CT灌注成像结合CT血管造影在缺血性肾脏病诊断中的价值

Value of CT perfusion imaging combined with CT angiography to the diagnosis of ischemic renal disease

目的探讨CT灌注成像结合CT血管造影(CT angiography,CTA)早期诊断缺血性肾脏病变及鉴别病变良、恶性质的价值。方法 72例缺血性肾脏病患者,其中恶性病变22例(恶性组),良性病变50例(良性组),均行CT灌注成像及CTA检查。评定2组图像显示情况;记录病灶感兴趣区内血流量、血容量、渗透率、平均转运时间;与组织病理结果进行对照,计算CT灌注成像结合CTA诊断缺血性肾脏病的准确性、灵敏度与特异度。结果恶性组图像显示良好率(81.8%)与良性组(84.0%)比较差异无统计学意义(P>0.05);恶性组病灶部位血容量[(11.98±6.28)mL/100g]、血流量[(84.67±23.10)mL/(100g·min)]、渗透率[(28.48±11.91)mL/(100g·min)]均低于良性组[(22.46±4.22)mL/100g、(322.10±54.20)mL/(100g·min)、(57.20±6.67)mL/(100g·min)](P<0.05),平均转运时间[(7.46±3.10)s]较良性组[(4.78±1.20)s]长(P<0.05);CT灌注成像结合CTA诊断恶性病变20例,良性病变52例,与组织病理结果进行对照,诊断准确率为97.2%,灵敏度为90.0%,特异度为100.0%。结论 CT灌注成像结合CTA可用于缺血性肾脏病的早期诊断,根据病灶检查参数可对病变良、恶性质作出鉴别诊断。

Objective To evaluate the value of CT perfusion imaging combined with CT angiography（CTA）to the early diagnosis of ischemic renal disease and the differential diagnosis of benign and malignant lesions.Methods Seventy-two patients with ischemic renal disease were divided into 22 patients with malignant lesions（malignant group）and 50 patients with benign lesions（benign group）.All patients received CT perfusion imaging and CTA.The signs of renal lesions were evaluated,and the blood flow,blood volume,permeability rate and mean transit time at region of interest were recorded,and the image results were compared with the histopathologic results.The accuracy,sensitivity and specificity of CT perfusion imaging combined with CTA for diagnosing ischemic renal disease were calculated.Results The good image visualization rate showed no significant difference between malignant group（81.8%）and benign group（84.0%）（P〈0.05）.The values of blood volume（（11.98±6.28）mL/100 g）,blood flow（（84.67±23.10）mL/（100 g·min））and permeability rate（（28.48±11.91）mL/（100 g·min））were significantly lower than those in benign group（（22.46±4.22）mL/100 g,（322.10±54.20）mL/（100 g·min）,（57.20±6.67）mL/（100 g·min））（P〈0.05）,and mean transit time was significantly longer in malignant group（（7.46±3.10）s）than that in benign group（（4.78±1.20）s）（P〈0.05）.CT perfusion imaging combined with CTA diagnosed 20 cases of malignant lesions and 52 cases of benign lesions,with the diagnostic accuracy of 97.2%,the sensitivity of 90.0% and the specificity of 100.0%.Conclusion CT perfusion imaging combined with CTA can be used for early diagnosis of ischemic renal disease,and the parameters can be used for the differential diagnosis of benign and malignant ischemic renal disease.