乳腺肿瘤血管生成功能性变化特征及其机制

目的 探讨乳腺良恶性不同肿瘤、同种肿瘤不同灌注区域血流灌注特征以及血管生成表型的差异.方法 应用超声造影时间-强度曲线(TIC)定量分析技术检测30例乳腺恶性肿瘤、30例乳腺纤维腺瘤瘤灶边缘及中心部区域灌注参数及平均灌注参数峰值强度(PI)、曲线下面积(AUC)、达峰时间(TTP)、廓清时间(WOT),免疫组化技术检测CD34、血管内皮生长因子(VEGF)、Flk-1/KDR在两组肿瘤中的表达.结果 恶性组TIC形态多数(87.88%,29/33)呈速升缓降型,良性组多数(80.00%,12/15)呈缓升速降型.恶性组平均AUC、WOT大于良性组(P<0.05),平均PI、TTP两组间无统计学差异(P>0.05).恶性组病灶边缘的PI、AUC、WOT、TTP与中心相比有统计学差异(P＜0.05),良性组病灶边缘的各灌注参数与中心相比无统计学差异(P>0.05).恶性组微血管密度显著高于良性组(P<0.05),尤其富集于癌巢边缘.VEGF及Flk-1/KDR在恶性组血管内皮细胞尤其癌巢边缘呈强阳性表达,在良性组血管内皮细胞几乎不表达(P<0.05).结论 实时超声造影TIC形态、各平均灌注参数及区域灌注参数的差异为乳腺良恶性肿瘤的鉴别诊断提供了重要依据.针对VEGF或Flk-1/KDR为靶点进行乳腺癌特异性分子显像可能为乳腺癌的准确诊断提供新的思路.

Abstract：

Objective To compare the histological morphology, hemodynamics and angiogenesis-related molecules between benign and malignant breast tumor and investigate their variation in different perfusion regions in the same type of tumors.Methods Thirty patients with malignant breast carcinoma and 30 with breast fibroadenoma underwent contrast-enhanced ultrasound examination with time-intensity quantitative analysis. The perfusion indices including peak intensity (PI), area under the curve (AUC), time to peak (TTP) and wash-out time (WOT) were measured both inside and on the margin of the foci. The expressions of CD34, vascular endothelial growth factor (VEGF), and Flk-1/KDR in both groups were measured immuhistochemically. Results The time-intensity curve (TIC) of malignant tumor group was characterized by rapid ascent and slow descent, while that of the benign group presented with slow ascent and rapid descent. The AUC and WOT of the malignant tumor group were significantly higher than those of the benign group, while the PI and TTP showed no significant difference. In malignant tumor group, PI, AUC and WOT on the margin of the foci were significantly higher those of the inside region, while TTP showed a reverse pattern. No significant differences were found in the perfusion parameters between the inside and outside of the foci in the benign group. The distribution of CD34 was heterogeneous in breast carcinoma, and the micro-vessels were densely distributed especially on the margin of the cancer nest. The microvessel density of the malignant group (34.48±8.34) was significantly higher than that of the benign group (18.65±4.69). Diffuse or focal high VEGF expression was found on the margin of the cancer nest and necrotic tissue, but hardly detected in the benign group. Flk-1/KDR expressed diffusely or fiscally in breast carcinoma with especial high expression on the margin of the cancer nest and necrotic tissue, but was virtually undetectable in the benign group. Conclusion The perfusion pattern, TIC, mean perfusion parameter and variation of the regional perfusion parameters provide valuable evidence for differential diagnoses between benign and malignant breast tumors. Molecular imaging targeting VEGF and Flk-1/KD shed light on new approaches to early diagnosis of breast carcinoma.     

Solitary pulmonary nodules: comparison of multi-slice computed tomography perfusion study with vascular endothelial growth factor and microvessel density

