利用CT灌注成像研究转移性肺癌的血供  

Using perfusion CT to evaluate blood supply of pulmonary metastases in vivo

作　　者：吴安乐[1] 周康荣[1] 颜志平[1] 王建华[1] 

机构地区：[1]复旦大学附属中山医院放射科上海市影像医学研究所

出　　处：《中华放射学杂志》2007年第4期366-370,共5页Chinese Journal of Radiology

基　　金：卫生部博士点基金(9741)

摘　　要：目的利用 CT 灌注成像观察转移性肺癌的血供。方法选取符合入选标准的肺部转移瘤患者19例,通过 DSA 导引下分别行支气管动脉和选择性肺动脉插管,插管后将患者平移至多层螺旋 CT(MSCT)下分别行转移瘤的双导管增强的同层动态螺旋 CT 扫描,其中支气管动脉内对比剂流率为1.5 ml/s,总量6～8 ml,肺动脉导管内对比剂流率3 ml/s,总量40 ml,2次扫描间隔为10 min。扫描后采用功能 CT 软件分别在转移瘤内选取3个不同感兴趣区,即高强化区、低(不)强化区和整个瘤体区进行灌注值和高峰强化值(PEI)测量,并描绘时间-密度曲线,同时测量转移瘤最大直径。结果经肺动脉和支气管动脉途径增强后肿瘤结节灌注值分别是133.70(29.00～346.75)和2.30(0～24.25)ml·min^(-1)·ml^(-1),两者间差异具有统计学意义(Z=-6.281,P<0.01);PEI 值分别是100.00(20.75～428.60)和11.30(1.05～26.00)HU,差异也有统计学意义(Z=-5.776,P<0.01)。3个不同感兴趣区的肿瘤结节,经两种不同途径增强后灌注值和 PEI 值间差异均具有统计学意义(P<0.05);经肺动脉和经支气管动脉途径增强后灌注值与肿瘤结节直径均无相关关系(r 值分别为-0.167和0.104,P>0.05),而经肺动脉和经支气管动脉途径增强后肿瘤结节 PEI 值与结节直径均呈正相关(r 值分别为0.421和0.405,P<0.05)。结论转移性肺癌血供主要来自于肺动脉,同时支气管动脉也参与了肿瘤的血供,随着肿瘤的不断增大,肺动脉和支气管动脉血供均不断增多。功能CT 为活体状态下评价肺部转移瘤的肿瘤血管生成提供了良好的研究途径。Objective Using perfusion CT to evaluate blood supply of pulmonary metastases in vivo. Methods Nineteen patients were enrolled in this study according to inclusive criteria. Selective bronchial arterial catheterization and superselective pulmonary arterial catheterization were carried out simultaneously in each patient under digital subtraction angiography （DSA） guidance before CT scan, respectively. And then patients were moved to multi-slice spiral CT （MSCT） scanner. During breathhold, single location dynamic CT sequences were performed to acquire contrast enhancement imaging in pulmonary metastasis at a rate of 1.5 ml/s and total amount of 6-8 ml contrast medium by bronchial arterial catheter infusion firstly, then ten minutes later at a rate of 3 ml/s and total amount of 40 ml contrast material through pulmonary arterial catheter infusion. Density-time curves were evaluated from three different regions of interest （ROI） in each patient： a large ROI comprising the whole tumor area and two smaller ROIs placed over the area with the highest and lowest enhancement, respectively. Perfusion and peak enhancement index （PEI） were calculated using perfusion CT software retrieved from MSCT instrument in each patient, and the largest diameter was measured through axial CT images. Results Values of Perfusion of metastasis through pulmonary arterial enhancement was significantly higher than that through bronchial arterial enhancement 133.70（29. 00-346. 75）vs 2. 30（0-24. 25） ml · min^-1 ml·^-1. There was significant difference in PEI between pulmonary arterial enhancement and bronchial arterial enhancement 100. 00 （ 20. 75-428. 60 ） vs 11.30 （ 1.05w26. 00） HU as well. Values of perfusion and PEI measured from the three ROIs through pulmonary enhancement were significantly larger than those obtained through bronchial artery enhancement, respectively （ P 〈 0. 05 ） . Perfusion was not correlated with tumor diameter under the two different enhancement patterns （ P 〉 0. 05 ）. The

关 键 词：肺肿瘤 肿瘤转移 支气管动脉 肺动脉 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]