为(74.6±2.6)ml·min^(-1)·100 g^(-1);差异有统计学意义(P=0.02);BV分别为(10.9±0.5)ml/100 g和(9.0±0.6)ml/100 g,差异有统计学意义(P=0.03);PS分别为(15.9±0.5)ml·min^(-1)·100 ml^(-1)和(11.8±1.0)ml·min^(-1)·100 ml^(-1),差异有统计学意义(P=0.001);肿瘤最大直径分别为(4.9±1.1)cm和(5.4±1.7)cm,差异无统计学意义(P=0.232)。多因素Logistic回归分析结果显示PS是影响同步放化疗敏感性的独立因素。结论 CT灌注成像有助于预测局部晚期非小细胞肺癌同步放化疗的疗效。

Objective To explore the application value of CT perfusion imaging in predicting the therapeutic effects of concurrent chemoradiotherapy on non-small cell lung cancer（ NSCLC）. Methods Thirty-one patients with NSCLC who underwent CT perfusion before concurrent chemoradiotherapy in our hospital from March 2013 to July 2016 were enrolled in the study. All the patients were divided into sensitive group（ n = 22） and non-sensitive group（ n = 9） according to the efficiency of concurrent chemoradiotherapy. The indexes including blood flow（ BF）,blood volume（ BV）,permeability surface（ PS）were observed and compared between two groups to analyze the factors influencing the therapeutic effects of concurrent chemoradiotherapy. Results The levels of BF,BV and PS in sensitive group were significantly higher than those in non-sensitive group（ P〈 0. 05）. The maximum diameter of tumors was not correlated with therapeutic effects of concurrent chemoradiotherapy（ P 〉0. 05）. Multivariate Logistic regression analysis showed that PS was independent factors influencing sensitivity of concurrent chemoradiotherapy in patients with NSCLC. Conclusion CT perfusion imaging is helpful to predict the therapeutic effects of concurrent chemoradiotherapy on NSCLC.