320排容积CT双入口灌注技术评价肺腺癌和肺鳞癌血供特征的应用研究

发布时间：2018-02-24 11:39

本文关键词： 肺肿瘤体层摄影术 X线计算机灌注成像　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:采用东芝320排容积CT对40例经病理证实的肺癌进行容积灌注扫描后行双入口灌注图像后处理分析,通过双入口CT灌注成像技术对肺腺癌和肺鳞癌血供特征的评价,探讨东芝320排容积CT双入口灌注成像技术用于区分肺癌体循环血供和肺循环血供的可行性及肺腺癌和肺鳞癌血供特征的差异,以期为临床介入治疗提供指导。研究方法:收集2015.05月至2016.09月青岛大学附属医院收治的经手术或CT引导下穿刺活检或纤维支气管镜检查得到病理证实的40例原发性肺癌患者,行胸部容积CT灌注扫描后行双入口灌注图像后处理分析,沿肿瘤边缘绘制感兴趣区并尽量避开肉眼可见的坏死钙化及脂肪成分,由2名高年资医师单独测量记录肺部癌性肿块的支气管动脉灌注血流量(BF)、肺动脉灌注血流量(PF)、肺动脉灌注指数[PI;PI=PF/(PF+BF)]及肿块体积,将肺癌分为中央型肺癌和周围型肺癌。采用组内相关系数(ICC)分析观察者间一致性。观察病灶的时间密度曲线(time density curves,TCD)形态。采用两独立样本t检验比较肺腺癌和肺鳞癌、中央型和周围型肺癌各灌注值之间的差异。采用Spearman相关分析评估各灌注参数与肿瘤体积的相关性。以P0.05为差异具有统计学意义。结果:1.2名医师测量病灶的PF、BF、PI的一致性良好,ICC分别为0.97、0.93、0.91。2.37例病灶的TCD曲线在肺循环和体循环共两个上升斜率,且前者斜率小于后者斜率。3例病灶的TCD曲线有多个上升斜率,曲线整体呈上升型。3.40例肺癌患者的平均PF为[(54.26±21.07)ml/(min·100 ml)],BF为(64.41±22.06)ml/(min·100 ml),PI为(43.38±16.07)%,其中肺腺癌23例、肺鳞癌17例,腺癌的PF为[(51.56±22.19)ml/(min·100 ml)],BF为[(66.09±18.08)ml/(min·100 ml)],PI为(38.80±14.88)%,肺鳞癌的平均PF为[(57.90±21.12)ml/(min·100 ml)],平均BF为[(62.13±26.96)ml/(min·100 ml)],PI为(49.58±15.95)%,肺腺癌PI小于肺鳞癌(t=-2.196,P0.05)。肺腺癌与肺鳞癌的BF与PF均无统计学差异(P0.05,t分别为-0.911,0.556)。4.周围型肺癌17例,中央型肺癌23例。周围型肺癌PF为[(47.57±24.31)ml/(min·100ml)],BF为[(65.84±19.12)ml/(min·100 ml)],PI为(48.15±7.14)%,中央型肺癌[(53.80±20.03)ml/(min·100 ml)],BF为(60.84±18.30)ml/(min·100 ml),PI为(43.20±5.74)%,周围型肺癌的PI高于中央型肺癌(t=-2.305,P0.05)。中央型肺癌和周围型肺癌之间PF与BF的差异均无统计学意义(P均0.05,t分别为0.842,-0.851)。5.肿瘤体积4.19~75.29 cm3,PI与肿瘤体积呈负相关(r=-0.39,P=0.01),PF、BF与肿瘤体积无明显线性相关(P=0.88、0.21)。结论:肺癌主要由体循环供血。双入口CT灌注技术可重复性良好,该技术可用于区分肺癌的肺循环血供和体循环血供;肺腺癌和肺鳞癌的PI有差异,其灌注参数PI值与肿瘤的大小及位置有关。意义:探究双入口CT灌注用于肺癌灌注研究的可行性及不同类型肺癌血供是否有差异,以期为临床预判和介入治疗提供指导。
[Abstract]:Objective: to evaluate the blood supply characteristics of lung adenocarcinoma and squamous cell carcinoma (SCC) by Dual-Inlet Perfusion Imaging (DTI) and Dual-Inlet Perfusion Imaging (DTI) in 40 patients with pathologically proved lung cancer by Toshiba 320 slice volume CT. To explore the feasibility of using Toshiba 320 row volume CT dual portal perfusion imaging to distinguish the blood supply of lung cancer from that of lung cancer, and to explore the difference of blood supply characteristics between lung adenocarcinoma and lung squamous cell carcinoma. Methods: 40 cases of primary lung cancer confirmed by operation or CT guided biopsy or fiberoptic bronchoscopy were collected from Qingdao University affiliated Hospital from May, 2015 to September, 2016. The chest volume CT perfusion scan was performed after double portal perfusion image postprocessing analysis. The region of interest was drawn along the edge of the tumor and the necrotic calcification and fat components were avoided as far as possible. The bronchial artery perfusion blood flow (BFFN), pulmonary artery perfusion blood flow (PAF), pulmonary artery perfusion index (PII-PIP / PF BFV) and mass volume were measured separately by two senior physicians in lung carcinomatous masses. Lung cancer was divided into central lung