320排CT体部灌注技术对肺内孤立实性占位病变的诊断价值  

Study of body perfusion on 320-slice CT for diagnosis of solitary pulmonary space-occupying lesions

作　　者：郭成伟[1] 孙文超[1] 崔现成 GUO Cheng-wei;SUN Wen-chao;CUI Xian-cheng(Department of Radiology,the 252 Central hospital of PLA,Baoding,Hebei071000,China)

机构地区：[1]解放军第252医院放射科

出　　处：《临床肺科杂志》2019年第10期1789-1793,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨320排CT体部灌注(dual-inputCTperfusion,DI-CTP)技术对肺内孤立性占位的诊断价值。方法收集经病理证实的肺内孤立性占位78例,(恶性病变:腺癌25例,鳞癌20例、神经内分泌癌2例、转移瘤1例;良性病变:炎性假瘤18例,活动性结核9例,硬化性血管瘤2例,错构瘤1例),应用DI-CTP技术分析肺动脉灌注量(PF)、支气管动脉灌注量(BF)、灌注指数[PI=PF/(PF+BF)]和时间-密度曲线(TDC),计算灌注总量(TLP=PF+BF)和达峰时间(TTP)。评价灌注参数及TTP对肺内孤立性占位的诊断效能。结果腺癌、鳞癌、炎性假瘤与结核的PF、BF、PI、TLP与TTP均值各组间差异具有显著性(F=4.71、P<0.01,F=3.22、P<0.01,F=18.26、P<0.01,F=3.23、P<0.01,F=37.25、P<0.01)。良恶性肺占位BF(t=3.03,P<0.01)、TLP(t=2.46,P<0.01)、PI(t=-5.68,P<0.01)及TTP(t=9.64,P<0.01)间差异均存在显著性,但PF在良恶性占位间差异无统计学意义(t=1.29,P>0.05)。ROC曲线显示TTP诊断价值高、PI诊断价值中等,曲下面积(AUC)分别为0.950、0.839;二者分别取最佳临界值51.15%、17.55s,其相对应的敏感度分别为98.0%、96.1%,特异度分别为73.0%、86.2%。结论DI-CTP技术可对肺结节的血流动力学定量评价,其中PI和TTP是诊断肺内孤立性占位良恶性的重要预测参数。Objective To evaluate the value of dual-input CT perfusion(DI-CTP)in solitary pulmonary space-occupying lesions.Methods 78 solitary pulmonary lesions confirmed by pathology(malignant lesions:adenocarcinoma 25 cases,squamous cell carcinoma 20 cases,neuroendocrine carcinoma 2 cases,metastasis 1 case;benign lesions:inflammatory pseudotumor 18 cases,active tuberculosis 9 cases,sclerosing hemangioma 2 cases,hamartoma 1 case)were collected.Pulmonary perfusion volume(PF),bronchial artery perfusion volume(BF),perfusion index[PI=PF/(PF+BF)]and time-density curve(TDC)were analyzed by DI-CTP.Total perfusion volume(TLP=PF+BF)and peak to time(TTP)were calculated to evaluate the diagnostic efficacy of perfusion parameters and TTP for solitary pulmonary space occupancy.Results There were significant differences in PF,BF,PI,TLP and TTP among adenocarcinoma,squamous cell carcinoma,inflammatory pseudotumor and tuberculosis(F=4.71,P<0.01;F=3.22,P<0.01;F=18.26,P<0.01;F=3.23,P<0.01;F=37.25,P<0.01).There were significant differences in BF(t=3.03 P<0.01),TLP(t=2.46,P<0.01),PI(t=-5.68,P<0.01)and TTP(t=9.64,P<0.01)between benign and malignant lung masses,but there was no significant difference in PF(t=1.29,P>0.05).ROC curve showed that TTP had the best diagnostic value,PI had moderate diagnostic value,and the area under curve(AUC)was 0.950 and 0.839 respectively.The best critical values were 51.15%and 17.55s,respectively.The sensitivity were 98.0%and 96.1%,and specificity were 73.0%and 86.2%,correspondingly.Conclusion DI-CTP can accurately evaluate the hemodynamic of pulmonary nodules,and PI and TTP are important predictive parameters for the diagnosis of benign and malignant solitary pulmonary masses.

关 键 词：灌注成像 肺癌 孤立性肺结节 X线断层摄影 

分 类 号：R734.2[医药卫生—肿瘤]