多层螺旋CT平扫及灌注扫描对肺癌放疗疗效的评估价值

Value of plain and perfusion scan of multi-slice spiral CT in evaluating the curative effect of radiotherapy for lung cancer

目的探讨多层螺旋CT平扫及灌注扫描对肺癌放疗疗效的评估价值。方法选择80例接受单纯放疗的肺癌患者为研究对象,所有患者均于放疗前1周内及放疗后2个月行胸部CT平扫及灌注扫描,测量病灶最大径线以及灌注参数,包括血容量(BV)、血流量(BF)、增强峰值(PH)、平均通过时间(MTT)及表面通透性(PS)。放疗2个月后对患者的临床疗效进行评估,分为完全缓解(CR)、部分缓解(PR)、疾病稳定(SD)和疾病进展(PD),以CR+PR+SD为有效组,PD为无效组,比较放疗前及放疗后2个月有效组和无效组病灶的灌注参数。结果放疗后2个月,CT测量病灶最大径线为(3.16±1.04)cm,小于放疗前的(3.56±1.23)cm,差异有统计学意义(P﹤0.05)。放疗后2个月病灶的BV和BF均明显低于放疗前,差异均有统计学意义(P﹤0.01)。放疗后2个月有效组病灶的BV和BF均低于放疗前,且均低于同时间点无效组,差异均有统计学意义(P﹤0.05)。结论评估肺癌的放疗疗效时,CT平扫仅能够提示肿瘤径线的变化,而CT灌注扫描则能够通过灌注参数反映肿瘤微循环的变化,放疗后BF及BV指标的改变较为显著。

Objective To explore the value of plain and perfusion scan of multi-slice spiral CT in evaluating the curative effect of radiotherapy for lung cancer. Method A sum of 80 patients with lung cancer treated by radiotherapy alone were included in the research. All patients underwent chest CT plain scan and perfusion scan within 1 week before radiotherapy and 2 months after radiotherapy. The maximum diameter of the lesions were measured, and the related parameters including blood volume (BV), blood flow (BF), peak height (PH), mean transit time (MTT) and permeable surface (PS) were determined. In 2 months after radiotherapy, clinical efficacy was evaluated as complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD), and accordingly CR+PR+SD were stratified as response group, while PD was included as non-response group, besides, the perfusion related parameters before radiotherapy and 2 months after radiotherapy in the two groups were compared. Result Two months after radiotherapy, the maximum diameter of the lesions measured by CT was (3.16±1.04) cm, and was decreased significantly compared with that before radiotherapy at (3.56±1.23) cm, with statistically significant difference observed (P<0.05). Two months after radiotherapy, the BV and BF decreased significantly compared with that before radiotherapy, with statistically significant difference observed (P<0.01). Both the BV and BF in response group exhibited significant decreased in 2 months after radiotherapy, and was lower than that in non- response group, with statistically significant difference noted (P<0.05). Conclusion When evaluating the efficacy of radiotherapy for lung cancer, CT plain scan can only present the change of tumor diameter, while CT perfusion scan could reflect the variation of microcirculation through perfusion parameters, additionally, BF and BV may alter markedly after radiotherapy.