Background The solitary pulmonary nodule （SPN） is one of the most common findings on chest radiographs. The objectives of clinical practice are to differentiate malignant nodules from benign nodules in the least invasive way and to make a specific diagnosis. This study was aimed to evaluate the correlation between perfusion imaging features and microvessel density （MVD） and vascular endothelial growth factors （VEGF） in SPNs using multi-slice computed tomography （MSCT）; and to provide the theoretical basis for SPN blood flow pattern and blood flow quantitative features. Also, the study called for the discussion of the method＇s clinical application value in the differential diagnosis of benign and malignant SPNs.Methods Sixty-eight patients with SPN underwent multi-location dynamic contrast enhanced （nonionic contrast material was administrated via the antecubital vein at a rate of 4 ml/s） MSCT. Precontrast and postcontrast attenuations on every scan was studied. Perfusion, peak height, and the ratio of the peak height of the SPN to that of the aorta were analyzed. Perfusion was calculated using the maximum gradient of the time-density curves （TDC） and the peak height of the aorta. The quantitative parameters （perfusion, peak height, ratio of peak height of the SPN to that of the aorta） of the blood flow pattern were compared with MVD and the VEGF expression of immunohistochemistry. Results The perfusion peak heights of malignant （（96.15±11.55） HU） and inflammatory （（101.15±8.41） HU） SPNs were significantly higher than those of benign （（47.24±9.15） HU） SPNs （P 〈0.05, P 〈0.05）. Ratios of SPN-to-aorta of malignant and inflammatory SPNs were significantly higher than those of benign SPNs （P 〈0.05, P 〈0.05）. No significant differences were found between the peak height and SPN-to-aorta ratio of malignant SPNs and inflammatory SPNs （P 〉0.05, P 〉0.05）. The precontrast densities of inflammatory SPNs were lower than those of malignant SPNs （P 〈0.05）. Perfusion values of malignant and inflammatory SPNs were significantly higher than those of the benign SPNs （P 〈0.05, P 〈0.05）. The VEGF positive expressions appeared in 32 patients with malignant SPNs and 2 patients with benign SPNs, and the average value of the MVD was higher in patients with malignant SPNs （36.88±6.76） than in patients with either benign （4.51±0.60） or inflammatory （26.11±5.43） SPNs （P 〈0.05, P 〈0.05）. There were statistically significant correlations between the CT perfusion feature and the MVD. The highest correlation was between the peak height of SPN and the MVD （r=0.657, P 〈0.05）.Conclusions Tumor microvessel density and VEGF expression facilitate the exploration of the pathophysiological basis of CT perfusion in SPNs. Multi-slice CT perfusion has shown strong positive correlations with angiogenesis in SPNs.     

APPLICATION OF TRANSVAGINAL CDFI IN THE DISTINGUISHMENT BETWEEN BENIGN AND MALIGNANT OVARIAN TUMORXUE

Objective To assess the value of transvaginal CDFI in the diagnosis of malignant ovarian tumors and to discriminate the benign from malignant ovarian tumors. Methods96 patients pelvic masses were studied by transvaginal ultrasonograph mass scoring, and by CDFI through pulsatility index (PI) and resistance index (RI) of peripheral blood flow of mass analyses.ResultsMass ultrasonic scoring: scoring＞9, 91.9% masses were malignant tumors. Scoring≤9, 91.5% masses were benign tumors. PI and RI of peripheral blood flow of masses were detected by CDFI: PI＜1.0, 92.5% cases; RI＜0.5, 97.4% cases were malignant tumors. The diagnosis match rate of malignant ovarian tumors was 97.0%. The diagnosis match rate of benign ovarian tumor was 96.2%. The diagnosis match rate was improved.ConclusionOvarian mass ultrasonic scoring＞9 and PI＜1.0, RI＜0.5 of mass peripheral blood flow are the special ultrasonic features of malignant ovarian tumor and the better methods to distinguish the benign ovarian tumor from the malignant one.     

APPLICATION OF TRANSVAGINAL CDFI IN THE DISTIN- GUISHMENT BETWEEN BENIGN AND MALIGNANT OVARIAN TUMOR

Objective To assess the value of transvaginal CDFI in the diagnosis of malignant ovariantumors and to discriminate the benign from malignant ovarian tumors. Methods 96 patients pelvic masses were studied by transvaginal ultrasonograph mass scoring, and by CDFI through pulsatility index (PI) and resistance index (RI) of peripheral blood flow of mass analyses. Results Mass ultrasonic scoring : scoring >9, 91.9% masses were malignant tumors. Scoring ≤<9, 91.5% masses were benign tumors. PI and Rl of peripheral blood flow of masses were detected by CDFI: Pl< 1 .0 . 92.5% cases; RI<0.5, 97.4% cases were malignant tumors. The diagnosis match rate of malignant ovarian tumors was 97.0% . The diagnosis match rate of benign ovarian tumor was 96 .2% . The diagnosis match rate was improved. Conclusion Ovarian mass ultrasonic scoring>9 and PI< 1 .0 , RI<0 .5 of mass peripheral blood flow are the special ultrasonic features of malignant ovarian tumor and the better methods to distinguish the benign ovarian tumor fro     

