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目的探讨肺部孤立性球形病变灶周CT灌注(CT perfusion,CTP)参数定量分析的诊断价值。资料与方法选取位于肺动脉或右心室所在层面的孤立性肺部球形病变22例,其中恶性组14例(腺癌8例,肺泡癌3例,大细胞癌1例,腺鳞癌及血管外皮瘤各1例),良性组8例(炎性假瘤2例,活动性结核1例,结核球2例,硬化性血管瘤3例)。采用64层CT行灌注检查。将所得原始数据传至Syngo工作站行后处理得到CTP图,测量病变灶周及对侧肺与病变相对应区域的近、远肺门侧的血流量(BF)、血容量(BV)、表面通透性(PS)、平均通过时间(MTT)等灌注参数值。所有病例取得术后病灶近、远肺门侧边缘外1.0 cm范围内的肺组织以及远离病变区域的肺组织各一块,行免疫组织化学染色,比较微血管密度(MVD)有无差异。结果 (1)良、恶性组灶周近/远肺门侧灌注参数BF、BV、PS、MTT相对值(病变灶周灌注参数/对侧肺灌注参数)分别为rBF 1.37±0.59/0.99±0.38、0.88±0.53/0.92±0.41,rBV1.78±1.29/1.08±0.35、1.18±0.88/0.96±0.40,rPS 1.25±1.07/0.78±0.69、1.47±1.12/1.29±1.07,rMTT1.35±0.60/1.16±0.40、1.56±1.30/1.06±0.19;两组间各灌注参数相对值差异无显著统计学意义(P>0.05)。(2)良、恶性组灶周MVD相对值(病变灶周MVD值/同侧正常肺MVD值)分别为1.09±0.21和0.91±0.28,两者间差异无显著统计学意义(P>0.05)。结论良、恶性肺部球形病变灶周CTP参数值间有一定差异,但无统计学意义,对鉴别诊断无明确帮助。
Objective To investigate the diagnostic value of parametric quantitative CT perfusion (CTP) in solitary spherical lesions of the lung. Materials and Methods 22 cases of solitary pulmonary spondylosis located in the level of pulmonary artery or right ventricle were selected. Among them, 14 cases were malignant (8 cases of adenocarcinoma, 3 cases of alveolar carcinoma, 1 case of large cell carcinoma, adenosquamous carcinoma and hemangiopericytoma 1 in each), 8 in the benign group (inflammatory pseudotumor in 2, active tuberculosis in 1, tuberculoma in 2 and sclerosing hemangioma in 3). 64-slice CT perfusion examination. The obtained raw data were sent to Syngo workstation for post-processing to obtain CTPs. The BF, BV, BV, Permeability (PS), mean transit time (MTT) and other perfusion parameter values. In all cases, the lesions were located near the distal edge of the lung, 1.0 cm away from the edge of the lung tissue and lung lesions away from the lesion area of a piece, immunohistochemical staining, microvessel density (MVD) with or without the difference. Results (1) The BF, BV, PS and MTT relative perfusion parameters of peri / distal hilar and perfusion parameters of benign and malignant lesions were rBF 1.37 ± 0.59 / 0.99 ± 0.38 , 0.88 ± 0.53 / 0.92 ± 0.41, rBV 1.78 ± 1.29 / 1.08 ± 0.35, 1.18 ± 0.88 / 0.96 ± 0.40, rPS 1.25 ± 1.07 / 0.78 ± 0.69, 1.47 ± 1.12 / 1.29 ± 1.07, rMTT 1.35 ± 0.60 / 1.16 ± 0.40 and 1.56 ± 1.30 / 1.06 ± 0.19 respectively. There was no significant difference in the relative value of perfusion parameters between the two groups (P> 0.05). (2) The relative MVD values (MVD value of lesions / MVD of ipsilateral normal lungs) in benign and malignant groups were 1.09 ± 0.21 and 0.91 ± 0.28, respectively, with no significant difference (P> 0.05) . Conclusions There is a certain difference between the CTP values of benign and malignant lung lesions in each week, but there is no statistical significance, and there is no definite help in differential diagnosis.