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背景与目的:良、恶性肿瘤的血流供应与代谢在质、量上有着明显的差异,目前正在开发使用新的影像学技术来鉴别恶性、良性结节的血供情况,灌注成像技术是其中一种。本文采用多层螺旋CT灌注成像技术,定量评价肺内块状病灶的血流特点及其对良、恶性肿瘤进行鉴别诊断的价值。方法:52例初诊为肺部肿物的患者(37例恶性、7例良性、8例活动性炎性),行16排螺旋CT灌注扫描。利用功能软件包自动获取动、静脉、病灶的时间-密度曲线及病变的灌注参数,包括灌注量(perfusionvolume,PV)、血容量(bloodvolume,BV)、对比剂平均通过时间(meantransittimeMTT)、增强峰值(peakheight,PH)。结果:恶性、活动性炎性、良性病变PV值分为(27.63±15.06)ml·min-1·ml-1、(30.80±20.33)ml·min-1·ml-1、(11.81±3.74)ml·min-1·ml-1,PH值分别为(28.46±12.07)Hu、(32.15±15.89)Hu、(10.41±3.77)Hu,BV分别为(21.64±10.97)ml/100g、(28.38±14.55)ml/100g、(10.61±5.33)ml/100g,恶性及活动性炎性病变这3值均显著高于良性病变。恶性、活动性炎性、良性病变的MTT值分别为(28.39±21.66)s、(25.91±14.57)s、(29.86±13.57)s,三者差异没有统计学意义。恶性、活动性炎性病变间4个灌注参数均没有统计学差异。若以PV值>20ml·min-1·ml-1,且PH>15Hu作为鉴别恶性、良性病变(除外活动炎性病变)的阈值,其灵敏度、特异度、准确性分为91.9%、100%、84.1%。结论:多层螺旋CT灌注成像能定量评价肺部肿物血流模式,可用于无创性诊断和鉴别诊断肺部病变。
BACKGROUND & OBJECTIVE: The blood supply and metabolism of benign and malignant tumors are obviously different in quality and quantity. Currently, new imaging techniques are being developed to identify the malignant and benign nodular blood supply. Perfusion imaging technique is one of them A. In this paper, multi-slice spiral CT perfusion imaging technique to quantitatively evaluate the characteristics of massive pulmonary blood flow and the differential diagnosis of benign and malignant tumors. Methods: Fifty-two patients with newly diagnosed pulmonary masses (37 malignant, 7 benign, 8 active inflammatory) underwent 16-slice spiral CT perfusion scan. The function-software package was used to automatically obtain the time-density curve of the arteriovenous and venous lesions and perfusion parameters of the lesions, including perfusion volume (PV), blood volume (BV), meanranscreation time (MTT), peak enhancement (peakheight, PH). Results: The values of PV in malignant, active inflammatory and benign lesions were (27.63 ± 15.06) ml · min-1 · ml-1, (30.80 ± 20.33) ml · min-1 · ml-1 and (11.81 ± 3.74) (28.46 ± 12.07) Hu, (32.15 ± 15.89) Hu, (10.41 ± 3.77) Hu and BV were (21.64 ± 10.97) ml / 100g and 28.38 ± 14.55) ml / 100g, (10.61 ± 5.33) ml / 100g. The values of malignant and active inflammatory lesions were significantly higher than those of benign lesions. The MTT values of malignant, active inflammatory and benign lesions were (28.39 ± 21.66) s and (25.91 ± 14.57) s and (29.86 ± 13.57) s, respectively. There was no significant difference among the three groups. There was no significant difference in the four perfusion parameters between malignant and active inflammatory lesions. Sensitivity, specificity and accuracy were 91.9% and 100% respectively when the threshold value of PV value> 20ml · min-1 · ml-1 and PH> 15Hu was used to distinguish malignant and benign lesions (excluding active inflammatory lesions) , 84.1%. Conclusion: Multi-slice spiral CT perfusion imaging can quantitatively evaluate the blood flow pattern in the lung and can be used for noninvasive diagnosis and differential diagnosis of pulmonary lesions.