Quantitative evaluation of benign meningioma and hemangiopericytoma with peritumoral brain edema by 64-slice CT perfusion imaging

Background Hemangiopericytomas （HPCs） have a relentless tendency for local recurrence and metastases,differentiating between benign meningiomas and HPCs before surgery is important for both treatment planning and the prognosis appraisal.The purpose of this study was to evaluate the correlations between CT perfusion parameters and microvessel density （MVD） in extra-axial tumors and the possible role of CT perfusion imaging in preoperatively differentiating benign meningiomas and HPCs.Methods Seventeen patients with benign meningiomas and peritumoral edema, 12 patients with HPCs and peritumoral edema underwent 64-slice CT perfusion imaging pre-operation.Perfusion was calculated using the Patlak method.The quantitative parameters, include cerebral blood volume （CBV）, permeability surface （PS） of parenchyma, peritumoral edema among benign meningiomas and HPCs were compared respectively.CBV and PS in parenchyma, peritumoral edema of benign meningiomas and HPCs were also compared to that of the contrallateral normal white matter respectively.The correlations between CBV, PS of tumoral parenchyma and MVD were examined.Results The value of CBV and PS in parenchyma of HPCs were significantly higher than that of benign meningiomas （P〈0.05）, while the values of CBV and PS in peritumoral edema of benign meningiomas and HPCs were not significantly different （P 〉0.05）.MVD in parenchyma of HPCs were significantly higher than that of benign meningiomas （P〈0.05）.There were positive correlations between CBV and MVD （r=0.648, P〈0.05）, PS and MVD （r=0.541, P〈0.05） respectively.Furthermore, the value of CBV and PS in parenchyma of benign meningiomas and HPCs were significantly higher than that of contrallateral normal white matter （P〈0.05）, the value of CBV in peritumoral edema of benign meningiomas and HPCs were significantly lower than that of contrallateral normal white matter （P〈0.05）, while the value of PS in peritumoral edema of benign meningiomas and HPCs were not significantly different with that of contrallateral normal white matter （P 〉0.05）.Conclusions CT perfusion imaging can provide critical information on the vascuiarity of HPC and benign meningiomas.Determination of maximal CBV and corresponding PS values in the parenchyma may be useful in the preoperative differentiating HPC from benign meningiomas.     

Features of Computed Tomography Perfusion of Mediastinal Lymphadenopathies: a Pathology-based Retrospective Study

Objective To explore the features of various mediastinal lymphadenopathies using computed tomography perfusion (CTP). Methods CTP parameters (CTPs) of the selected mediastinal nodes from 59 patients with pathology-proven malignant lymph nodes and of those from 29 patients with clinically diagnosed or pathology-proven inflammatory lymphadenopathies were collected. Patients were divided into subgroups by etiology and phase of primary disease, including different pathological malignant nodes and diverse inflammatory nodes. CTPs were defined as blood flow (BF), blood volume (BV), mean transit time (MTT), permeability (PMB), and time to peak (TTP). Differences of CTPs were compared between malignant and benign nodes, and among subgroups, respectively. Results In the mediastinum, no significant differences of CTPs were found between malignant and benign groups (all P>0.05), the same for subgroups of malignant nodes (all P>0.05). Acute lymphadenitis had higher BF and BV than chronic inflammatory, lymphoid tuberculosis, sarcoidosis and malignant nodes. The BF of malignant nodes was markedly slower than that of acute lymphadenitis (P=0.01), but faster than chronic inflammatory nodes (P=0.04) and sarcoidosis (P=0.03), with no significant difference compared with lymphoid tuberculosis. Pneumonia-complicated lymphoid tuberculosis showed the longest MTT while sarcoidosis displayed the shortest MTT, and inflammatory nodes, lymphoid tuberculosis without complicated pneumonia and malignant nodes had moderate MTT. Conclusion CTPs show promising potential in distinguishing various lymphadenopathies in the mediastinum, but more studies are needed to improve their specificity.     

