CT灌注成像在肺癌疗效评价中的应用

目的探讨CT灌注成像在肺癌放化疗疗效评价中的应用价值。资料与方法 23例经穿刺病理证实的肺癌初治患者于放化疗前及放化疗结束后1周内分别行CT灌注扫描。在工作站自动生成时间-密度曲线、组织灌注值、血容量、达峰时间及灌注伪彩图。比较肺癌治疗前后瘤区各灌注参数的变化。结果根据RECIST标准,经6个月随访,治疗有效16例,无效7例,有效组治疗前平均灌注值、血容量、强化幅度及结节-主动脉强化比值均高于无效组,差异有统计学意义(t=3.55、3.19、2.26、4.41,P<0.05)。有效组治疗后平均灌注值、血容量、强化幅度及强化比值均较治疗前显著降低,差异有统计学意义(t=7.87、8.16、7.48、6.78,P<0.01)。无效组治疗前后各灌注参数差异无统计学意义(P>0.05)。放疗患者中灌注伪彩图形象显示出肿瘤组织及周围肺不张。结论 CT灌注扫描能够反映肿瘤的血供情况,并可定量评价肺癌放化疗前后血流灌注的改变,早期预测治疗效果,优化放化疗方案。

CT Perfusion Imaging in Diagnosing and Evaluating Therapeutic Effect on Lung Cancer

Purpose To evaluate the value of CT perfusion imaging in diagnosing therapeutic effect of lung cancer. Materials and Methods Twenty-three patients with lung cancer proved histologically underwent CT perfusion scanning before and after chemotherapy or radiation therapy. All data were automatically analyzed, and obtained time-density curve (TDC), perfusion (P), blood volume (BV), time to peak (TTP) and the transverse functional CT map images. The changes of each parameter before and after therapy were compared. Results According to the response to chemotherapy or radiation therapy based on RECIST and followed up for 6 months, 16 out of 23 patients obtained effective treatment, and 7 patients obtained ineffective treatment. The mean P, BV, enhancement extent and ratio of nodule to artery for 23 patients obtained effective treatment before treatment were statistically higher than those obtained ineffective treatment (t=3.55, 3.19, 2.26, 4.41, P< 0.05). After treatment, the mean P, BV, enhancement extent and ratio of nodule to artery for 23 patients obtained effective treatment were significantly decreased than those before treatment (t=7.87, 8.16, 7.48, 6.78, P < 0.01). No obvious difference in any parameter for 7 patients obtained ineffective treatment was observed before and after treatment (P> 0.05). Transverse functional CT map images showed tumor and surrounding atelectasis. Conclusion CT perfusion scanning can reflect the blood supply of tumors, and quantitatively assess the changes of blood perfusion before and after treatment of lung cancer, further early predict the outcome and optimize the chemotherapy and radiation therapy.