SPECT肺灌注与CT异机融合图像评价非小细胞肺癌肺功能的价值

目的 探讨SPECT肺灌注与CT异机融合图像评价Ⅲ期非小细胞肺癌(NSCLC)患者区域肺功能的意义.方法 选择Ⅲ期NSCLC患者32例,治疗前行肺功能测试和胸部CT扫描,并在相同体位下行SPECT肺灌注显像,两套图像均传至Philips Pinnacle3放射治疗计划系统,依据外标记点进行手动异机图像融合.参考CT与SPECT肺灌注融合图像,按灌注缺损区与肿瘤病灶的大小关系分为4级:0级为无灌注受损;1级为肿瘤及其周围局部肺灌注受损;2级为1叶肺灌注受损;3级为超过1叶肺灌注受损.采用SPSS 13.0软件,行PearsonX2检验.结果 32例Ⅲ期NSCLC患者中,31例有程度不等的肺灌注缺损,其中1级13例,2级8例,3级10例.中央型NSCLC患者肺灌注缺损较周围型NSCLC患者严重,差异有统计学意义(X2=10.495,P＜0.05).8例患者肺功能测试有不同程度的异常.CT与SPECT肺灌注融合图像阳性率96.9%(31/32),较肺功能测试阳性率25.0%(8/32)高,差异有统计学意义(X2=34.724,P＜0.05).结论 SPECT肺灌注与CT异机融合图像能更好显示Ⅲ期NSCLC患者区域肺组织的功能状况,为此类患者制订手术方案、预测术后肺功能、优化放疗计划等提供更多的信息.

Value of fusion SPECT lung perfusion and CT images in the evaluation of lung function for patients with non-small cell lung cancer

objective The aim of this study was to assess the value of fusion SPECT perfusion and CT images acquired separately at 2 time-points in evaluating regional lung function of patients with stage Ⅲ non-small cell lung cancer(NSCLC).Methods Thirty-two patients with untreated stage Ⅲ NSCLC underwent pulmonary function test(PFT),CT and SPECT imaging.Two series of images were registered by software fusion based on external markers by Philips Pinnacle3 planning treatment system.The SPECT/CT fu sion images were graded by comparing lung perfusion defect with the area of radiological abnormality.Grade O:no lung perfusion defect in the area of radiological abnormality.Grade 1:the area of lung perfusion defect was similar to the size of radiological abnormality.Grade 2:the area of lung perfusion defect was bigger than that of radiological abnormality.and extended to 1 pulmonary lobe.Grade 3:the area of lung perfusion defect exceeded 1 pulmonary lobe.Statistically significant difference was evaluated by Pearson X2-test using SPSS 13.0 software.Results In 32 patients with stage Ⅲ NSCLC,31 patients had lung perfusion defects.There were 13 patients with grade 1,8 with grade 2,10 with grade 3.There was statistically significant difference between central lung cancer and peripheral lung cancer(X2=10.495,P＜0.05);8 patients had PFT abnormality.There was also statistically significant difference between the positive rate of SPECT/CT fusion images and PFT96.9%(31/32)vs 25.0%(8/32),X2=34.724,P＜0.05].Conclusion The fusion of SPECT lung perfusion and CT images acquired separately at 2 different time-points is a feasible technique for assessing the regional lung function of patients with stageⅢNSCLC,thereby offering more information for surgical planning,prediction of postoperative lung function and optimization of radiation treatment plans.