99mTc-MDP SPECT/CT联合血清碱性磷酸酶和钙离子诊断单发骨转移瘤

Objective To investigate the clinical value of 99mTc methylene diphosphonate (MDP) SPECT/CT bone imaging combined with serum alkaline phosphatase (ALP) and calcium ion (Ca2+) in the diagnosis of benign and malignant nature of single bone tumors. Methods 106 patients with confirmed malignant tumors and single bone tumors in our hospital from January 2021 to December 2022 were included. After admission, 99mTc MDP SPECT/CT whole body and local bone imaging was completed and serum ALP and Ca2+levels were detected. Routine follow-up for at least 6 months, based on the pathological or comprehensive imaging (CT and MRI) findings of bone tumors, the diagnosis of benign and malignant bone tumors should be made. Results There were 44 confirmed cases of bone metastases and 62 negative cases, the gender, age, and primary tumor types of the two groups were comparable (P>0.05). Bone imaging diagnosed 53 cases of bone metastases and 53 cases were negative. The accuracy of bone imaging in diagnosing bone metastases was 78.3% [(37+46)/106], sensitivity was 84.1% (37/44), specificity was 74.2% (46/62), positive predictive value was 69.8% (37/53), and negative predictive value was 86.8% (46/53). The serum ALP and Ca2+levels in the bone metastasis group were significantly higher than the negative group (P<0.05). ROC showed AUC of bone imaging combined with ALP+Ca2+for the diagnosis of bone metastases was 0.876 (95% CI=0.823~0.924, P<0.001), sensitivity of 88.6% and specificity of 90.5%. Conclusion 99mTc MDP SPECT/CT bone imaging could provide structural changes and functional metabolic characteristics of single bone metastases, with good sensitivity, but limited specificity and accuracy. Combining serum ALP and Ca2+can furtherly improve diagnostic performance and has important clinical potential.     

彩色多普勒超声、超声造影及CA-125对卵巢病变的鉴别诊断价值

目的 探讨彩色多普勒超声、超声造影及CA-125对卵巢病变的鉴别诊断价值.方法 分析总结65例卵巢病变的彩色多普勒超声、超声造影资料及血清CA-125水平,并对其诊断的准确性进行评价.结果 65例卵巢病变中,21例(21/35)良性病变者血清CA-125测值<35μ/ml,28例(28/30)恶性病变者血清CA-125测值>35μ/ml,而14例良性及2例恶性病变者血清CA-125测值存在交叉;彩色多普勒超声提示良性病变30例,恶性肿瘤22例,13例不能明确诊断(其中良性5例,恶性8例);超声造影提示良性病变34例,恶性肿瘤29例,误诊2例(1例卵泡膜细胞瘤,另1例交界性囊腺瘤);血清CA-125、彩色多普勒超声及超声造影对卵巢良恶性病变诊断的敏感性分别为66.7%、73.3%、96.7%,特异性为60.0%、85.7%、97.1%.结论 血清CA-125及超声检查有助于卵巢病变的诊断及鉴别诊断,而超声造影在显示肿瘤的血流灌注信息方面具有优越性,能进一步提高卵巢病变的早期诊断及鉴别诊断准确性.

Abstract：

Objective To assess the value of color Doppler ultrasonography, contrast-enhanced ultrasound and detection of serum CA-125 levels in the differential diagnosis of ovarian masses. Methods The findings of color Doppler ultrasonography, contrast-enhanced ultrasound and the serum levels of CA-125 were comparatively analyzed in 65 patients with ovarian masses, and the diagnostic accuracy of the 3 methods was estimated. Results Of the 65 cases of ovarian masses, 21 of the 35 patients with benign ovarian masses had serum CA-125 levels below 35 U/ml, and 28 of the 30 patients with malignant masses showed CA-125 levels over 35 U/ml. Color Doppler ultrasonography identified 30 benign and 22 malignant cases, but failed to produce definite results in 13 cases (including 5 with benign and 8 with malignant masses). By contrast-enhanced ultrasound, benign masses were found in 34 cases and malignant masses in 29 cases, and misdiagnosis occurred in 2 cases (including 1 case of thecoma and 1 of ovarian borderline tumor). With serum CA-125 detection, color Doppler ultrasonography and contrast-enhanced ultrasound, the diagnostic sensitivity for ovarian masses was 66.7%, 73.3%, and 96.7%, and the specificity was 60.0%, 85.7%, and 97.1%, respectively. Conclusions Detection of serum CA-125 level and ultrasound examinations help in the diagnosis and differential diagnosis of benign and malignant ovarian masses. Compared with serum CA-125 detection and color Doppler ultrasonography, contrast-enhanced ultrasound is more informative on perfusion patterns of the ovarian masses to result in higher accuracy in early and differential diagnosis of the ovarian masses.     

