CT灌注成像评价乳腺癌腋窝淋巴结状态的临床应用价值  

The clinical application of CT perfusion in assessing the status of axillary lymph nodes in patients with breast cancer

作　　者：刘云[1] 丁英奇[2] 孟海霞[1] 闫少宁[1] 马强[1] 杨利莉[1] 杨蔚[1] 侍明海[1] 平学军[1] 张志远[1] 

机构地区：[1]宁夏医学院附属医院放射科,银川750004 [2]河北北方学院附属第二医院骨科

出　　处：《中华放射学杂志》2008年第6期577-581,共5页Chinese Journal of Radiology

基　　金：国家留学基金委资助项目（2003864019）

摘　　要：目的探讨CT灌注成像（CTP）评价乳腺癌腋窝肿大淋巴结状态的临床应用价值。方法对45例局限浸润性乳腺癌伴有临床可触及同侧腋窝淋巴结肿大患者的46个“靶”淋巴结进行多层螺旋CT（MSCT）动态增强扫描，在静脉内以4．0ml／s流率注射40ml对比剂后，对病灶5mm层厚连续4个层面行同层动态扫描，分别半自动计算“靶”淋巴结及其扫描层面肌肉组织灌注参数值：血流量（BF）、血容量（BV）、平均通过时间（MTT）和表面渗透性（PS），并使用非参数Mann-Whitneyu检验进行统计学分析。结果46个腋窝“靶”淋巴结经术后病理学标本证实为转移性淋巴结32个、阴性14个（均为反应性增生淋巴结炎）。32个转移性“靶”淋巴结中有22个为前哨淋巴结（68％）。阴性和转移性“靶”淋巴结的灌注参数平均值分别为：BF（76．18±31．53）和（161．60±40．94）ml·100mg^-1。·mg^-1；BV（5．81±2．50）和（9．15±3．02）ml／100mg；MTT（6．80±1．55）和（5．50±1．84）s；PS（25．82±4．62）和（25．96±7．47）ml·100mg^-1·min^-1。转移性和阴性“靶”淋巴结BF之间的r=0．14，P〈0．05，BV、MTT和PS之间的r值分别为-0．03、0．05、0．07，P值均〉0．05。结论CTP在形态学基础上增加功能信息可为临床评价淋巴结状态提供有用信息。Objective To evaluate the clinical application of CT perfusion in predicting the status of axillary lymph nodes in patients with breast cancer. Methods Forty-five patients with infiltrating breast cancers and 46 clinically palpable axillary lymph nodes underwent dynamic multi-slice spiral CT（MSCT）. Semi-automatic calculation of perfusion parameters including blood flow （BF） , blood volume （BV） , mean transit time（MTT） and permeability surface（PS） of ＂target＂ lymph nodes and muscles in the same scan level were respectively measured and analyzed. Nonparametric Mann-Whitney U test was used for the statistics. Results Forty-six ＂target＂ lymph nodes examined by CTP were metastasis in 32 cases and reactive hyperplastic lymph node inflammation in 14 cases at pathology. 22 of 32 metastatic ＂target＂ nodes （68%） were sentinel lymph nodes（SLN）. BF of CTP for inflammation and metastatic ＂target＂ nodes were （76. 18±31.53） and （161.60±40.94） ml. 100 mg^-1·min^-1, BVwere （5.81 ±2.50） and （9. 15 ± 3.02） ml/ 100 mg, MTT were （6.80 ± 1.55） and （5.50 ± 1.84） s, PS were （25.82 ±4.62） and （25.96 ± 7.47） ml · 100 mg^-1· min^-1. There were significant correlations between the BF value of inflammation and metastatic ＂target＂ nodes （r = 0. 14, P 〈 0. 05 ） and there were no significant correlations among the BV, MTT and PS values of inflammation and metastatic ＂target＂ nodes （r=-0.03,0.05, 0. 07,P 〉 0. 05 ）. Conclusion CTP can provide useful information for evaluating lymph node status.

关 键 词：乳腺肿瘤 淋巴结 体层摄影术 X线计算机 灌流 

分 类 号：R686[医药卫生—骨科学]