双入口CT灌注对孤立性肺结节良恶性鉴别诊断的价值

发布时间：2018-05-26 10:57

本文选题：灌注 + 体层摄影术　；参考：《青岛大学》2017年硕士论文

【摘要】：目的探讨基于320排CT灌注采用DICTp模型区分肺内病变的两套循环血供,并对肺内孤立性结节(SPN)的定性诊断进行分析研究。方法收集青岛大学附属医院2014年6月至2016年6月69例SPN患者,采用CT双入口灌注模式,以CT值范围为-80—150HU(组1)、-200—150HU(组2)和-300—150HU(组3)分别进行计算,输入动脉为肺动脉、降主动脉;肺循环和体循环的分界线为左心房峰值时间,手动绘制病灶内的ROI,得到肺动脉血流量(pulmonary flow,PF)、支气管动脉血流量(bronchial flow,BF)及血流灌注指数[perfusion index,PI=PF/(PF+BF)]。由两名高年资医师采用双盲法独立分析灌注参数,并绘制ROC曲线,分析不同低阈值对灌注结果的影响,并比较灌注参数的特异性和敏感度,评价最佳灌注指数的实用性。结果以手术病理或随访资料作为金标准,8例临床资料失访。61例最终诊断为恶性病变有42例,非恶性病变有19例。PF在不同CT值范围中具有统计学差异,恶性病变PF(42.5-84)ml/min/100ml良性病变(41.8-55.6)ml/min/100ml,而BF、PI仅在A组具有统计学差异。其中A组肺恶性肿瘤的灌注参数为:PF(42.59±23.15)ml/min/100ml,BF(56.19±26.89)ml/min/100ml,PI(24.56±20.86)%。良性肿瘤的灌注参数为:PF(51.70±31.41)ml/min/100ml,BF(38.40±19.92)ml/min/100ml,PI(65.54±26.23)%。进一步分析ROC曲线发现,PI值最能鉴别良恶性。PI是三组灌注参数中最大的曲线下面积,为0.873,其灵敏度94.9%,特异度57.9%,阳性似然比是6.25,阴性似然比是0.08。结论肺癌有体循环和肺循环供血,其中体循环血供所占比例较大;而良性病变则为肺循环占优势。双入口灌注的PI指数可以作为一个有价值的判断良恶性的指标,其可能潜在具有对肺癌的治疗指导及放疗的疗效评估价值。
[Abstract]:Objective to study the diagnosis of pulmonary solitary nodule (SPN) by using DICTp model to distinguish two sets of circulating blood supply of pulmonary lesions based on 320 slice CT perfusion. Methods Sixty-nine patients with SPN from June 2014 to June 2016 in affiliated Hospital of Qingdao University were collected. Ct double-portal perfusion model was used. The CT values were calculated in the range of -80-150 HUU (group 1) and -300-150 HUU (group 3). The input artery was pulmonary artery. The dividing line of descending aorta and pulmonary circulation and systemic circulation was the peak time of left atrium. The pulmonary artery blood flow (pulmonary flow), bronchial flow (BF) and perfusion index (perfusion index) were obtained by drawing the ROI in the lesion by hand. Two senior doctors used double blind method to independently analyze perfusion parameters and draw ROC curves to analyze the effects of different low thresholds on perfusion results. The specificity and sensitivity of perfusion parameters were compared to evaluate the practicability of the best perfusion index. Results there were 42 cases of malignant lesions and 19 cases of non-malignant lesions. There were statistical differences in different CT values between 8 cases of missing clinical data and 61 cases of failure of clinical data, and 19 cases of non-malignant lesions. Malignant PF(42.5-84)ml/min/100ml benign lesions were 41.8-55.6ml / min / 100ml, while BFS Pi was only statistically different in group A. In group A, the perfusion parameters of lung malignant tumors were 42.59 卤23.15ml / min / 100ml / min / 100 ml / min = 56.19 卤26.89ml / min / 100ml / min / 100 ml / min = 24.56 卤20.86g / min respectively, and the perfusion parameters of group A were 42.59 卤23.15ml / min / 100ml / min respectively. The perfusion parameters of benign tumors were 51.70 卤31.41 ml / min / 100 ml / min, 38.40 卤19.92 ml / min / 100 ml / min = 65.54 卤26.23. Further analysis of ROC curve showed that Pi value was the largest area under the curve in the three groups of perfusion parameters. The sensitivity was 94.9 and the specificity was 57.9. The positive likelihood ratio was 6.25 and the negative likelihood ratio was 0.08. Conclusion there are systemic circulation and pulmonary circulation blood supply in lung cancer, in which the proportion of systemic circulation blood supply is larger, while the benign disease is the dominant pulmonary circulation. The Pi index of double inlet perfusion can be used as a valuable index for the diagnosis of benign and malignant tumor. It may have potential value in guiding the treatment of lung cancer and evaluating the curative effect of radiotherapy.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.44

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