CT双输入模型低剂量容积灌注成像对肺孤立性炎性假瘤的诊断价值

Value of Dual-Input Volume CT Low-Dose Perfusion Imaging in the Diagnosis of Isolated Lung Inflammatory Pseudotumor

目的探讨CT双输入模型低剂量容积灌注成像对肺孤立性炎性假瘤的诊断价值。方法选取经手术或穿刺病理检查证实的肺孤立性、直径范围2.0~5.0 cm炎性假瘤22例和周围型肺癌38例,均行CT双输入模型低剂量容积灌注成像,分析肺孤立性炎性假瘤和周围型肺癌血供情况,比较二者强化达峰时间(TTP)和灌注参数肺动脉血流量(PF)、支气管动脉血流量(BF)、灌注指数(PI),并应用受试者工作特征(ROC)曲线分析TTP和灌注参数鉴别诊断肺孤立性炎性假瘤与周围型肺癌的价值。结果肺孤立性炎性假瘤由肺动脉和支气管动脉较均衡供血,PF(50.71±19.02)ml/min,BF(42.13±21.27)ml/min,二者比较差异无统计学意义(P>0.05);PI(44.04±10.49)%。周围型肺癌由肺动脉和支气管动脉双重供血,PF(68.67±34.75)ml/min高于BF(48.26±24.31)ml/min,差异有统计学意义(P<0.05);PI(54.50±15.74)%。肺孤立性炎性假瘤患者TTP短于周围型肺癌患者,PF和PI低于周围型肺癌患者,差异有统计学意义(P<0.05或P<0.01)。TTP鉴别诊断肺孤立性炎性假瘤与周围型肺癌的曲线下面积(AUC)为0.93,诊断价值较高,当TTP 18.06 s作为预测肺良恶性结节的临界值时,敏感度为97.6%,特异度为92.3%;PF和PI鉴别诊断肺孤立性炎性假瘤与周围型肺癌的AUC分别为0.71和0.70,诊断价值中等。结论CT双输入模型低剂量容积灌注成像TTP有助于提高肺孤立性炎性假瘤与周围型肺癌的鉴别诊断价值。

Objective To evaluate the diagnositic value of the dual-input volume CT low-dose perfusion imaging in isolated lung inflammatory pseudotumor of the lung(IPL).Methods All isolated pulmonary nodules with a diameter range of 2.0-5.0 cm confirmed by pathology or puncture pathology(22 cases of inflammatory pseudotumor and 38 cases of peripheral lung cancer)were analyzed by dual-input volume CT low-dose perfusion imaging.The blood supply of inflammatory pseudotumor and peripheral lung cancer was analyzed,respectivley.Time to peak enhancement(TTP),and the perfusion index pulmonary flow(PF),bronchial flow(BF)and perfusion index(PI)were compared.The receiver operating characteristic(ROC)curve was used to analyze the value of TTP and perfusion indexs in differential diagnosis of inflammatory pseudotumor and peripheral lung cancer.Results The inflammatory pseudotumor was supplied by the balanced pulmonary artery and bronchial artery,and there was no significant difference in PF(50.71±19.02)ml/min and BF(42.13±21.27)ml/min(P>0.05).The PI was(44.04±10.49)%.Peripheral lung cancer was supplied by both pulmonary artery and bronchial artery,the PF(68.67±34.75)ml/min was higher than BF(48.26±24.31)ml/min(P<0.05)and the PI was(54.50±15.74)%.The TTP of isolated inflammatory pseudotumor was significantly lower than that of peripheral lung cancer,and the PF and PI were also lower than those of peripheral lung cancer(P<0.05 or P<0.01).The area under curve(AUC)of TTP was 0.93 for differential diagnosis of solitary inflammatory pseudotumor and peripheral lung cancer,which had a higher diagnostic value.When TTP=18.06 s was used as the cut-off value for predicting benign and malignant nodules,the sensitivity and specificity were 97.6%and 92.3%respectively.The AUC of PF and PI for differential diagnosis of solitary inflammatory pseudotumor and peripheral lung cancer was 0.71 and 0.70 respectively,showing a moderate diagnostic value.Conclusion TTP of dual-input volume CT low-dose perfusion imaging was helpful to improve the differential diagnosis between inflammatory pseudotumor and peripheral lung cancer.