摘要
目的研究CT灌注成像对良、恶性肺结节的诊断价值。方法前瞻性研究88例直径2～4cm的肺结节的多层螺旋CT灌注表现。其中肺癌62例,良性病变26例(炎性假瘤12例,结核球10例,错构瘤3例,曲菌球1例)。采用8层螺旋CT灌注成像,电影模式,层厚5mm,4层/圈,扫描时间1s/r,数据采集时间40s。碘普胺(300mg I/ml)50ml,用高压注射器经前臂浅静脉注射,流率4ml/s,延迟5.6s。CTPerfusion2软件分析测量结节的血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)和拟合时间-密度曲线。结果良、恶性结节的BV值(分别为5.33、10.00ml/100g)和PS值(分别为13.11、44.94ml.100g-1.min-1)差异有统计学意义(F值分别为29.368和48.027,P值均为0.000)。以BV≥6ml/100g作为恶性病变的阈值,其敏感度87.3%,特异度100.0%,阳性预测值100.0%,阴性预测值65.4%,准确度89.9%。以PS≥30ml.100g-1.min-1作为恶性结节的阈值,则敏感度96.4%,特异度75.0%,阳性预测值87.1%,阴性预测值87.2%,准确度88.6%。以BV≥6ml/100g同时PS≥30ml.100g-1.min-1作为恶性结节的阈值,则敏感度96.8%,特异度92.3%,阳性预测值96.8%,阴性预测值92.3%,准确度95.5%。肺癌的拟合时间-密度曲线和主动脉的关系密切,起始端与主动脉同步,峰值在主动脉峰值区域或稍后,85.5%(B型+C型,53/62)呈缓慢下降或平台型。结论多层螺旋CT灌注对肺结节的良恶性鉴别诊断有较大帮助。
Objective To evaluate the diagnosis value of CT perfusion in pulmonary nodules. Methods A prospective study was undertaken in eighty-eight patients with the diameter of 2 - 4 cm of pulmonary nodules using MSCT perfusion. They were proved with pathology as peripheral lung cancer in 62 cases, benign nodules in 26 cases（ 12 cases of inflammatory pseudotumor, 10 cases of tubercle nodule, 3 cases of hamartoma, 1 case of aspergilloma）. Using 8-row detector spiral CT, cine scan, slice thickness 5 mm/4 slices, scan time was 1 second per circle, acquisition time was 40 seconds. Ultravist（300 mg L/ml） was administered at a delay of 5.6 seconds rate of 4 ml/s from forearm superficial for a total of 50 ml and a vein by hyperbaric injection. The CT data were transferred to a workstation （Sun Microsystems, Advantage Windows 4. 0, GE Medical Systems） and analyzed by a CT Perfusion 2-body tumor software. The timedensity curve and parameters which include blood flow（BF）, blood volume（ BV）, mean transit time（MTT） and permeability （PS） of CT perfusion were analyzed. Results The differences of BV and PS were statistically significant between lung cancer to benign nodules （F = 29.368 ,P = 0. 000 and F = 48. 027 ,P = O. 000）. When BV≥6 ml/100 g was set as the diagnostic threshold, the sensitivity, specificity, positive predict value, negative predict value and accuracy were 87.3%, 100.0%, 100. 0%, and 65.4%, respectively. When PS≥30 ml · 100 g^-1·min^-1 was set as the diagnostic threshold, the sensitivity, specificity, positive predict value, negative predict value and accuracy were 96.4%, 75.0%, 87.1%, 87. 2%, and 88.6%, respectively. When BV≥6 ml/100 g and PS≥30 ml · 100 g^-1 · min^-1 were set as the diagnostic threshold, the sensitivity, specificity, positive predict value, negative predict value and accuracy were 96. 8% , 92. 3% , 96. 8%, 92. 3%, and 95.5% , respectively. The time-density curve of lung cancer was correlation to that of aorta. The beginning of the curve was synchronization and the location of the peak was same or slightly delayed in lung cancer to aorta. The time-density＇s form （type B ＋ type C） of lung cancer （85.5%） was descent slowly or flat. Conclusion MSCT perfusion is helpful to the diagnosis and differential diagnosis of aorta pulmonary nodules.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2005年第10期1041-1045,共5页
Chinese Journal of Radiology
