不同病理类型、TNM分期、转移/复发非小细胞肺癌患者双源CT灌注参数的差异及其临床意义

Differences in perfusion parameters of dual-source CT in patients with different pathological types,TNM stages and metastatic-recurrent non-small-cell lung carcinoma and their clinical significance

目的探讨不同病理类型、TNM分期、转移/复发非小细胞肺癌(NSCLC)患者双源CT灌注参数的差异及其临床意义。方法回顾性分析2020年3月至2022年3月郑州中心医院收治的78例NSCLC患者的双源CT灌注成像资料。所有患者均行双源CT灌注扫描,采集图像后进行数据分析。采用单因素方差分析或t检验比较不同类型NSCLC患者双源CT灌注参数的差异,采用受试者工作特征曲线(ROC)分析双源CT灌注参数联合对NSCLC患者病理特征的预测价值。结果肺腺癌患者碘基值(IC)、标准化碘基值(NIC)、血流量(BF)、血容量(BV)、主动脉强化峰值(PEI)均高于肺鳞癌和腺鳞癌患者,肺鳞癌患者IC、NIC、BF、BV、PEI均高于腺鳞癌患者(P<0.05)。中央型肺癌NSCLC患者IC、NIC、BF、BV、PEI均高于周围型肺癌患者(P<0.05)。淋巴结转移NSCLC患者IC、NIC、BF、BV、PEI均低于未发生淋巴结转移患者(P<0.05)。随着分化程度增高,NSCLC患者IC、NIC、BF、BV、PEI逐渐升高(P<0.05)。TNM分期低分期NSCLC患者IC、NIC、BF、BV、PEI高于高分期患者,平均通过时间(MTT)低于高分期患者(P<0.05)。术后转移/复发NSCLC患者IC、NIC、BF、BV、PEI低于未转移/复发者,MTT高于未转移/复发者(P<0.05)。双源CT灌注参数联合预测NSCLC患者病理类型、淋巴结转移、分化程度、TNM分期、术后转移/复发的曲线下面积分别为0.815、0.925、0.766、0.833、0.861。结论NSCLC患者不同病理类型、TNM分期、转移/复发之间双源CT灌注参数存在明显差异,多种双源CT灌注参数联合对NSCLC患者病理类型、淋巴结转移、分化程度、TNM分期、术后转移/复发具有较高的预测价值,利于指导临床治疗及预后评估。

Objective To investigate the difference and significance of dual-source CT perfusion parameters among patients with non-small cell lung cancer(NSCLC)with different pathological types,TNM stages,metastasis and recurrence.Methods The data of dual-source CT perfusion imaging in 78 patients with NSCLC admitted to Zhengzhou Central Hospital from March 2020 to March 2022 were analyzed retrospectively.All patients underwent dual source CT perfusion scanning,and the data were analyzed after the images were collected.One-way analysis of variance or t-test were used to compare the difference of perfusion parameters of dual-source CT in different types of NSCLC patients,receiver operating characteristic curve(ROC)was used to analyze the predictive value of dual-source CT perfusion parameters for pathological characteristics of NSCLC.Results The levels of IC,NIC,BF,BV,PEI were higher in patients with lung adenocarcinoma than those with lung squamous cell carcinoma and lung adenosquamous cell carcinoma,and the levels of IC,NIC,BF,BV,PEI in patients with squamous cell carcinoma of the lung were higher than those in patients with lung adenosquamous carcinoma(P<0.05).The levels of IC,NIC,BF,BV,PEI in patients with central lung cancer were higher than those in patients with peripheral lung cancer(P<0.05).The levels of IC,NIC,BF,BV,PEI in NSCLC patients with lymph node metastasis were lower than those without lymph node metastasis(P<0.05).The levels of IC,NIC,BF,BV and PEI increased with the degree of differentiation(P<0.05).The levels of IC,NIC,BF,BV,PEI were higher in patients with low TNM stage than those in patients with high TNM stage(P<0.05)and the mean transit time(MTT)was lower in patients with low TNM stage than in patients with high TNM stage(P<0.05).The levels of IC,NIC,BF,BV,PEI in patients with metastatic/recurrent NSCLC were lower than those without metastatic/recurrent NSCLC,and MTT was higher than those without metastatic/recurrent NSCLC(P<0.05).The area under the curve of dual-source CT perfusion parameters for predicting different pathological types,lymph node metastasis,differentiation,TNM stage and postoperative metastasis/recurrence were 0.815,0.925,0.766,0.833 and 0.861,respectively.Conclusions The dualsource CT perfusion parameters of NSCLC patients are significantly different among different pathological types,TNM stages,and metastasis/recurrence.The combination of multiple dual-source CT perfusion parameters has high predictive value for the pathological type,lymph node metastasis,differentiation,TNM stage and postoperative metastasis/recurrence of NSCLC,which is conducive to guiding clinical treatment and prognosis evaluation.