320层容积CT灌注成像诊断肺孤立性结节

目的 评价320层容积CT灌注成像鉴别诊断肺孤立性结节的价值。 方法 分析63例直径≤3 cm肺孤立性结节的容积CT灌注成像表现,其中恶性结节组30例,慢性炎性结节组17例,急性炎性结节组7例,良性结节组9例。采用320层容积CT灌注成像,用体部肿瘤灌注软件得到肺动脉灌注值(PP)、支气管动脉灌注值(BP)、灌注指数(PI)和时间-密度曲线(TDC),评价灌注参数的诊断效能。 结果 恶性结节组、良性结节组、慢性炎性结节组及活动性炎性结节组PP值分别为(67.50±21.78)ml/(100 ml·min)、(30.11±13.24)ml/(100 ml·min)、(81.11±21.11)ml/(100 ml·min)、(106.34±7.80) ml/(100 ml·min),BP分别为(80.40±20.96)ml/(100 ml·min)、(27.00±14.18)ml/(100 ml·min)、(50.75±21.89)ml/(100 ml·min)、(11.06±4.31)ml/(100 ml·min),PI分别为(45.87±7.60)%、(51.13±7.44)%、(48.09±13.12)%、(75.91±10.13)%。4组SPN的TDC类型不同,恶性结节组的TDC A型27例(27/30,90.00%),B型3例(3/30,10.00%);良性结节组的TDC为C型(9/9,100%);慢性炎症结节组的TDC共4种类型,B型7例(7/17,41.18%),C型1例(1/17,5.88%),D型4例(4/17,23.53%),B^-型5例(5/17,29.41%);急性炎症结节组的TDC为E型(7/7,100%)。BP在所得参数中鉴别各组最优。以PI>70%作为急性炎性结节的诊断阈值,敏感度100%(7/7),特异度100%(56/56);以PP<45 ml/(100 ml·min)且BP<50 ml/(100 ml·min)作为良性结节的诊断阈值,其敏感度、特异度、阳性预测值及阴性预测值分别为81.82%(9/11)、88.46%(46/52)、60.00%(9/15)、95.83%(46/48)。 结论 320层容积CT灌注成像对于在肺孤立性结节中鉴别恶性及良性结节,包括急性炎性、慢性炎性具有较高价值。

320-detector row CT volume lung perfusion imaging in diagnosis of solitary pulmonary nodule

Objective To investigate the value of 320-detector row CT volume perfusion imaging in the diagnosis of solitary pulmonary nodules (SPN).Methods CT perfusion characteristics of 63 patients with SPN were analyzed. All patients were proved with pathology, including malignant nodules (n=30), chronic inflammatory nodules (n=17), activity inflammatory nodules (n=7) and benign nodules (n=9). The time-density curve (TDC) and parameters including pulmonary perfusion (PP), bronchial perfusion (BP), pulmonary index (PI) were analyzed. Results PP of malignant nodules, chronic inflammatory nodules, acute inflammatory nodules, benign nodules was (67.50±21.78) ml/(100 ml·min), (30.11±13.24) ml/(100 ml·min), (81.11±21.11) ml/(100 ml·min) and (106.34±7.80) ml/(100 ml·min), respectively, while BP was (80.40±20.96) ml/(100 ml·min), (27.00±14.18) ml/(100 ml·min), (50.75±21.89) ml/(100 ml·min) and (11.06±4.31) ml/(100 ml·min), PI value was (45.87±7.60)%, (51.13±7.44)%, (48.09±13.12)% and (75.91±10.13)%, respectively. TDC of malignant nodules was defined as A (27/30, 90.00%) and B (3/30, 10.00%), of benign nodules was C (9/9, 100%), of chronic inflammatory nodules was defined as B (7/17, 41.18%), C (1/17, 5.88%), D (4/17, 23.53%) and B^- (5/17, 29.41%), while of activity inflammatory nodules was E (7/7, 100%). BP was the best parameter for identification. When the cut-off of PI values was >70%, the sensitivity and specificity were all 100%. When PP<45 ml/(100 ml·min) and BP<50 ml/(100 ml·min) were taken as the diagnostic thresholds, the sensitivity, specificity, positive predict value, negative predict value and accuracy was 81.82% (9/11), 88.46% (46/52), 60.00% (9/15) and 95.83% (46/48), respectively. Conclusion 320-detector row CT volume perfusion imaging could be helpful to the differential diagnosis of SPN, especially for malignant nodules and benign nodules, including chronic inflammatory nodules and active inflammatory nodules.