SPECT/CT肺灌注显像评价非小细胞肺癌患者肺功能的价值及相关因素研究  

Evaluation of lung function with SPECT/CT lung perfusion imaging and the potential factors of per-fusion defects in patients with non-small-cell lung cancer

作　　者：孙洪福[1] 王中堂[1] 周涛[1] 李宝生[1] 

机构地区：[1]山东省肿瘤医院放疗科六病区,济南250117

出　　处：《中华核医学与分子影像杂志》2016年第4期322-325,共4页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨SPECT/CT肺灌注显像（SPECT/CT－LPI）在评价NSCLC患者肺功能中的价值，并分析与SPECT肺灌注缺损相关的临床因素。 方法回顾性分析2006年12月至2013年3月间治疗前行肺功能测试（PFT）、胸部CT和SPECT/CT－LPI的48例NSCLC患者（男43例，女5例；平均61.06岁）资料。据SPECT/CT－LPI图像将肺灌注缺损分为4级。0级，无灌注缺损或肺灌注缺损不明显；1级，肿瘤及其周围局部区域肺灌注缺损；2级，达1叶肺灌注缺损；3级，超过1叶肺灌注缺损。收集分析患者相关临床因素。统计学分析采用χ2检验及Logistic多因素回归。 结果 48例NSCLC患者肺灌注缺损发生率为91.67%（44/48），其中1级肺灌注缺损18例、2级15例、3级11例；PFT异常发生率33.33%（16/48），SPECT/CT－LPI组与PFT组比较差异有统计学意义（χ2＝34.844, P〈0.01）。中央型与周围型2组间及肺门淋巴结有无转移2组间≥2级肺灌注缺损出现率差异均有统计学意义（χ2＝8.392和10.801，均P〈0.01）。Logistic回归分析显示，肿瘤位置（中央型赋值1，周围型赋值2）、肿瘤大小（最大径≤3.0 cm赋值1，〉3.0 cm且≤5.0 cm赋值2，〉5.0 cm赋值3）及肺门淋巴结情况（有转移赋值1，无转移赋值0）对SPECT肺灌注缺损影响有统计学意义（Wald＝8.176、5.352和10.100，均P〈0.05）。结论与PFT相比，SPECT/CT－LPI图像能更好地显示NSCLC患者区域肺组织功能；肿瘤位置、肿瘤大小及肺门淋巴结情况有助于预测肺灌注缺损分级；对于中央型、原发灶较大及有肺门淋巴结转移患者，建议行SPECT－LPI了解患者肺功能状况。Objective TO assess the value of SPECT/CT lung perfusion imaging （SPECT/CT- LPI） in evaluation of the regional lung function and the correlation between lung perfusion defects （LPD） and the clinical findings in NSCLC patients. Methods A total of 48 NSCLC patients （43 males, 5 fe- males; average age 61.06 years） who underwent pulmonary function tests （PFT）, CT and 99Tcm-MAA SPECT/CT-LPI from December 2006 to March 2013, were retrospectively studied. LPD were divided into four grades ： grade 0 （ no lung perfusion defect was identified） , grade 1 （ the area of lung perfusion defect （LPDA） was similar to the size of local tumor）, grade 2 （ the LPDA was larger than local tumor and ex- tends to 1 pulmonary lobe）, grade 3 （the LPDA exceeded 1 pulmonary lobe）. Xa test, one-way analysis of variance and Logistic regression analysis were used to analyze the correlation of the lung perfusion function and clinical findings. Results LPD were found in 44 patients （91.67%, 44/48）, including 18 with grade 1, 15 with grade 2, 11 with grade 3. The abnormal results of PFT were found in 16 patients （33.33%, 16/ 48）. The abnormal findings by SPECT/CT-LPI were more than that by PFT （X2= 34.844, P〈0.01）. The rates of LPD with grade i〉 2 were significant different between patients with central lung cancer and those with peripheral lung cancer （X2= 8.392, P〈0.01 ） , and between hilar lymph nodes positive group and nega- tive group （X2 = 10. 801, P〈0.01）. The degree of LPD was related to tumor location （ 1 was assigned for central lung cancer, 2 was assigned for peripheral lung cancer） , tumor size （ 1 was assigned for maximum diameter ~〈3.0 cm, 2 was assigned for 〉3.0 cm and ~〈5.0 Cnl, 3 was assigned for 〉5.0 cm） and hilar lymph node （ 1 was assigned for with metastasis, 0 was assigned for no metastasis） （ Wald= 8.176, 5.352, 10.100, all P〈0. 05）. Conclusions Compared with PFT, SPECT/CT-LPI has a more significant value in assessment of the regional

关 键 词：癌 非小细胞肺 体层摄影术 发射型计算机 单光子 体层摄影术 x线计算机 MAA 

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