320排CT肺三期增强扫描诊断孤立性肺病变  

320-detector row CT three-phase enhanced scanning in diagnosis of solitary pulmonary lesion

作　　者：柳维义[1] 谭理连[1] 李志铭[1] 江金带[1] 李树欣[1] 利晞[1] 

机构地区：[1]广州医科大学附属第二医院CT/MR部,广东广州510260

出　　处：《中国医学影像技术》2014年第4期535-539,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的探讨最佳320排CT肺三期增强扫描时相,评价其诊断孤立性肺病变(SPL)的临床价值。方法对100例SPL患者[A组(周围型肺癌)55例;B组(良性肿瘤或慢性炎症)23例;C组(活动性炎症)22例]及40名健康成年人(D组)行320排CT容积灌注扫描,采用体部灌注软件处理得到时间-密度曲线(T-DC),记录并比较各组肺动脉峰值时间(PA-TTP)、左心房峰值时间(LA-TTP)、胸主动脉峰值时间(AO-TTP)和SPL强化峰值时间(SPL-TTP)。在平扫,肺动脉、左心房、胸主动脉和SPL达强化峰值时以及延迟3min共6个时相测量病灶CT值,计算CT净增值(NE)。应用ROC曲线分析比较各时相NE对SPL的诊断效能。结果 A、B、C、D组PA-TTP、LA-TTP及AO-TTP差异均无统计学意义(P均>0.05)。A、B、C组SPL-TTP差异有统计学意义(F=52.163,P<0.001),C组SPL-TTP为(17.36±2.52)s,明显早于A、B组。A组中,应用SPL达强化峰值时(28s)NE诊断周围型肺癌的ROC曲线下面积(AUC)最大,为0.872,敏感度92.7%,特异度80.0%。C组中,应用SPL达强化峰值时(18s)NE诊断炎症的AUC最大,为0.985,敏感度100%,特异度88.5%。结论以18s、28s、3min为扫描时相,320排CT肺三期增强扫描对鉴别诊断SPL具有较高价值。Objective To explore the best phase of three-phase enhanced scanning of 320-detector CT （320-DCT）, and to evaluate its value for solitary pulmonary lesion （SPL）. Methods A total of 100 patients with SPL （group A [peripheral lung cancer, n： 55], group B [benign tumor or chronic inflammation, n： 23], group C [active inflammation, n： 22]） and 40 healthy adults （group D） underwent dynamic volume perfusion CT with 320-DCT. Body-perfusion software was used to get the time to density curve （T-DC）, and then the peak enhancement time of pulmonary artery （PA-TTP）, left atrium （LA-TTP）, thoracic artery （AO-TTP） and SPL （SPL-TTP） were recorded and compared. CT value was measured at the following time point, i.e. pre-contrast, peak enhancement of pulmonary artery, left atrium, thoracic artery and SPL, de- layed 3 min, and the net enhancement （NE） of CT value was calculated. The performance of NE in diagnosis of SPL at dif- ferent phases were analyzed by using ROC curve. Results There was no significant diifference of PA-TTP, LA-TTP, AO- TTP all 4 groups （all P〈0.05）. The peak enhancement time of group A, B and C had significant differences （F= 52. 163, P〈0. 001）. SPL-TTP in group C was （17.36±2.52）s, much earlier than that in group B and C. In group A, NE at the phase of peak enhancement of SPL （28 s） had the greatest diagnostic efficacy, the area under ROC （AUC） was 0. 872, in- dicating a sensitivity of 92.7% ,specificity of 80.0% for identifying lung cancer. In group C, NE at the phase of peak en- hancement of SPL （18 s） had the greatest diagnostic efficacy, AUC was 0. 985, indicating a sensitivity of 100 s, specificity of 88.5% for identifying acute inflammation. Conclusion Taking 18 s, 28 s, 3 min as the scan phases, 320-DCT three- phase enhanced scanning has great differential diagnosis value for patients with SPL.

关 键 词：体层摄影术 X线计算机 灌注成像 三期扫描 肺 肺孤立性病变 

分 类 号：R814.42[医药卫生—影像医学与核医学] R734.2[医药卫生—放射医学]