多层螺旋CT灌注成像技术在良恶性肺结节鉴别诊断中的应用价值

目的探讨64排螺旋CT灌注成像在孤立性肺结节的良恶性鉴别诊断中的应用价值。方法29例孤立性肺结节（直径≤4cm，20例恶性，9例良性）患者，其中男性20例，女性9例，年龄28～76岁，平均年龄59．7岁。应用64排螺旋CT对孤立性肺结节行灌注扫描（造影剂总量100m1,流速4ml／s）。将动态扫描数据输入GE工作站（ADW4．2P），应用工作站随机Perfusion 3-体部肿瘤软件包分析和测定肺内病灶的血容积（BV）、血流量（BF）、平均通过时间（MTT）、表面通透性（PS）的数值和时间-密度曲线（time—density curve，TDC），并测量孤立性肺结节增强前的CT值、强化值、结节／动脉强化值比。结果肺恶性结节的灌注参数均高于肺良性结节，BF、BV、PS值均有统计学意义（P〈0．05），BV的差异最显著。以BV≥4ml／100mg为诊断阈值，结节BV≥4ml／100mg的诊断为恶性，敏感性95％、特异性100％。恶性结节的强化值和结节／动脉强化值比均明显高于良性结节（P=0．002．P=0．020）。结论动态对比增强CT提供了孤立性肺结节的血流模式的定量信息,可用于无创性的诊断和评价孤立性肺结节。

The differential diagnostic value of perfusionimaging with multislice spiral CT in solitary pulmonary nodule DING Yi,

Objective To evaluate the differential diagnostic ability of 64-slice spiral CT perfusion imaging between benign and malignant solitary pulmonary nodules（SPN）. Methods Atotalof29patientswithsolitarypulmonarynodules（diameter ≤ 4cm, 20 malignant,9 benign）, male 20,female 9,aged 28 - 76 years, mean age 59.7 years,were performed perfusion scanning with 64-slice spiral CT （the total dose of contrast material was 100 ml ,with injection rate 4 ml/s）. All the data were measured by GE workstation （ADW4.2 platform ）.With the CT perfusion 3-body tumor software, the parameters of CT perfusion including blood volume （BV） ,blood flow （BF） ,mean transit time （MTT） ,permeability surface （PS）and time-density curve （TDC）were analyzed. The TDC were created according to a region of interest （ROI） drawn over nodules. The per-contrast density,the peak value in density,enhancement value （= peak height density subtract per-contrast density）and SPN-to-aorta enhanced ratio were measured. Results These parameter values in pulmonary malignant nodules were all higher than those in pulmonary benign nodules. There were significant differences in BF, BV and PS （P 〈 0.05 ） between 2 groups, especially in BV （P = 0.0000）. When BV ≥ 4 ml/100 mg was set as a diagnostic threshold, the lesions with ≥ 4 ml/100 mg were diagnosed as malignant. The sensitivity and specificity in differential diagnosis was 95 % and 100 %, respectively. The enhancement value and SPN-to-aorta enhanced ratio of the malignant nodules was significantly higher than that of benign nodules （P = 0.002 ,P = 0.020）.Conclusion Dynamic contrast enhanced functional CT can provide quantitative information about blood flow patterns of SPNs and it is proved to be an alternate non-invasive option in the evaluation and management of SPN.