多层螺旋CT灌注成像技术对肺混杂性磨玻璃结节血供的评价  

Multi-Slice Spiral CT Perfusion Imaging for Blood Supply of Pulmonary Mixed Ground-Glass Nodules

作　　者：暴军辉[1] 闫巧焕[2] 刘振兴[3] 王俊英 吕英刚[1] 

机构地区：[1]河北工程大学附属医院影像二科,河北邯郸056002 [2]邯郸市第一医院老年一科,河北邯郸056001 [3]邢台市人民医院影像科,河北邢台054001

出　　处：《中国呼吸与危重监护杂志》2016年第3期279-283,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：河北省科技支撑项目(编号:12276104D-19);河北省医学科学研究重点课题计划项目(编号:20090188);邯郸市科学技术研究与发展项目(编号:0923108054-5)

摘　　要：目的探讨多层螺旋CT灌注成像技术对肺混杂性磨玻璃结节(m GGN)实性部分血供的评估价值。方法回顾性分析2011年3月至2015年5月在河北工程大学附属医院、邯郸市第一医院及邢台市人民医院经病理证实的m GGN患者97例,采用多层螺旋CT灌注成像技术分析m GGN实性部分血供,比较CT灌注参数对良、恶性病变的诊断价值。结果共纳入97例m GGN患者,其中80例为恶性病变,17例为良性病变。m GGN恶性病变中血容量(BV)、峰值增强影像(PEI)及表面通透性(PS)均高于良性病变,而灌注峰值时间低于良性病变且差异有统计学意义(P<0.05)。微浸润腺癌(MIA)、浸润性腺癌(IAC)患者的BV、PEI以及PS显著高于浸润前病变(P<0.05),IAC中BV、PS显著高于MIA组(P<0.05)。非条件多因素Logistic回归分析结果显示,病理类型中IAC、MIA及浸润前病变,BV、PEI及PS均与m GGN呈正相关。受试者工作特征曲线显示,BV+PS+PEI三者联合时,敏感性、特异性、阳性预测值、阴性预测值以及诊断准确率分别为95.28%、86.65%、91.10%、87.52%及91.76%,其曲线下面积显著高于单一检测指标(P<0.05)。结论多层螺旋CT灌注成像技术可用于评估m GGN的血供,CT灌注参数联合应用可用于鉴别良、恶性病变。Objective To investigate the clinical value of multi-slice spiral CT perfusion imaging for blood supply of pulmonary mixed ground-glass nodules（ m GGN）. Methods The m GGN patients were retrospectively analyzed from March 2011 to May 2015 in Affiliated Hospital of Hebei University of Engineering,Handan First Hospital and Xingtai People＇ s Hospital. Multi-slice spiral CT perfusion imaging for blood supply was applied to evaluate the blood supply of solid lesions in m GGN,and the diagnostic values of CT perfusion parameters were compared for differentiating the benigh m GGN from the malignant m GGN.Results Totally 97 m GGN patients were enrolled in this study,in which 80 were malignant m GGN and 17 were benigh m GGN. Blood volume（ BV）,peak enhancement image（ PEI） and permeability surface（ PS）in malignant m GGN lesions were higher than those of benign lesions,while the time to peak was less than that of benign lesions,and the differences were all statistically significant（ P〈 0. 05）. BV,PEI and PS in minimally invasive adenocarcinoma（ MIA） and invasive adenocarcinoma（ IAC） patients were significantly higher than those in the patients with precancerous lesions（ P〈 0. 05）. BV and PS in IAC patients were significantly higher than those in MIA patients（ P〈 0. 05）. Logistic regression analysis showed that IAC,MIA and the precancerous lesions,BV,PEI and PS were positively correlated with m GGN. Receiver operating characteristic（ ROC） curve showed that the sensitivity,specificity,positive predictive value,negative predictive value,and diagnostic accuracy rates with BV ＋ PS ＋ PEI combined,were 95. 28%,86. 65%,91. 10%,87. 52% and 91. 76%,respectively,while the area under ROC curve was significantly higher than those with single parameter（ P〈 0. 05）. Conclusion Multi-slice spiral CT perfusion imaging can evaluate the blood supply of m GGN,and BV ＋ PS ＋ PEI combined can be used in differentiation of the benigh and malignant m GGN.

关 键 词：多层螺旋CT灌注成像 肺内磨玻璃样结节 血供 诊断 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R563