320排CT双入口灌注技术在肺癌术前评估中的应用价值

发布时间：2018-02-11 17:24

本文关键词： 双入口灌注肺癌病理类型淋巴结 Ki67　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景近年来,随着环境污染的加重,肺癌的发病率及死亡率仍居于所有恶性肿瘤首位。由于其早期临床症状无特异性,发现时多数处于中晚期,2/3患者确诊时已失去手术机会,预后欠佳。因此早发现、早诊断、早治疗对肺癌患者的预后及生活质量的提高有着重要的临床价值;临床治疗方案的制定及预后与肺癌的病理类型及准确分期、分级密切相关。所以,对肿瘤作出明确的诊断和精确的分级、分期有助于治疗方案的选择,从而可改善患者的生存质量、提高生存期。目的探讨320排CT双入口灌注技术在术前评估肺癌的病理类型、有无纵隔淋巴结转移及Ki67阳性表达率的应用价值。材料和方法选取郑州大学第一附属医院2015年10月-2016年12月经穿刺或术后病理证实的肺癌患者71例(男39例,女32例),年龄32-70岁,中位年龄56岁。采用东芝320排CT(Aquilion ONE,Toshiba Medical Systems,Otawara,Japan)扫描仪对所有患者进行肺部动态容积灌注扫描,运用双入口灌注(Dual-input CT perfusion,DI-CTP)模式对图像进行后处理,得到三个灌注参数:体循环中的支气管动脉血流量(BAF,bronchial artery flow)、肺循环中的肺动脉血流量(PAF,pulmonary artery flow)及灌注指数[PI=PAF/(BAF+PAF),perfusion index];采用方差分析探讨腺癌、鳞癌及小细胞肺癌的DI-CTP参数的差异;采用独立样本t检验分析纵隔淋巴结转移与肺癌原发灶的DI-CTP参数的关系,并运用ROC曲线分析DI-CTP参数评价肺癌纵隔淋巴结转移的诊断效能;根据免疫组化结果,将Ki67阳性表达率按弱(10%-25%)、中(26%-50%)、强(50%)分为3组,采用Spearman秩相关分析对DI-CTP参数及Ki67阳性表达率作统计学处理。结果1.经穿刺或术后病理证实肺癌共71例,其中腺癌25例,鳞癌22例,小细胞肺癌18例,其他病理类型肺癌共6例,包括神经内分泌癌2例、腺鳞癌3例、肉瘤样癌1例。鳞癌、腺癌及小细胞肺癌三组的DI-CTP参数PAF、BAF、PI间的差异无统计学意义(P0.05)。2.61例患者行淋巴结清扫术,有淋巴结转移组(27例)BAF高于无淋巴结转移组(34例),差异有统计学意义(t=4.173,P0.001);有淋巴结转移组PI低于无淋巴结转移组,差异有统计学意义(t=-3.378,P=0.001);两组PAF间的差异无统计学意义(P0.05)。三个参数中,BAF的ROC曲线曲线下面积最大,为0.773,当以BAF56.42ml·min-1·(100ml)-1作为预测肺癌纵隔淋巴结转移的临界值时,灵敏度为74.1%,特异度为76.5%;PI的ROC曲线下面积为0.739,以PI41.57%作为预测纵隔淋巴结转移的临界值时,灵敏度为82.4%,特异度为66.7%。3.53例患者行Ki67免疫组化检查,低表达15例,中表达15例,高表达23例;经Spearman秩相关分析得到:BAF与Ki67阳性表达率呈正相关(r=0.759,P0.001),PI与Ki67的阳性表达率呈负相关(r=-0.534,P0.001),PAF与Ki67的阳性表达率无相关性(P0.05)。结论肺癌DI-CTP参数PAF、BAF及PI与肺癌的病理类型无关;肺癌DI-CTP参数对术前预测肺癌是否发生纵隔淋巴结转移及Ki67的阳性表达率的强弱有重要参考价值,从而可为术前评估肺癌的生物学行为、术前分期及治疗方案的制定等提供参考。
[Abstract]:Background: in recent years, with the increase of environmental pollution, the incidence and mortality of lung cancer among all malignant tumors is still first. Because of no specific clinical symptoms in its early stage, the majority found at advanced stage, 2/3 patients have lost the chance of operation, the prognosis is poor. Therefore early detection, early diagnosis, early treatment of patients with lung cancer the prognosis and improve the quality of life has important clinical value; pathological type clinical treatment planning and prognosis of lung cancer and tumor staging and grading are closely related. So, make a clear diagnosis and accurate classification of tumor staging, contribute to the choice of treatment, which can improve the quality of life of patients, improve objective to investigate the survival. 320 rows of CT double entrance perfusion technology assessment of pathological types of lung cancer before operation, there is no value of mediastinal lymph node metastasis and the positive expression rate of Ki67 in the selection of materials and methods. 71 patients with lung cancer in October 2015 of the First Affiliated Hospital of Zhengzhou University -2016 12 menstrual biopsy or postoperative pathology cases (male 39 cases, female 32 cases), age 32-70 years, median age was 56 years. The Toshiba 320 slice CT (Aquilion ONE, Toshiba Medical Systems, Otawara, Japan) of the lung perfusion scan of dynamic volume all patients with the scanner, the use of double entrance perfusion (Dual-input CT perfusion, DI-CTP) model for image postprocessing, get three perfusion parameters: bronchial