【摘要】：目的:研究孤立性肺結(jié)節(jié)(SPN)雙源CT灌注參數(shù)與有腔血管參數(shù)的相關(guān)性,探討雙源CT灌注成像診斷不同性質(zhì)SPN的價值。方法:收集遵義醫(yī)學(xué)院附屬醫(yī)院2015年1月至2016年9月經(jīng)胸部CT平掃發(fā)現(xiàn)肺內(nèi)結(jié)節(jié)并行雙源CT灌注掃描后經(jīng)手術(shù)病理證實的SPN患者65例,男43例,女22例,年齡23~74歲,平均51.27歲。將灌注圖像傳輸至工作站(Siemens Syngo Multimodality workplace),選擇VPCT body軟件行圖像后處理,獲得時間-密度曲線(TDC)及血流量(BF)、血容量(BV)、表面通透性(PMB)、平均通過時間(MTT)等灌注參數(shù)和相應(yīng)灌注偽彩圖。采用PV-9000二步法免疫組化檢測系統(tǒng)對65例SPN組織標(biāo)本染色,然后對有腔血管數(shù)目(LVN)、有腔血管面積(LVA)、有腔血管周長(LVP)進(jìn)行計數(shù)。根據(jù)病理結(jié)果將SPN分為惡性、良性及炎性三組,惡性組39例(腺癌21例,鱗癌12例,大細(xì)胞神經(jīng)內(nèi)分泌癌2例,腺鱗癌1例,小細(xì)胞癌1例,類癌1例,肉瘤樣癌1例),良性組14例(結(jié)核球9例,曲菌病l例,炎性肌纖維母細(xì)胞瘤1例,硬化性血管瘤1例,神經(jīng)纖維瘤1例,錯構(gòu)瘤1例),炎性結(jié)節(jié)組12例。觀察三組不同性質(zhì)SPN之間雙源CT灌注參數(shù)及有腔血管參數(shù)的差異;分析SPN雙源CT灌注參數(shù)與有腔血管參數(shù)的相關(guān)性;利用ROC曲線分析雙源CT灌注參數(shù)判斷惡性SPN的診斷效能。結(jié)果:(1)TDC:惡性結(jié)節(jié)組多呈Ⅰ型曲線,占74%(29/39),表現(xiàn)為速升速降型,降支伴平臺期;炎性結(jié)節(jié)組多呈Ⅱ型曲線,占75%(9/12),表現(xiàn)為速升緩降型;良性結(jié)節(jié)組多呈Ⅲ型曲線,占86%(12/14),表現(xiàn)為平緩小幅度上升,在一定范圍內(nèi)波動。(2)惡性、炎性組的BF、BV、LVN、LVA及LVP值明顯高于良性結(jié)節(jié)組,差異有統(tǒng)計學(xué)意義(P0.05);惡性組與炎性組間PMB、LVA、LVP的差異有統(tǒng)計學(xué)意義(P0.05),BF、BV、LVN的差異無統(tǒng)計學(xué)意義(P0.05)。惡性組PMB明顯高于良性組,差異有統(tǒng)計學(xué)意義(P0.05),炎性組和良性組之間PMB差異無統(tǒng)計學(xué)意義(P0.05);惡性、炎性及良性組MTT組間比較,差異無統(tǒng)計學(xué)意義(P0.05)。(3)雙源CT灌注參數(shù)BF、BV與LVN、LVA、LVP呈正相關(guān),PMB與LVA、LVP呈正相關(guān),MTT與LVN、LVA、LVP均無相關(guān)性。(4)當(dāng)BF≥56 ml/100ml/min時,診斷惡性組SPN的敏感度為85%,特異度為54%;當(dāng)BV≥6.34 ml/100ml時,診斷惡性組SPN的敏感度為82%,特異度為54%;當(dāng)PMB≥8.88ml/100ml/min時,診斷惡性組SPN的敏感度為100%,特異度為50%;如果聯(lián)合BF、BV與PMB,當(dāng)BF≥60 ml/100ml/min,BV≥6.59 ml/100ml,PMB≥9.9 ml/100ml/min時,診斷惡性組SPN的敏感度為82%,特異度為62%。結(jié)論:良性、炎性及惡性組SPN的微血管構(gòu)成存在顯著差異;SPN雙源CT灌注參數(shù)與有腔血管參數(shù)(LVN、LVA、LVP)存在相關(guān)性,可以作為無創(chuàng)地評價腫瘤血管生成的指標(biāo);雙源CT灌注成像有助于SPN的診斷與鑒別診斷。
[Abstract]:Objective: to study the correlation between (SPN) perfusion parameters and luminal vascular parameters in solitary pulmonary nodules (SPN), and to explore the value of dual-source CT perfusion imaging in the diagnosis of SPN with different characteristics. Methods: from January 2015 to September 2016, 65 SPN patients (43 males and 22 females), aged 2374 years (mean 51.27 years), were diagnosed by plain chest CT scan and double-source CT perfusion scan in the affiliated Hospital of Zunyi Medical College. The perfusion images were transferred to the workstation (Siemens Syngo Multimodality workplace), to select the VPCT body software for post-processing. The perfusion parameters such as time-density curve (TDC) and (BF), blood volume (BV), surface permeability (PMB), average transit time (MTT) and the corresponding perfusion pseudo-color images were obtained. PV-9000 two-step immunohistochemical method was used to detect the number of SPN tissues in 65 cases, and then counted the number of (LVN), luminal vessels, the area of (LVA), vessels and the circumference of (LVA), vessels. According to the pathological results, SPN was divided into three groups: malignant, benign and inflammatory. There were 39 cases in malignant group (adenocarcinoma 21 cases, squamous cell carcinoma 12 cases, large cell neuroendocrine carcinoma 2 cases, adenosquamous carcinoma 1 case, small cell carcinoma 1 case, carcinoid 1 case). One case of sarcomatoid carcinoma, 14 cases of benign group (9 cases of tuberculoma, 1 case of aspergillosis, 1 case of inflammatory myofibroblastoma, 1 case of sclerosing hemangioma, 1 case of neurofibroma, 1 case of hamartoma) and 12 cases of inflammatory nodule group. To observe the difference of perfusion parameters and luminal vascular parameters between three groups of SPN with different properties, to analyze the correlation between the perfusion parameters of dual-source CT and vascular parameters of SPN, and to evaluate the diagnostic efficacy of malignant SPN by using ROC curve to analyze the perfusion parameters of dual-source CT. Results: (1) TDC: malignant nodules showed type 鈪，

本文編號：2198297