cancer and peripheral lung cancer. The consistency between observers was analyzed by intragroup correlation coefficient (ICCs). The time density density curve (TCD) was observed. Two independent samples t test were used to compare lung adenocarcinoma and lung squamous cell carcinoma. Spearman correlation analysis was used to evaluate the correlation between perfusion parameters and tumor volume. The TCD curves of the well-induced lesions were 0.970.93 and 0.91.2.37, respectively, with two ascending slopes of pulmonary circulation and systemic circulation. The slope of the former was smaller than that of the latter, and the TCD curve of the former was smaller than the latter. 3. 40 patients with lung cancer had an average PF of 54.26 卤21.07ml / min 路100ml] BF = 64.41 卤22.06ml / min 路100ml Pi = 43.38 卤16.07ml / min, including 23 cases of lung adenocarcinoma and 17 cases of lung squamous cell carcinoma. The PF of adenocarcinoma was [51.56 卤22.19ml / r / min 路100ml] BF = [66.09 卤18.08ml / min 路100ml] Pi was 38.80 卤14.88m / min, the mean PF of squamous cell carcinoma was [57.90 卤21.12ml / min 路100ml], the mean BF was [62.13 卤26.96ml / min 路100ml] and that of adenocarcinoma of lung was 49.58 卤15.95ml / min, respectively. The BF and PF of lung adenocarcinoma and lung squamous cell carcinoma were 0.9-110.556.40.17 cases respectively. Central lung cancer (PF = 47.57 卤24.31ml / min 路100ml)] BF = [65.84 卤19.12ml / min 路100ml] Pi = 48.15 卤7.14m, central lung cancer (53.80 卤20.03ml / min 路100ml)] BF = 60.84 卤18.30ml / min 路100ml). The Pi of peripheral lung cancer was 43.20 卤5.74ml / min. The Pi of peripheral lung cancer was higher than that of central type lung cancer (P < 0.05). There was no significant difference between central lung cancer and peripheral lung cancer (PF = 43.84 卤18.30ml / min 路100ml). The Pi of peripheral lung cancer was higher than that of central lung cancer (P < 0.05). There was no significant difference in PF and BF between central lung cancer and peripheral lung cancer. The correlation between tumor volume and tumor volume was negative correlation between Pi and tumor volume. There was no significant linear correlation between PFBF and tumor volume. Conclusion: lung cancer is mainly supplied by systemic circulation. The double portal CT perfusion technique has good reproducibility. This technique can be used to distinguish pulmonary circulation blood supply from systemic circulation blood supply in lung cancer, and there are differences in Pi between lung adenocarcinoma and lung squamous cell carcinoma. The Pi value of perfusion parameters is related to the size and location of tumor. Significance: to explore the feasibility of dual-portal CT perfusion in lung cancer perfusion study and whether there are differences in blood supply of different types of lung cancer in order to provide guidance for clinical prejudgment and interventional therapy.
【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

【参考文献】