CT灌注联合能谱成像评价支气管动脉化疗栓塞治疗肺癌患者近期疗效分析

CT perfusion combined with energy spectrum imaging to evaluate the short-term efficacy of bronchial arterial chemoembolization for lung cancer

目的探讨动态容积CT灌注联合能谱成像在经支气管动脉化疗栓塞(BACE)治疗的肺癌患者的近期疗效评价中的价值。方法病例对照研究。回顾性收集2018年1月至2022年2月丽水市中心医院经病理结果证实的31例肺癌行BACE治疗的患者资料,男23例、女8例,年龄31~84岁,平均67岁。所有患者均在术前1周内和术后1个月行病灶部位灌注扫描。基于所有患者的原始图像重建出能谱图像,收集并比较术前、术后灌注参数血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)及能谱参数动脉期CT值(CTA)、静脉期CT值(CTV)、动脉期碘浓度(ICA)、静脉期碘浓度(ICV)、动脉期标准化碘浓度(NICA)、静脉期标准化碘浓度(NICV)等的变化情况,确认灌注参数及能谱参数对评价BACE治疗中晚期肺癌近期疗效的意义。采用SPSS 26.0软件进行统计分析。结果肺癌患者BACE术后1个月的客观缓解率(ORR)为54.8%(17/31),疾病控制率(DCR)为96.8%(30/31)。对经BACE治疗前后患者的CT灌注参数及能谱参数值进行比较,研究结果显示相比治疗前,治疗后BF、BV、MTT、ICA、ICV、NICV均显著下降,差异均有统计学意义[58.06(40.47,87.22)比23.57(10.92,36.24)ml·min^(-1)·100g^(-1),3.33(2.86,6.09)比2.12(1.96,3.61)ml/100g,2.70(2.19,3.88)比1.53(1.12,2.25)s,3.51(3.11,4.14)比1.74(1.26,2.50)mg/ml,2.00(1.30,2.45)比1.32(0.92,1.76)mg/ml,0.51(0.42,0.57)比0.33(0.23,0.39)](均P<0.05)。同时,相比于未缓解组,研究结果显示BACE前后缓解组的各参数变化差值更明显,其中ΔBF、ΔBV、ΔMTT、ΔPS、ΔCTA、ΔCTV、ΔICA、ΔICV、ΔNICA、ΔNICV均显著增大,变化差值均有统计学意义[36.82(32.38,45.34)比9.50(-1.43,12.34)ml·min^(-1)·100g^(-1),4.46(2.52,5.79)比0.22(-0.76,4.09)ml/100g,4.22(2.25,6.77)比0.43(-2.53,1.88)s,10.07(2.89,13.13)比-2.01(-6.77,4.28)ml·min^(-1)·100g^(-1),14.22(11.88,20.57)比4.18(-5.25,6.37)HU,34.6(14.88,43.15)比11.60(0.26,25.05)HU,0.95(0.54,1.47)比0.11(0.20,0.59)mg/ml,1.57(1.10,2.38)比0.26(-0.21,0.63)mg/ml,0.05(0.03,0.08)比-0.02(-0.04,0.01),0.18(0.13,0.21)比0.11(-0.06,0.16)](均P<0.05)。结论CT灌注联合能谱成像能有效的评价中晚期肺癌患者BACE治疗前后肿瘤血管灌注情况的变化,对判断治疗后近期疗效具有重要价值。

Objective To evaluate the clinical value of dynamic volumetric CT perfusion combined with energy spectrum imaging in bronchial arterial chemoembolization(BACE)in patients with lung cancer.Methods The data of 31 patients with lung cancer confirmed by pathology and treated with BACE in Lishui Central Hospital from January 2018 to February 2022 were retrospectively collected,including 23 men and 8 women,aged 31-84(67)years.All patients received perfusion scans of lesion sites within 1 week before surgery and 1 month after surgery.We collected and compared the changes in preoperative and postoperative perfusion parameters such as blood flow(BF),blood volume(BV),mean through time(MTT),permeability surface(PS)and energy spectrum parameters including arterial phase CT value(CTA),venous phase CT value(CTV),arterial phase iodine concentration(ICA),venous phase of iodine concentration(ICV),arterial standardization iodine concentration(NICA),and intravenous standardized iodine concentration(NICV)to confirm the significance of these parameters in evaluating the short-term efficacy of BACE in the treatment of advanced lung cancer.Data normality was tested using the Kolmogorov-Smirnov test and normally distributed measurement data are expressed here as mean±standard deviation;the independent-samples t-test was used for comparisons between two groups.The measurement data that were not normally distributed are expressed as median(interquartile interval)[M(Q1,Q3)],and the comparison between the two groups used the Kruskal-Wallis test.Count data are expressed as cases(%),and comparisons between groups used theχ^(2) test.Results The objective response rate(ORR)and disease control rate(DCR)at 1 month after BACE were 54.8%(17/31)and 96.8%(30/31),respectively.CT perfusion parameters and energy spectrum parameters of patients before and after BACE treatment were compared.The results showed that BF,BV,MTT,ICA,ICV and NICV were significantly decreased after BACE treatment compared with before treatment,and the differences were statistically significant[58.06(40.47,87.22)vs.23.57(10.92,36.24)ml·min^(-1)·100^(-1),3.33(2.86,6.09)vs.2.12(1.96,3.61)ml/100g,2.70(2.19,3.88)vs.1.53(1.12,2.25)s,3.51(3.11,4.14)vs.1.74(1.26,2.50)mg/ml,2.00(1.30,2.45)vs.1.32(0.92,1.76)mg/ml,0.51(0.42,0.57)vs.0.33(0.23,0.39)](all P<0.05).At the same time,compared with the non-remission group,the study results showed that the difference of parameters in remission group before and after BACE was more obvious,includingΔBF,ΔBV,ΔMTT,ΔPS,ΔCTA,ΔCTV,ΔICA,ΔICV,ΔNICA,ΔNICV were significantly increased,and the difference was statistically significant[36.82(32.38,45.34)vs.9.50(-1.43,12.34)ml·min^(-1)·100^(-1),4.46(2.52,5.79)vs.0.22(-0.76,4.09)ml/100g,4.22(2.25,6.77)vs.0.43(-2.53,1.88)s,10.07(2.89,13.13)vs.-2.01(-6.77,4.28)ml·min^(-1)·100^(-1),14.22(11.88,20.57)vs.4.18(-5.25,6.37)HU,34.6(14.88,43.15)vs.11.60(0.26,25.05)HU,0.95(0.54,1.47)vs.0.11(0.20,0.59)mg/ml,1.57(1.10,2.38)vs.0.26(-0.21,0.63)mg/ml,0.05(0.03,0.08)vs.-0.02(-0.04,0.01),0.18(0.13,0.21)vs.0.11(-0.06,0.16)](all P<0.05).Conclusions CT perfusion combined with spectral imaging could effectively evaluate the changes in tumor vascular perfusion in patients with advanced lung cancer before and after BACE treatment,which has important value in judging the short-term efficacy after treatment.