64排螺旋CT灌注成像在肺癌、肺炎及结核鉴别诊断中的价值

发布时间：2018-06-26 18:31

本文选题：CT灌注成像 + 受试者工作特征曲线　；参考：《福建医科大学》2012年硕士论文

【摘要】：目的：研究CT灌注成像在肺癌、肺炎及结核鉴别诊断中的价值。材料和方法：分析35例经病理证实的肺癌、结核及肺炎患者的CT灌注扫描资料，其中肺癌22例，结核7例，肺炎6例，所有患者均用Siemens SOMATOMsensation64层螺旋CT进行CT灌注扫描(对比剂总量50ml,注射速率4～6ml/s)，采用随机syngo Body PCT软件中的Lung tumor项对病灶进行分析，分别获得时间-密度曲线（TDC），血流量（BF）、血容量（BV）、毛细血管通透性（PMB）3个灌注参数，对各灌注参数进行相关性分析。结果：(1)肺癌、肺炎及结核的TDC形态各不相同。肺癌的TDC分为A、B、C、D四型，其中以C型为主（36%），表现为曲线逐渐上升达峰值后，几乎没有降支，持续在较高水平；结核的TDC分为A、B、C三型，其中以A型为主（42%），，表现为曲线上升及下降缓慢，整个曲线较低平，增强幅度小于10HU左右；炎症的TDC分为A、B二型，其中以A型为主（67%），表现与肺癌时间-密度曲线的C型类似，但增强幅度明显高于肺癌。(2)结果显示肺癌、肺炎与结核之间的BV无统计学意义（P0.05）。肺癌、肺炎与结核之间的PMB、BF有统计学意义(P0.05)，肺癌的BF、PMB值均高于肺炎与结核,其中肺炎与结核的BF、PMB无统计学意义(P0.05)。(3)选择Youden指数最大值作为灌注参数诊断的最佳临界点。鉴别诊断肺癌与结核时，PMB值的ROC曲线的AUC为0.812，阈值为16.36，敏感性77.3%，特异性100%， BF值的ROC曲线的AUC为0.838，阈值为11.30，敏感性72.7%，特异性100%。鉴别诊断肺癌与炎症时，PMB值的ROC曲线的AUC为0.833，阈值为13.99，敏感性81.8%，特异性100%， BF值的ROC曲线的AUC为0.826，阈值为14.82，敏感性68.2%，特异性100%。结论：64层螺旋CT灌注成像的时间-密度曲线及灌注参数能够客观评价肺部病变的血流学动力学状况，综合分析有助于肺癌、肺炎及结核的鉴别诊断。
[Abstract]:Objective: to study the value of CT perfusion imaging in differential diagnosis of lung cancer, pneumonia and tuberculosis. Materials and methods: Ct perfusion scan data of 35 patients with lung cancer, tuberculosis and pneumonia, including 22 cases of lung cancer, 7 cases of tuberculosis and 6 cases of pneumonia, were analyzed. All the patients were performed CT perfusion scanning (total volume of contrast medium 50 ml, injection rate 4~6ml/s) with Siemens SOMATOMsensation64 slice spiral CT. Lung item in random syngo body PCT software was used to analyze the lesions. Three perfusion parameters including time-density curve (TDC), blood flow (BF), blood volume (BV) and capillary permeability (PMB) were obtained. Results: (1) the morphology of TDC was different in lung cancer, pneumonia and tuberculosis. The TDC of lung cancer was divided into four types: type C (36%), showing that there was almost no descending branch after the curve reached the peak value, and the TDC of tuberculosis was classified into three types. Among them, type A (42%) showed a slow ascending and descending curve, the whole curve was relatively low and the enhancement amplitude was less than 10HU, the inflammatory TDC was divided into two types: type A (67%), which was similar to type C of the time-density curve of lung cancer. But the enhancement range was significantly higher than that of lung cancer. (2) the results showed that there was no significant difference in BV between lung cancer, pneumonia and tuberculosis (P0.05). In lung cancer, pneumonia and tuberculosis, there was significant difference in PMBMB between lung cancer, pneumonia and tuberculosis (P0.05), and the BFF-PMB value of lung cancer was higher than that of pneumonia and tuberculosis. There was no significant difference between lung cancer and tuberculosis (P0.05). (3), and the maximum value of Youden index was chosen as the best critical point for the diagnosis of perfusion parameters. The ROC curve of PMB was 0.812, the threshold was 16.36, the sensitivity was 77.3, the specificity was 100, the ROC curve of BF was 0.838, the threshold was 11.30, the sensitivity was 72.7, and the specificity was 100. The ROC curve of PMB in differential diagnosis of lung cancer and inflammation was 0.833, the threshold was 13.99, the sensitivity was 81.8, the specificity was 100, the ROC curve of BF was 0.826, the threshold was 14.82, the sensitivity was 68.2 and the specificity was 100. Conclusion the time-density curve and perfusion parameters of 64-slice spiral CT perfusion imaging can objectively evaluate the hemodynamic status of pulmonary lesions, and comprehensive analysis is helpful to the differential diagnosis of lung cancer, pneumonia and tuberculosis.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.41

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