artery blood flow in the systemic circulation (BAF bronchial, artery flow), pulmonary artery blood flow in the pulmonary circulation (PAF pulmonary, artery flow) and perfusion index [PI=PAF/ (BAF+PAF), perfusion index]; by analysis of variance of adenocarcinoma, the differences of DI-CTP parameters of squamous cell carcinoma and small cell lung cancer; independent samples t test was used to analyze the DI-CTP parameter of mediastinal lymph node metastasis and primary tumor. System, and using the ROC curve analysis of diagnostic efficacy evaluation of mediastinal lymph node metastasis DI-CTP parameters; according to the results of immunohistochemistry, the positive expression rate of Ki67 (10%-25%), according to the weak in (26%-50%), strong (50%) divided into 3 groups, using Spearman rank correlation analysis for statistical processing of the DI-CTP parameter and Ki67 positive the expression rate of 1.. The results by biopsy or postoperative pathology confirmed lung cancer were 71 cases, including 25 cases of adenocarcinoma, 22 cases of squamous cell carcinoma, 18 cases of small cell lung cancer and other pathological types of lung cancer were 6 cases, including 2 cases of neuroendocrine carcinoma, 3 cases of adenosquamous carcinoma, 1 cases of sarcomatoid carcinoma. Squamous cell carcinoma, DI-CTP parameters PAF, three groups of adenocarcinoma and small cell lung cancer BAF, there was no significant difference between PI (P0.05).2.61 patients underwent lymph node dissection, lymph node metastasis group (27 cases) BAF higher than the group without lymph node metastasis (34 cases), the difference was statistically significant (t=4.173, P0.001); lymph node metastasis was lower than that without lymph node PI Transfer group, the difference was statistically significant (t=-3.378, P=0.001); there was no significant difference between the two groups of PAF (P0.05). Three parameters, ROC curve area under the BAF curve of the maximum is 0.773, when the BAF56.42ml min-1 (100ml) -1 as a predictor of mediastinal lymph node metastasis of the critical value, the sensitivity was 74.1%, specificity was 76.5%; the area under the PI curve of ROC was 0.739, with PI41.57% as a predictor of mediastinal lymph node metastasis of the critical value, the sensitivity was 82.4%, specificity of 66.7%.3.53 patients underwent Ki67 immunohistochemical examination, 15 cases low expression, the expression of 15 cases, 23 cases of high expression; by Spearman rank correlation analysis: BAF was positively correlated with the positive expression rate of Ki67 (r=0.759, P0.001), the positive expression of PI and Ki67 was negatively correlated (r=-0.534, P0.001), the positive expression of PAF and Ki67 was no significant correlation (P0.05). The lung cancer DI-CTP parameters PAF, BAF and PI and lung cancer pathology the The DI-CTP parameters of lung cancer have important reference value for predicting the mediastinal lymph node metastasis and the positive expression rate of Ki67 before operation, so that it can provide references for preoperative assessment of biological behavior, preoperative staging and treatment plan of lung cancer.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2;R730.44

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