首过双入口灌注CT成像在诊断孤立性肺结节的作用研究

发布时间：2018-03-07 06:19

  本文选题：孤立性肺结节　切入点：体层摄影技术　出处：《延边大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨320排CT首过双入口灌注技术及灌注TDC曲线最大斜率法的应用对于孤立性肺结节良恶性的诊断价值。分析各个灌注值BF、PF、PI、TPF及灌注TDC曲线中左心房达峰时间前后出现的最大斜率对于鉴别良恶性孤立性肺结节的意义,为早期诊断、治疗、评估SPN提供依据。方法分析我院经CT平扫发现孤立性肺结节患者51例,均行320排双入口肺部灌注扫描,全部病例经病理证实,其中恶性结节35例,良性结节16例。所有扫描均选用东芝Aquilion One 320排CT Lung Perfusion扫描程序进行容积扫描,运用双入口体部灌注软件对数据进行采集与处理,通过软件运算获得良、恶性结节的肺动脉血流量(PF)、支气管动脉血流量(BF)及灌注指数(PI),并计算出总体灌注量(TPF)及分析病灶时间-密度曲线(TDC)在左心房达峰时间(LA-TTP)前后出现两段上升支曲线的斜率变化情况,分别获取的良、恶性SPN的灌注参数及LA-TTP前后SPN上升支曲线的斜率值。利用SPSS统计学软件对数据进行分析,以P0.05视为数据之间差异具有统计学意义。结果1.灌注参数:恶性、良性SPN的支气管动脉血流量(BF)比较有统计学差异(P0.01);恶性、良性SPN的灌注指数(PI)比较有统计学差异(P0.01)。其中,将良性组SPN分为炎性组SPN及结核球组SPN,分别对恶性组、炎性组、结核球组SPN的各灌注参数之间进行相互比较,恶性组SPN的BF值分别与炎性组BF值、结核球组BF值比较,存在有统计学差异(P0.01、P0.01);炎性组SPN的PF值分别与恶性组PF值、结核球组PF值比较,存在统计学差异(P0.01、P0.01);恶性组PI值、炎性组PI值、结核球组PI值进行相互比较,均有统计学差异(恶性组、炎性组比较P0.01,恶性组、结核球组比较P0.05,炎性组、结核球组比较P0.01);结核球组SPN的TPF值分别与恶性组TPF值及炎性组TPF值比较,存在统计学差异(P0.01、P0.05)。2.达峰时间比较:恶性、良性SPN的TDC曲线中肺动脉达峰时间(PA-TTP)、左心房达峰时间(LA-TTP)、主动脉达峰时间(A-TTP)、SPN达峰时间(SPN-TTP)进行比较,无统计学差异(P0.05)。3.最大斜率比较:恶性、良性组SPN的TDC曲线中,LA-TTP前出现的上升曲线的最大斜率、LA-TTP后出现的上升曲线的最大斜率、SPN的TDC曲线总体斜率,组间比较分别有统计学差异(P0.05、P0.01、P0.01)。在恶性组中LA-TTP前、后上升曲线的最大斜率比较有统计学差异(P0.01),称之为主动脉型曲线,恶性TDC曲线共计35例均为此类曲线;在良性组中LA-TTP前、后上升曲线的最大斜率比较有统计学差异(P0.01),称之为肺动脉型曲线,其中11例炎性SPN曲线呈典型的肺动脉型曲线,5例结核球SPN曲线呈上升缓慢的低平曲线,称为结核球型曲线。4.通过ROC曲线分析所得,灌注指数PI值的ROC曲线下面积最大,为0.952(P0.01),BF、PF 及 TPF 的 ROC 曲线下面积分别为 0.084、0.570、0.332,当PI取值47.85%,诊断恶性SPN的敏感度及特异度最高分别为87.50%、91.40%。5.应用Spearman相关分析所得,恶性组SPN的直径与PI值的相关性最大,相关系数为-0.701(P0.01),与BF、PF、TPF值的相关系数均没有PI值的相关系数高。6.各恶性病理分型的灌注值比较:进行腺癌、鳞癌、小细胞肺癌的各个灌注参数之间比较,无统计学差异(P0.05)。结论首过双入口 CT灌注技术所得到的灌注参数及病灶TDC曲线最大斜率法的应用可以对孤立性肺结节的血流供应情况及良恶性鉴别提供有力参考。
[Abstract]:Objective to investigate the application of 320 slice CT first pass perfusion technique and double entrance perfusion TDC curve of maximum slope method for the value of benign and malignant solitary pulmonary nodule diagnosis. Analysis of the various perfusion values of BF, PF, PI, TPF and TDC perfusion curve of left atrium reached the maximum slope of the peak time occurred before and after for identification of benign and malignant solitary pulmonary nodules significance for early diagnosis, treatment, provide the basis for the assessment of SPN. Methods: analysis of our hospital by CT scan found 51 cases of patients with solitary pulmonary nodules, underwent 320 slice dual entrance lung perfusion scan, all cases were confirmed by pathology, including 35 cases of malignant nodules, 16 cases of benign nodules. All scans are used for Toshiba Aquilion One CT Lung volume scanning of 320 slice Perfusion scanner, data acquisition and processing by using double entrance body perfusion software. Through the software operation was good, pulmonary blood flow of malignant nodules (PF), bronchial artery Blood flow (BF) and perfusion index (PI), and calculate the total perfusion (TPF) and analysis of time density curve (TDC) lesions in the left atrium peak time (LA-TTP) before and after the change of slope of the ascending branch curve two, respectively, obtained good, slope before and after the perfusion parameters and LA-TTP of malignant SPN SPN rising branch curve value. The data were analyzed by SPSS statistical software, using P0.05 as the statistically significant differences between the 1. data. Results: malignant bronchial artery perfusion parameters, blood flow in benign SPN (BF) were statistically significant difference (P0.01); malignant, benign SPN perfusion index (PI) compared with statistical difference (P0.01). Among them, the SPN group is divided into benign inflammatory group SPN and group SPN respectively for tuberculosis, malignant group, inflammatory group, the perfusion parameters between tuberculoma group SPN comparison, the SPN of malignant group BF respectively and inflammatory group BF, tuberculoma 缁凚F鍊兼瘮杈，

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