320排CT双入口体部灌注成像对肺内单发性炎性假瘤与周围型肺癌鉴别诊断价值

Differential diagnosis of single inflammatory pseudotumor and peripheral lung cancer with 320-slice CT dual-input perfusion imaging

目的探讨320排CT双入口体部灌注成像对单发肺炎性假瘤与周围型肺癌的鉴别诊断价值。方法回顾性分析经病理证实周围型肺癌52例(腺癌28例、鳞癌24例)及炎性假瘤21例,应用CT体部双入口灌注成像获得肺动脉血流量(PF)、支气管动脉血流量(BF),计算灌注指数(PI)和灌注总量(TLP),根据拟合时间-密度曲线获得强化达峰时间(TTP),分析鳞癌、腺癌与炎性假瘤间的差异,评价其诊断炎性假瘤与周围型肺癌的价值。结果鳞癌、腺癌与炎性假瘤间PF、TTP总体差异均有统计学意义(P均<0.01)。炎性假瘤与周围型肺癌间PF、TLP、TTP差异均有统计学意义(P均<0.01)。TTP诊断肺癌与炎性假瘤的AUC为0.99(P<0.01),诊断价值高;以TTP=16.3s作为临界值,敏感度为100%,特异度为95.0%;PF和TLP的AUC分别为0.76(P<0.01)和0.71(P<0.01),诊断价值中等。结论炎性假瘤和周围型肺癌均由肺动脉、支气管动脉双重供血;TTP有助于二者的鉴别诊断。

Objective To explore the value of dual-input perfusion imaging (DI-CTP) in differential diagnosis of single inflammatory pseudotumor and peripheral lung cancer with 320-slice CT. Methods Totally 52 patients with single pathological proved peripheral lung cancer (28 with adenocarcinoma, 24 with squamous cell carcinoma) and 21 patients with inflammatory pseudoaneurysm were enrolled. Pulmonary artery flow (PF) and bronchial artery flow (BF) were obtained, the perfusion index (PI) and total perfusion (TLP) were calculated. Time-density curve was obtained from DI-CTP, and the enhanced time to peak (TTP) were calculated. The above indexes were analyzed among squamous cell carcinoma, adenocarcinoma and inflammatory pseudotumor, and their values in differential diagnosis of peripheral lung cancer and inflammatory pseudotumor were evaluated. Results There were significant differences of PF and TTP among squamous cell carcinoma, adenocarcinoma and inflammatory pseudotumor (all P <0.01), also of PF, TLP and TTP between inflammatory pseudotumors and peripheral lung cancer (all P <0.01). AUC of TTP was 0.99 ( P <0.01), which had high diagnostic value. Taken TTP=16.3 s as the critical value, the sensitivity and specificity in predicting inflammatory pseudotumors and peripheral lung cancer was 100% and 95.0%, respectively. AUC of PF and TLP was 0.76 ( P <0.01) and 0.71 ( P <0.01), respectively, which had moderate diagnostic value. Conclusion Inflammatory pseudotumor and peripheral lung cancer both have pulmonary artery and bronchial artery blood supply. TTP is helpful to differential diagnosis of inflammatory pseudotumor and peripheral lung cancer.