【摘要】 目的　研究多层螺旋CT肿瘤灌注对肺肿瘤的诊断价值。方法　对 46例肺部病变进行前瞻性分析。其中肺癌2 9例 ,病灶最大直径 2～ 7cm (平均 4cm)。 17例良性病灶中 ,结核 7例 ,肺脓肿 3例 ,非特异性炎症 3例 ,炎性假瘤 1例 ,曲菌球 1例 ,错构瘤 2例 ,病灶最大直径 2～ 5cm(平均 3cm )。采用GELightspeedQx/iExtra 8排探测器螺旋CT ,电影模式 ,层厚 5mm/4层。扫描时间 1s/圈 ,数据采集时间 40s。非离子对比剂 (3 0 0mgI/ml) 5 0ml用高压注射器经前臂浅静脉注射 ,速率 4ml/s ,延迟 5 .6s。CT灌注 2 体部肿瘤软件包分析。测定病变的血流量 (BF)、血容积 (BV )、平均通过时间(MTT)和表面渗透性 (PS)。结果　良恶性比较以BV和PS值有显著性差异 (P =0 .0 0 2和P =0 .0 0 0 )。若以BV值≥ 6作为恶性病变的域值 ,则灵敏度为 10 0 % ,特异度 64 .7% ,阳性预测值 82 .9% ,阴性预测值为 10 0 %。以PS值≥ 3 0作为恶性病变域值 ,灵敏度为 86.2 % ,特异度 88.2 % ,阳性预测值 92 .6% ,阴性预测值为 79%。结论　螺旋CT肺灌注在肺部病变的良恶性鉴别中有较大的帮助。灌注参数以BV和PS为佳 ,BV的敏感度高而PS的特异度高 ,两者相结合有利于提高诊断的正确率。更多还原

【Abstract】 Objective To evaluate the significance of CT perfusion in 46 patients with lung neoplasms.Methods A prospective study was undertaken in patients with pulmonary nodules using cine dynamic scan of MSCT. They were histologically proven as peripheral lung cancer in 23 cases,central lung cancer in 6 cases,tubercle in 7 cases,lung abscess in 3 cases,unspecific inflammation in 3 cases,inflammatory pseudotumor in 1 case,aspergilloma in 1 case and hamartoma in 2 cases. The diameter of lesions was 2-7 cm (mean 4 cm) for malignancy and 2-5 cm (mean 3 cm) for benignancy. Using 8-row detector spiral CT,cine scan was performed with 5 mm slice thick /4 slices,1 second scan time per circle,40 s acquisition time and 120 kV,80 mA. Total 50 ml contrast medium (300 mgI/ml) was administered at a delay 5.6 s and a rate of 4 ml/s from forearm superficial vein with hyperbaric injector. The CT data were transferred to a workstation and analyzed with a CT perfusion 2-body tumor software. The parameters of CT perfusion include blood flow (BF),blood volume (BV),mean transit time (MTT) and permeability surface (PS).Results In patients with lung cancer,BF,BV,MTT and PS of the lesions were (38.7±31.9) ml/(min·100 g),(10.1±4.2) ml/100 g,(21.8±10.8) s and (47.3±22.3) ml/(min·100 g).When BV≥6 ml/100g was set as a diagnostic threshold,the sensitivity,specificity,positive predict values and negative predict values were 100%,64.7%,82.9% and 100% respectively. When PS≥30 ml/(min·100g) was set as a diagnostic threshold,the sensitivity,specificity,positive predict values and negative predict values were 86.2%,88.2%,92.6% and 79% respectively.Conclusion BV and PS measured by CT perfusion might be as parameters of diagnosis of lung cancer.更多还原