CT灌注成像对孤立性肺结节的定性诊断价值  

CT perfusion imaging in differential diagnosis of solitary pulmonary nodules

作　　者：夏春华 季亚莉[1,2] 高斌 胡永胜[1,2] 黄永翠 徐宁[1,2] 

机构地区：[1]安徽医科大学第三附属医院 [2]合肥市第一人民医院影像中心,合肥230061

出　　处：《放射学实践》2011年第3期290-294,共5页Radiologic Practice

基　　金：安徽省国际合作项目基金资助(09080703021)

摘　　要：目的:探讨多层螺旋CT灌注成像(CTPI)在孤立性肺结节良恶性鉴别诊断中的临床应用价值。方法:直径≤3 cm的SPN患者35例(其中恶性结节25例,良性结节10例)进行前瞻性CT灌注成像研究,先行全肺层厚为10 mm螺旋CT扫描,然后对病灶进行灌注扫描。选择同层面主动脉为灌注动脉,分别测得SPN的血流量(BF)、血容量(BV)、平均通过时间(MTT)和表面通透性(PS)并拟合时间-密度曲线(TDC),结合增强前后SPN的形态学指标进行综合分析。结果:恶性结节的BF、BV、MTT和PS值分别为(146.17±58.77)ml/100 mg、(6.45±1.38)ml/(100g.min)、(5.09±3.19)s和(16.33±6.62)ml/(100g.min),良性结节的BF、BV、MTT和PS值分别为(69.90±58.09)ml/100 mg、(3.88±1.81)ml/(100g.min)、(4.06±1.77)s、(6.18±3.55)ml/(100g.min)。良、恶性SPN的TDC类型不同,恶性SPN的TDC可见A、B、C三型,其中以A型和C型为主(21/25,84.0%);良性SPN的TDC以D型(无明显强化型)为主。良、恶性SPN的增强峰值、增强净增值比较差异有统计学意义(P<0.05);而良、恶性结节的平扫CT值差异无统计学意义(P>0.05);以净增值≥25 HU为诊断恶性结节的阈值,其敏感度、特异度及符合率分别为88.9%、80.0%、84.2%。结论:CT-PI扫描可反映SPN内的血流动力学特征,结合SPN的形态学特征可提高SPN鉴别诊断的敏感性和准确性。Objective：To investigate perfusion characteristics of solitary pulmonary nodules（SPN） by using CT perfusion imaging（CTPI） and to evaluate the significance of perfusion in differentiating malignant from benign SPNs.Methods：Thirty-five patients with a SPN（malignant 25,benign 10） underwent CTPI.The perfusion data were transferred to a work-station（sun Microsystems Advantage windows 4.2,GE Medical Systems） and analyzed by CT perfusion 3 body tumor software.Region of interest（ROI） was selected to obtain blood volume（BV）,blood flow（BF）,mean transit time（MTT）,capillary permeability surface area product（PS）,time-density curve（TDC） and morphologic norms before and after enhancement.Results：BF,BV,MTT and PS of malignant nodules were respectively（146.17±58.77）ml/100mg,（6.45±1.38）ml/（100g·min）,（5.09±3.19）s and（16.33±6.62）ml/（100g·min）.And those of benign nodules were respectively（69.90±58.09）ml/100mg,（3.88±1.81）ml/（100g·min）,（4.06±1.77）s and（6.18±3.55）ml/（100g·min）.Comparing malignant lesions against benign ones,BF,BV and PS were statistically higher in malignant lesions（P0.05） and there was obvious difference on BV and PS.The TDC type of malignant and benign lesions was different.The TDC of malignant nodules was defined as A,B and C,A and C were constantly seen in malignant nodules（21/25,84%）;while the TDC of benign ones was D type.Malignant nodules showed significantly higher peak enhancement and net enhancement（P0.05）;Attenuation values on pre-enhancement images were not significantly different for malignant and benign nodules（P0.05）.With a cutoff value of 25HU of net enhancement,sensitivity,specificity and accuracy were respectively 88.89%,80% and 84.21%.Conclusion：CTPI can reflect the dynamic blood flow characteristics of SPNs,which is helpful for the differentiation of malignant and benign nodules with the morphology of SPNs.

关 键 词：孤立性肺结节 体层摄影术 X线计算机 灌注成像 血管成像 

分 类 号：R816.4[医药卫生—放射医学]