CT灌注成像评价乳腺癌腋窝淋巴结状态的临床应用价值

目的 探讨CT灌注成像(CTP)评价乳腺癌腋窝肿大淋巴结状态的临床应用价值.方法 对45例局限浸润性乳腺癌伴有临床可触及同侧腋窝淋巴结肿大患者的46个"靶"淋巴结进行多层螺旋CT(MSCT)动态增强扫描,在静脉内以4.0 ml/s流率注射40 ml对比剂后,对病灶5 min层厚连续4个层面行同层动态扫描,分别半自动计算"靶"淋巴结及其扫描层面肌肉组织灌注参数值:血流量(BF)、血容量(BV)、平均通过时间(MTY)和表面渗透性(PS),并使用非参数Mann-WhitneyU检验进行统计学分析.结果 46个腋窝"靶"淋巴结经术后病理学标本证实为转移性淋巴结32个、阴性14个(均为反应性增生淋巴结炎).32个转移性"靶"淋巴结中有22个为前哨淋巴结(68%).阴性和转移性"靶"淋巴结的灌注参数平均值分别为:BF(76.18±31.53)和(161.60±40.94)ml·100mg-1mg·min-1;BV(5.81±2.50)和(9.15±3.02)ml/100 mg;MTT(6.80±1.55)和(5.50 4±1.84)s;PS(25.82±4.62)和(25.96±7.47)ml·100 mg-1·min-1.转移性和阴性"靶"淋巴结BF之间的r=0.14,P<0.05,BV、MTY和Ps之间的r值分别为-0.03、0.05、0.07,P值均>0.05.结论 CTP在形态学基础上增加功能信息可为临床评价淋巴结状态提供有用信息.

The clinical application of CT perfusion in assessing the status of axillary lymph nodes in patients with breast cancer

Objective To evaluate the clinical application of CT perfusion in predicting the status of axillary lymph nodes in patients with breast cancer.Methods Fony-five patients with infiltrating breast cancers and 46 clinically palpable axillary lymph nodes underwent dynamic mtdti-slice spiral CT(MSCT).Semi-automatic calculation of perfusion parameters including blood flow(BF),blood volume(BV),mean transit time(MTT)and permeability surface(PS)of "target" lymph nodes and muscles in the same scan level were respectively meagured and analyzed.Nonparametric Mann-Whitney U test was used for the statistics.Results Forty-six "target" lymph nodes examined by CTP were metastasis in 32 cases and reactive hyperplastic lymph node inflammation in 14 cases at pathology.22 of 32 metastatic "target" nodes (68%)were sentinel lymph nodes(SLN).BF of CIP for inflammation and metastatic "target" nodes were (76.18±31.53)and(161.60±40.94)ml·100 mg-1·min-1,BV were(5.81±2.50)and(9.15±3.02)ml／100 mg.MTT were(6.80±1.55)and(5.50±1.84)s,PS were(25.82±4.62)and (25.96±7.47)ml·100 mg-1·min-1.There were significant correlations between the BF value of inflammation and metastatic "target" nodes(r=0.14,P<0.05)and there were no significant correlations among the BV,MTT and PS values of inflammation and metastatic "target" nodes(r=-0.03,0.05,0.07.P>0.05).Conelusion CTP can provide useful informafion for evaluating lymph node status.