靶向治疗非小细胞肺癌前后增强CT参数的改变及临床意义

目的研究靶向治疗非小细胞肺癌（NSCLC）前后实施CT增强动态扫描其定量参数的改变情况及临床意义。方法回顾性分析接受治疗的84例NSCLC患者临床影像学资料,全部患者治疗前后均予以CT增强动态扫描,观察病灶最大径、灌注值、M/A、Tp及PH的改变情况。结果 132例患者实施靶向治疗后,参考病灶的最大径改变,有76例为好转（好转组）,有28例为稳定（稳定组）,有28例为进展（进展组）。治疗后好转组病灶最大径、PH及灌注值较治疗前均显著减小且差异均有统计学意义（P〈0.05）;稳定组治疗前后最大径变化差异无统计学意义,同时PH、Tp、M/A值、灌注值较治疗前差异均无统计学意义（P〉0.05）;而进展组治疗后病灶最大径、PH及灌注值较治疗前均增大且差异均有统计学意义（P〈0.05）。对PH判定结果、灌注值判定结果分别与最大径判定结果进行判定一致性分析,结果显示,在判定NSCLC治疗效果方面,PH值、灌注值判定结果与最大径判定结果具有很高的一致性,Kappa值分别为0.757、0.616（均P〈0.05）。结论 NSCLC实施靶向治疗后,患者病灶的血流动力学及增强动态扫描的参数均发生改变,其中灌注值及PH改变能够反映治疗效果。当治疗为有效时,所得灌注值及PH均降低;为进展时,所得灌注值及PH均增大。肿瘤灌注值改变与病灶最大径对疗效判定具有一致性,可以将灌注值作为NSCLC靶向治疗效果的判定依据。

Change of quantitative parameters of dynamic enhanced CT scanning before and after targeted therapy for non-small cell lung cancer and its clinical significance

Objective To study the change of quantitative parameters of dynamic enhanced CT scanning before and after targeted therapy for non-small cell lung cancer（NSCLC） and its clinical significance. Methods Clinical images data of 132 patients with NSCLC were retrospectivele analyzed. All patients were given CT enhanced dynamic scanning, and the changes of the largest lesion diameter, perfusion value, M/A, Tp and PH were observed. Results 132 cases were given targeted therapy, after treatment refer to the largest diameter change, 76 cases were improved（improved group）,28 cases were stable（stable group）, 28 cases had progress（progress group）. In the improved group, after treatment the largest lesion diameter, PH and perfusion value decreased than before treatment, the differences were statistically significant（P〈0.05）. In stable group, there was no significant different in the largest lesion diameter, M/A, Tp, PH and perfusion value between before and after treatment（P〉0.05）. In progress group, after treatment the largest lesion diameter, PH and perfusion value increased than before treatment, the differences were statistically significant（P〈0.05）.Consistency analysis results showed that, in the aspect of determine treatment effect of NSCLC, PH value, perfusion value had very high consistency with the largest diameter, Kappa vaule were 0.757 and 0.616（P〈0.05）. Conclusion After targeted therapy for NSCLC, haemodynamics and enhanced dynamic scan parameters of lesions have changes, among which perfusion value and PH value were used to reflect the efficacy of treatment. When the treatment is effective, the perfusion value and PH are reduced; when the treatment has progress, the perfusion value and PH are increased. Tumor perfusion values change and lesions maximum diameter have consistency for therapeutic effect judgment. The perfusion value can be used as judgment reference for NSCLC targeted therapy effects.