孤立性肺结节双源CT灌注成像与微血管构成的相关性研究

发布时间：2018-08-22 21:05

【摘要】：目的:研究孤立性肺结节(SPN)双源CT灌注参数与有腔血管参数的相关性,探讨双源CT灌注成像诊断不同性质SPN的价值。方法:收集遵义医学院附属医院2015年1月至2016年9月经胸部CT平扫发现肺内结节并行双源CT灌注扫描后经手术病理证实的SPN患者65例,男43例,女22例,年龄23~74岁,平均51.27岁。将灌注图像传输至工作站(Siemens Syngo Multimodality workplace),选择VPCT body软件行图像后处理,获得时间-密度曲线(TDC)及血流量(BF)、血容量(BV)、表面通透性(PMB)、平均通过时间(MTT)等灌注参数和相应灌注伪彩图。采用PV-9000二步法免疫组化检测系统对65例SPN组织标本染色,然后对有腔血管数目(LVN)、有腔血管面积(LVA)、有腔血管周长(LVP)进行计数。根据病理结果将SPN分为恶性、良性及炎性三组,恶性组39例(腺癌21例,鳞癌12例,大细胞神经内分泌癌2例,腺鳞癌1例,小细胞癌1例,类癌1例,肉瘤样癌1例),良性组14例(结核球9例,曲菌病l例,炎性肌纤维母细胞瘤1例,硬化性血管瘤1例,神经纤维瘤1例,错构瘤1例),炎性结节组12例。观察三组不同性质SPN之间双源CT灌注参数及有腔血管参数的差异;分析SPN双源CT灌注参数与有腔血管参数的相关性;利用ROC曲线分析双源CT灌注参数判断恶性SPN的诊断效能。结果:(1)TDC:恶性结节组多呈Ⅰ型曲线,占74%(29/39),表现为速升速降型,降支伴平台期;炎性结节组多呈Ⅱ型曲线,占75%(9/12),表现为速升缓降型;良性结节组多呈Ⅲ型曲线,占86%(12/14),表现为平缓小幅度上升,在一定范围内波动。(2)恶性、炎性组的BF、BV、LVN、LVA及LVP值明显高于良性结节组,差异有统计学意义(P0.05);恶性组与炎性组间PMB、LVA、LVP的差异有统计学意义(P0.05),BF、BV、LVN的差异无统计学意义(P0.05)。恶性组PMB明显高于良性组,差异有统计学意义(P0.05),炎性组和良性组之间PMB差异无统计学意义(P0.05);恶性、炎性及良性组MTT组间比较,差异无统计学意义(P0.05)。(3)双源CT灌注参数BF、BV与LVN、LVA、LVP呈正相关,PMB与LVA、LVP呈正相关,MTT与LVN、LVA、LVP均无相关性。(4)当BF≥56 ml/100ml/min时,诊断恶性组SPN的敏感度为85%,特异度为54%;当BV≥6.34 ml/100ml时,诊断恶性组SPN的敏感度为82%,特异度为54%;当PMB≥8.88ml/100ml/min时,诊断恶性组SPN的敏感度为100%,特异度为50%;如果联合BF、BV与PMB,当BF≥60 ml/100ml/min,BV≥6.59 ml/100ml,PMB≥9.9 ml/100ml/min时,诊断恶性组SPN的敏感度为82%,特异度为62%。结论:良性、炎性及恶性组SPN的微血管构成存在显著差异;SPN双源CT灌注参数与有腔血管参数(LVN、LVA、LVP)存在相关性,可以作为无创地评价肿瘤血管生成的指标;双源CT灌注成像有助于SPN的诊断与鉴别诊断。
[Abstract]:Objective: to study the correlation between (SPN) perfusion parameters and luminal vascular parameters in solitary pulmonary nodules (SPN), and to explore the value of dual-source CT perfusion imaging in the diagnosis of SPN with different characteristics. Methods: from January 2015 to September 2016, 65 SPN patients (43 males and 22 females), aged 2374 years (mean 51.27 years), were diagnosed by plain chest CT scan and double-source CT perfusion scan in the affiliated Hospital of Zunyi Medical College. The perfusion images were transferred to the workstation (Siemens Syngo Multimodality workplace), to select the VPCT body software for post-processing. The perfusion parameters such as time-density curve (TDC) and (BF), blood volume (BV), surface permeability (PMB), average transit time (MTT) and the corresponding perfusion pseudo-color images were obtained. PV-9000 two-step immunohistochemical method was used to detect the number of SPN tissues in 65 cases, and then counted the number of (LVN), luminal vessels, the area of (LVA), vessels and the circumference of (LVA), vessels. According to the pathological results, SPN was divided into three groups: malignant, benign and inflammatory. There were 39 cases in malignant group (adenocarcinoma 21 cases, squamous cell carcinoma 12 cases, large cell neuroendocrine carcinoma 2 cases, adenosquamous carcinoma 1 case, small cell carcinoma 1 case, carcinoid 1 case). One case of sarcomatoid carcinoma, 14 cases of benign group (9 cases of tuberculoma, 1 case of aspergillosis, 1 case of inflammatory myofibroblastoma, 1 case of sclerosing hemangioma, 1 case of neurofibroma, 1 case of hamartoma) and 12 cases of inflammatory nodule group. To observe the difference of perfusion parameters and luminal vascular parameters between three groups of SPN with different properties, to analyze the correlation between the perfusion parameters of dual-source CT and vascular parameters of SPN, and to evaluate the diagnostic efficacy of malignant SPN by using ROC curve to analyze the perfusion parameters of dual-source CT. Results: (1) TDC: malignant nodules showed type 鈪，

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