Preliminary study of 3T 1H MR spectroscopy in bone and soft tissue tumors

Background Magnetic resonance spectroscopy （MRS） is one method that can examine noninvasively the alive specimen of the organ, metabolism of the organ and cell, and the biochemistry change. MRS provides the biochemistry information that may be used to diagnose tumors or differentiate the malignant tumor from benign. The objective of this study is to investigate the benign and malignant bone and soft tissue tumors by 1H-MR spectroscopy （^1H-MRS） on a 3 Tesla MR scanner, then to assess the usefulness of ^1H-MRS in diagnosing bone and soft tissue tumors and distinguishing benign from malignant tumors.
Methods Fifty-six patients with bone and soft tissue tumors proved clinically and pathologically were examined with ^1H-MRS. ^1H-MRS was performed to study malignant musculoskeletal tumors, benign tumors and normal muscle adjacent to lesions to analyze the characteristics, and single-voxel point-resolved spectroscopy sequence was used. Proton brain exam-single voxel of ^1H-MRS which directly appeared in the spectrum, was observed to find the peak height of choline compounds （Cho） opposite to the creatine （Cr）, and whether there was a Cho peak. Metabolite values were calculated automatically from the area under each metabolite peak by the Functool 3.1 software. Metabolite ratios of Cho/Cr were manually calculated. Then according to the results, it was judged whether there existed benign or malignant tumors. The Kappa statistical test was used to analyze the MRS results, the histopathology data and the surgical situation. Statistics processing was performed using the software packaqe SPSS11.5 for Windows.
Results ^1H-MRS spectra style of bone and soft tissue tumors was different from that of normal muscle, and differences also existed between benign and malignant tumors. Choline level in malignant tumor was markedly higher than that in benign tumors. Cho/Cr in malignant tumor was higher than in benign tumor significantly （P〈0.05）. The true positive rate of bone and soft tissue between benign and malignant tumors was 34/36, the true negative rate was 15/18, the false positive rate was 3/18 and the false negative rate was 2/36. Therefore in the group, sensitivity of the ^1H-MRS was 94% （34/36）, specificity was 83% （15/18）, positive predictive value was 92% （34/37）, negative predictive value was 88% （15/17） and the accuracy rate was 91% （49/54）. The MRS results and the histopathology inspection conclusions had very good uniformity. The K value was 0.76±0.10 （P 〈0.01）.
Conclusions The increase of Cho level measured by ^1H-MRS is related to the bone and soft tissue malignant tumor. Cho/Cr in malignant tumor was higher than in benign tumor, so they will play a vital role in the diagnosis and differential diagnosis of bone and soft tissue tumors.     

Feasibility and value of quantitative dynamic contrast enhancement MR imaging in the evaluation of sinonasal tumors

Background Quantitative dynamic contrast enhancement MR imaging （DCE-MRI）,used to measure properties of tissue microvasculature and tumor angiogenesis,is a promising method for distinguishing benign and malignant tumors and characterizing tumor response to antiangiogenic treatment.The aim of this study was to assess the feasibility of quantitative parameters derived from clinically used DCE-MRI for distinguishing benign from malignant tumors in the sinonasal area,which may be potentially useful for prediction and monitoring of treatment response to chemoradiotherapy of sinonasal tumors.Methods One hundred and forty-three patients with sinonasal tumors,including 78 malignant tumors and 65 benign tumors and tumor-like lesions,underwent clinically used DCE-MRI.Parametric maps were obtained for quantitative parameters including Ktrans,kep and ve.Two radiologists reviewed these maps and measured Ktrans,kep and ve in the tumor tissue.Data were analyzed using independent T-test or Mann-Whitney U test analysis and receiver operating characteristic curves.Results Ktrans,kep and ve showed significant differences between benign and malignant tumors in the sinonasal area （P=-0.000 1）.The accuracy of Ktrans,kep and ve in differentiation between benign and malignant sinonasal tumors were 72.0％,76.2％ and 67.1％,respectively.There were significant differences in kep and ve between malignant epithelial sinonasal tumors and lymphomas （P ＜0.05）.Using a ve value of 0.213 as the threshold value differentiated malignant epithelial tumors from lymphomas with an accuracy of 78.3％,sensitivity of 88.2％,specificity of 68.0％,positive predictive value of 66.7％,and negative predictive value of 90.9％.However,no significant difference in Ktrans and kep was found between malignant epithelial and non-epithelial tumors in the sinonasal area （P ＞0.05）.Conclusions It is feasible that quantitative parameters of tumors can be derived from clinically used DCE-MRI in the sinonasal region.Preliminary findings suggest an     

