320排螺旋CT低剂量容积灌注在孤立性肺结节鉴别诊断中的价值  

Value of low-dose volume lung perfusion imaging with 320-detector CT in differential diagnosis of SPNs

作　　者：柳维义[1] 谭理连[1] 李志铭[1] 李树欣[1] 江金带[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：《实用放射学杂志》2014年第5期755-758,803,共5页Journal of Practical Radiology

摘　　要：目的：探讨320排螺旋 CT（320-DCT）低剂量容积灌注成像对孤立性肺结节（SPN）的诊断与鉴别诊断价值。方法前瞻性地对130例 SPN（恶性79例,活动性炎性16例,良性16例,慢性炎性19例）行容积灌注研究。对比剂团注（碘必乐,370 mg I/mL,50 mL,5 mL/s）开始后0 s 或4 s 启动扫描,扫描间隔2 s,总采集时间38 s 或40 s。所得数据用320-DCT 体部肿瘤灌注软件（一室两进模型）分析得到肺动脉灌注量（PF）、支气管动脉灌注量（BF）、肺动脉灌注指数（PPI）及时间-密度曲线（TDC）,并计算结节灌注总量（TPF）。评价灌注参数及曲线对 SPN 的鉴别诊断效能。结果活动性炎症的 PF、PPI 明显高于其余3组且有显著性差异（P〈0.05、P〈0.001、P 〈0.001；P 〈0.001、P 〈0.05、P 〈0.001）。恶性结节的 BF 明显高于其余3组且有显著性差异（P 〈0.001、P 〈0.05、P 〈0.001）；但恶性结节的 PPI 与慢性炎性结节比较无显著性差异（P =0.162）。恶性结节和活动性炎症的 TPF 明显高于良性肿瘤和慢性炎性结节（P 〈0.001、P 〈0.001）。所有 SPN 的 TDC 表现形式共6种,除活动性炎性结节全部表现为Ⅰ型曲线外,其余3组有多种曲线表现。结论320排螺旋 CT 低剂量容积灌注成像提供了 SPNs 丰富的血流信息,对 SPNs 的鉴别诊断具有重大价值。Objective To evaluate the diagnostic value of low-dose volume perfusion imaging with 320-detector CT in differentia-ting solitary pulmonary nodules （SPNs）.Methods 130 patients with 130 SPNs （79 malignant tumors,1 6 active inflammations,1 6 benign nodules and 1 9 chronic inflammations）underwent contrast-enhanced dynamic volume perfusion CT prospectively.50ml of contrast medium with iodine concentration of 370 mg I/mL was injected at a flow rate of 5 mL/s,and the scan began at 0 second or 4 seconds after the bolus injection.20 or 21 intermittent low-dose volume acquisitions were made with 2 s intervals,and the total ac-quisition time was 38 s or 40 s.Post-procession was performed using a perfusion software on the CT （Body Perfusion,Dual-input single compartment mode）.The perfusion parameters （PF,BF,PPI）,T-DC and TPF were measured or calculated,and then as-sessed.Results PF and PPI of active inflammation nodules showed significant higher value than those of the other three kinds of nodules,and there were significant differences in PF and PPI between active inflammation nodules and other kinds of nodules.The value of BF in malignant nodules was higher than that in the other three kinds of nodules,however no statistic significant difference in PPI was found between malignant and chronic inflammation nodules.The value of TPF in malignant and active inflammation nod-ules was higher than that in benign and chronic nodules,and there were statistic significant differences between malignant and active nodules and chronic ones.Six types of T-DC were displayed on SPNs：malignant,benign and chronic nodules showed a variety of T-DC types,and active inflammatory nodules showed only one type-typeⅠ.Conclusion Low-dose volume perfusion technique with 320-detector row CT can provide abundant information about blood flow of SPNs,and it may be regarded as an important technique in the differential diagnosis of SPNs.

关 键 词：计算机体层成像 孤立性肺结节 低剂量 容积灌注 一室两进模型 

分 类 号：R814.42[医药卫生—影像医学与核医学] R563[医药卫生—放射医学]