正常胰腺64排螺旋CT灌注成像研究

目的:利用MSCT灌注成像技术,探讨正常胰腺64排螺旋CT灌注参数特征。方法:对非胰腺疾病60例患者行胰腺64排MSCT灌注扫描及常规双期增强扫描,计算出BF,PEI,TTP,BV感兴趣区的灌注参数,分析正常胰腺的灌注参数及特点。结果:正常胰腺的BF值随着年龄的增大呈明显下降趋势,且灌注参数BF值与年龄呈负相关。TTP值随着年龄的增加呈上升趋势,不同年龄组之间PEI、BV值的差异无统计学意义(P>0.05);不同年龄段正常胰腺胰头部和胰体尾部BF、PEI、TTP、BV值差异无统计学意义(P>0.05)。结论:胰腺64排螺旋CT灌注成像方法简单可行,能反映胰腺组织的血流动力学变化。     

肺良恶性结节或肿块CT灌注研究

目的探讨肺内不同良恶性结节或肿块的CT灌注特点,提高鉴别诊断水平。方法回顾性分析了2007年5月至2013年5月入住我院的110例肺部病变患者的临床资料,其中肺癌50例,肺良性肿物60例。应用PHILIPS BRILLIANCE 16层螺旋CT对上述两组患者肺部进行扫描,并使用CT灌注软件包一般灌注模式进行分析,对两组病变的灌注值(PV)、血容积(BV)、最高强化值(PEI)以及达峰时间(TTP)进行测定与记录。结果 (1)高、中分化肺癌组(n=24)与低、未分化肺癌组(n=26)PV、PEI及BV值相比,差异均具有统计学意义(P0.05,P0.01),但两组TTP无统计学差异(P0.05);(2)肺良性肿物组(n=60)与肺癌组(n=50)PV及PEI相比,差异均具有统计学意义(P0.05),但两组BV及TTP相比,差异无统计学意义(P0.05);(3)肺鳞癌组(n=28)与肺腺癌组(n=22)PV、PEI、BV及TTP相比,差异均无统计学意义(P0.05)。结论 16层螺旋CT灌注成像能够定量地反映肺内肿块血供特点的相关信息,有利于肺癌与肺内良性结节或肿块的鉴别诊断的鉴别诊断具有较高的价值,值得推广并应用。     

肺癌CT灌注成像与微血管管腔化程度的相关性

目的：探讨肺癌CT灌注成像与微血管管腔化程度的关系。方法：对36例肺癌结节进行CT灌注成像,记录灌注参数,包括血流量（BF）、血容量（BV）和最高增强值（PEI）,将各值分别与肺癌的微血管密度（MVD）、未形成完整管腔的MVD以及分化程度做相关性分析;将36例肺癌按灌注参数高低分为高灌注组与低灌注组,分析2组微血管管腔化程度和分化程度的差异。结果：36例肺癌结节灌注参数BF,BV和PEI的值分别为(39.7±11.5)mL/(100 mg·min),(8.6±3.8)mL/100 g 和(20.1±8.6)HU。PEI与MVD呈正相关（r=0.645,P＜0.01）,BF与MVD呈负相关（r=-0.280,P=0.048）;BF,BV,PEI与未形成完整管腔的MVD均呈负相关（均P＜0.05）,其中BF与未形成完整管腔的MVD相关性最高（r=-0.882,P＜0.01）。高灌注组中未形成完整管腔的MVD低于低灌注组,2组MVD无明显差别。BF,BV,PEI与分化程度均呈负相关,其中BF与分化程度的相关性最高（r=-0.751,P＜0.01）。结论：CT灌注成像有助于判定肺癌分化程度与血管生成状态,其病理基础主要与病变微血管管腔化程度有关。     

多层螺旋CT灌注成像在肺部肿块诊断及鉴别诊断中的应用价值

目的探讨多层螺旋CT灌注成像对肺部肿块的诊断价值。方法对49例确诊的肺部肿块(结节)性病变进行前瞻性CT灌注成像分析并记录血流量(BF)、血容量(BV)、平均通过时间(MTT)和毛细血管表面通透性(PS)及肿块的时间-密度曲线(TDC)。结果49例中,恶性肿块组36例,良性肿块组13例。两组病变间BF、BV、PS值均表现为恶性>良性,两组间差异有显著性意义(P<0.01);两组间MTT值差异无显著性意义(P>0.05)。肺部恶性肿块的时间-密度曲线有明显的上升支,达峰值后走行平缓;良性肿块曲线走行平坦,无明显上升支。结论CT灌注成像能较全面地反映肺部病变的血流信息,可为肺部肿块的诊断及鉴别诊断提供有价值的信息。     

鼻咽癌MSCT灌注与其肿瘤分期的关系

目的研究鼻咽癌MSCT灌注值与肿瘤分期的关系,探讨MSCT灌注成像对鼻咽癌分期的价值。方法经活检病理证实的鼻咽癌35例,静脉注射对比剂后行GT灌注扫描,动态图像经function CT软件处理,分别测量鼻咽癌肿瘤部位的血流量（BF）、最大强化指数（PEI）、峰值到达时间（TTP）及血容量（BV）作为灌注指标,CT灌注值和肿瘤分期采用Spearman等级相关分析。结果35例鼻咽癌肿瘤CT灌注值BF为（51.65±3.25）·ml·100g^-1·min^-1,其余各参数分别为PEI（28．65±1.52）HU．TTP（30.68±2.01）s,BV（12.49±1.07）ml／100g,PEI和BV与鼻咽癌分期之间呈正相关（rs=046,rs=0．55,P〈005）,BF和BV与鼻咽癌独立T分期之间呈正相关（rs=0．37,rs=042,P〈0．05）,其余指标与独立的T分期和N分期无相关性。结论鼻咽癌具有特征的CT灌注表现,CT灌注中的PEI和BV值与鼻咽癌的TNM分期均存在一定的相关性,CT灌注值可以反映鼻咽癌分期的部分特点。     

低剂量CT灌注成像在直肠癌诊断中的应用

目的探讨低剂量CT灌注成像在直肠癌诊断中的应用。方法收集2014年12月至2017年12月我院接收的疑似直肠癌病变患者110例临床资料,所有患者均接受低剂量CT灌注扫描,以纤维肠镜检结果分为良性组(80例)与恶性组(30例),分析低剂量CT灌注成像对直肠癌鉴别的准确性。结果与良性组相比,恶性组直肠癌患者的血容量(BV)、血流量(BF)增加,平均通过时间(MTT)及达到峰值时间(TTP)降低,差异均有统计学意义(P<0.05);低剂量CT灌注成像诊断结果与镜检结果相比,其灵敏度、特异度、准确率、kappa值分别为86.67%、96.25%、93.64%、0.838。结论低剂量CT灌注成像可以反映直肠癌组织血流动力学变化,对直肠癌鉴别有一定的诊断价值。     

多层螺旋CT灌注成像在肾脏良恶性肿瘤鉴别诊断中的临床应用

目的探讨多层螺旋CT(MSCTPI)灌注成像在肾脏良恶性肿瘤鉴别诊断中的应用价值。方法采用多层螺旋CT机对正常健康志愿者20例(对照组)及经手术病理证实的肾透明细胞癌患者22例(肾癌组)、肾错构瘤患者18例(肾错构瘤组)的肾皮质CT灌注参数进行检测,分别计算:灌注(perfusion);相对组织血容量(rBV);峰值时间(TTP);峰值增强影像(PEI)。结果①肾癌组的Perfusion、PEI值明显低于对照组,而rBV、TTP值明显高于对照组;②肾错构瘤组的Perfusion、PEI值明显低于对照组,而rBV、TTP值明显高于对照组;③肾癌组的perfusion、PEI值明显高于肾错构瘤组,而rBV、TTP值明显低于肾错构瘤组。结论多层螺旋CT灌注扫描技术能够较好地反映正常肾组织及肾脏良恶性肿瘤的血流动力学变化,为肾脏良恶性肿瘤的诊断与鉴别诊断提供可靠的依据,具有重要的临床应用价值。     

CT灌注技术在甲状腺肿瘤的应用

目的研究不同CT灌注采样方法对甲状腺病变评价的影响,以及甲状腺良、恶性病变的灌注参数特点。方法经手术病理证实的15例甲状腺良性肿瘤和10例甲状腺恶性肿瘤行多层螺旋CT灌注扫描,采用两种不同的采样方法,比较其灌注参数的差异性,并分析比较良、恶性肿瘤的灌注参数特点及其差异。采样方法Ⅰ：对所有病变进行整体采样（采样面积为各肿块面积的90％～100％）;采样方法Ⅱ：对病变实性强化部分进行采样,兴趣区10mm^2～20mm^2。以血流量（blood flow,BF）、血容量（blood volume,BV）、平均通过时间（mean transit time,MTT）、达峰时间（time to peak,TTP）作为评价CT灌注的参数。结果方法Ⅰ、Ⅱ中病变区的BF分别为135.86±53.5／235.34±43.51;BV分别为56.71±13.42／75.89±22.15;MTT分别为46.74±13.42／23.56±13.34;TTP分别为33.57±15.45／22.16±13.36。方法Ⅰ与方法Ⅱ的CT灌注参数BF、BV、MTT、TTP差异有统计学意义（P〈0.05）。方法Ⅰ中良、恶性病变的备参数值差异均无统计学意义;方法Ⅱ中MTT、TTP的差异有统计学意义（P〈0.05）。结论不同的CT灌注采样方法导致不同的评价结果,对明显不均匀强化的病变进行细致分析,采用方法Ⅱ更为适宜。MTT、TTP对甲状腺良、恶性病变的鉴别有一定参考意义。     

孤立性肺结节CT灌注的血流特征及应用研究

目的应用多层螺旋CT灌注成像研究孤立性肺结节的血流灌注特点并评价其在鉴别诊断结节良恶性中的应用价值。方法对44例孤立性肺结节患者行灌注扫描，分别测得结节血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面通透性（PS）值及拟合时间-密度曲线（TDC），并可在时间-密度曲线的基础上，测定孤立性肺结节增强前后的CT值、增强峰值、增强净增值、达峰时间等形态学指标。结果肺恶性结节的BF、BV、PS值及增强峰值、增强净增值、达峰时间均高于肺良性结节，有显著性差异（P值均〈0．05）。良，恶性结节的TDC形态不同。净增值25Hu可作为恶性结节的诊断阈值。结论CT灌注成像可反映孤立性肺结节内的血流动力学特点，并可用于无创性诊断和评价孤立性肺结节。     

CTP评估周围型肺癌组织学类型、分期及肿瘤坏死的价值

目的研究胸部C T灌注成像(CTP)对周围型肺癌组织学类型、分期及肿瘤坏死的评估价值。方法选取我院52例病理证实为周围型肺癌的患者为研究对象,CT观察大小、形态、密度等情况,计算患者CT灌注参数,包括灌注值(PER)、强化峰值(PE)、血容量(BV)、对比剂达峰值时间(TTP),分析不同组织学类型、分期以及肿瘤坏死患者的CT灌注值差异。结果临床分期:T1与T2比较,PER、PE、BV显著较高(P0.05),TTP显著较低(P0.05),T2与T3比较,PER、PE、BV显著较低(P0.05),而T2、T3患者TTP比较无统计学意义(P0.05);组织学类型:小细胞癌PER、PE、BV分别为(64.52±34.36)、(60.20±31.74)、(34.12±16.36)较高(P0.05),腺癌鳞癌,但比较均无统计学意义(P0.05);肿瘤坏死:未坏死组PER、PE、BV与坏死组比较显著较高(P0.05),TTP与坏死组比较显著较低(P0.05)。结论胸部CT灌注扫描对周围型肺癌患者分期、组织学类型及肿瘤坏死有一定的鉴别价值,尤其对于肿瘤是否出现坏死的反映明显,可为周围型肺癌早期诊断、术前分期及预后评价等提供重要的临床依据。