【作者】 李光军；

【导师】 伍建林；

【作者基本信息】 大连医科大学 ， 影像医学与核医学， 2004， 硕士

【摘要】 目的:研究多层螺旋CT灌注成像对肺肿瘤良恶性鉴别诊断价值及其反映的肿瘤灌注改变与肿瘤微血管密度的关系。材料与方法:对86例肺肿瘤患者进行多层螺旋CT灌注检查。所有病例均经手术或细胞学检查病理证实。恶性70例,其中腺癌42例,鳞癌25例,小细胞肺癌3例,良性16例,其中结核瘤7例,炎性假瘤8例,错构瘤1例。ADW4.0工作站CT灌注-2体部肿瘤软件包分析。分别选取胸主动脉及肺动脉主干或右心室为灌注动脉,相应选取胸壁软组织及降主动脉为流出血管,分别测定肺肿物内部的血流速(Blood Flow,BF)、血容量(Blood Volum,BV)、平均通过时间(Mean Transit Time,MTT)、表面通透性(Permeability Surface ,PS)。还对38例术后肿物组织标本进行LSAB法免疫组化染色,标记肿瘤血管内皮抗原CD34,计数肿瘤微血管密度(MVD)。结果:以主动脉为灌注动脉时的灌注参数:恶性肿瘤(70例),BF、BV、MTT、PS的值分别:945.25±138.33ml/100mg/min,226.95±114.76ml/100mg,4.06±3.01sec,94.12±11.26ml/100mg/min。良性(16例),863.63±223.36ml/100mg/min, 193.72±125.58ml/100mg, 4.33±3.56sec,76.28±30.80ml/100mg/min。 良、恶性肿物PS值有统计学差异(P<0.05 )。以肺动脉为灌注动脉的灌注参数:恶性肿瘤(25例), BF、BV、MTT、PS的值分别为:33.51±19.76ml/100mg/min,10.43±5.46ml/100mg,19.22±8.54sec,44.12±25.69ml/100mg/min。<WP=5>良性(9例),BF、BV、MTT、PS的值分别为:28.01±22.70ml/100mg/min,4.74±3.08ml/100mg,10.3±12.67sec,10.23±3.87ml/100mg/min。良、恶性肿物BV、MTT及PS值均有统计学差异(P<0.05,PS值P<0.01)。若以BV≥5ml/100mg为恶性肿瘤诊断界值,灵敏度为96%,特异度为78%,阳性预测值为92%,阴性预测值为87.5%。若以PS≥25ml/100mg/min为恶性肿瘤诊断界值,灵敏度为68%,特异度为67%,阳性预测值为85%,阴性预测值为42%。肺恶性肿瘤(25例)内部微血管计数为61.38±10.23个/高倍视野。良性肿物(13例)内部微血管计数为10.23±7.07个/高倍视野(×200,镜下视野面积为0.74mm2)。良、恶性肺肿物内部微血管计数有统计学差异(P<0.05)。CT灌注参数中以肺动脉或右心室作为灌注动脉时的BV值与恶性肿瘤内部微血管计数有正相关性,r = 0.752,P<0.01。结论: MSCT灌注成像对肺部病变的良、恶性诊断与鉴别诊断有意义。以肺动脉或右心室作为灌注动脉时,BV、MTT、PS值有鉴别诊断价值,其中BV、PS值鉴别诊断价值较大。二者结合有利于良、恶性肿物鉴别诊断。以肺动脉干或右心室作为灌注动脉的BV值与肿物微血管密度成正相关性。多层螺旋CT灌注成像对提示肿瘤放、化疗敏感性、疗效评价及预测预后等像提供了新的思路和方法。更多还原

【Abstract】 Purpose: Preliminary research the value of multislice helical CT perfusion imaging in distinguish diagnosis benign tumor from malignant ones and to explore the correlation of lung neoplasms and mircrovessel density(MVD). Materials and methods: 86 cases of lung neoplasmas were studied in perfusion imaging. 70malignant tumor. 42 adeuocarcinoma, 25 squamous, 3 small cell lung cancer. 16 benign tumor, 7tuberculomas, 8 inflammatory nodules, 1hamartoma. Perfusion images were transferred into body perfusion-2 software on ADW4.0 workstation to create and analyze perfusion images and parameters including Time-density courves (TDC)、Blood Flow (BF)、Blood volume (BV), Meant Transit Time (MTT) and Permeability Surface (PS). MVD were measured with. Immunohisto- chemical method in 38 cases of lung cancer. Results: The thoracic aorta was selected as input aorta,The mean BF,BV,MTT,PS in 25 malignant tumor was 33.51±19.76ml/100mg/min, 10.43±5.46ml/100mg,19.22±8.54sec, 44.12±25.69ml/100mg/min, respectively. In 16 benigntumor, perfusion parameters was 28.01±22.70ml/100mg/min, 4.74±3.08ml/100mg, 10.3±12.67sec, 10.23±3.87ml/100mg/min, respectively. The mean PS in malignant tumor and <WP=7>benign tumor was statistically significant( P<0.05 One-Way ANOVA analysis ). The pulmonary trunk was selected as input aorta, The mean BF,BV,MTT,PS in 25 malignant tumor was 33.51±19.76ml/100mg/min, 10.43±5.46ml/100mg, 19.22±8.54sec, 44.12±25.69ml/100mg/min, respectively. In 9 benign tumor perfusion parameters was 28.01±22.70ml/100mg/min, 4.74±3.08ml/100mg, 10.3±12.67sec, 10.23±3.87ml/100mg/min, respectively. The mean BV, MTT and PS in malignant tumor and benign tumor was statistically significant( P<0.05 One-Way ANOVA analysis ). When BV≥5ml/100mg was set as a diagnotic threshold , the sensitivity, specificity, positive predict values and negative predict values were 96%, 78%, 92%, 87.5%, resoestively. When PS≥25ml/100mg/min was set as a diagnotic threshold , the sensitivity, specificity, positive predict values and negative predict values were 68%, 67%, 85%, 42%, resoestively. MVD of cancer was 61.38±10.23 in hot spot field.MVD of benign tumor was 10.23±7.07 in hot spot field. MVD between the two groups showed statistically significant( P<0.05 One-Way ANOVA analysis ). The mean BV of cancer positive correlated with MVD( r=0.752 P<0.01), if the pulmonary trunk was selected as input aorta.Conclusion: MSCT perfusion imaging is helpful with conventional CT in the differentiation of beign lung neplasms from malignant ones. The pulmonary trunk was selected as input aorta, The mean BV, PS in malignant tumor and benign tumor was statistically significant. Cambined BV with PS can help us improve the rate of malignant tumor diagnosis. And the mean BV of cancer positive correlated with MVD.更多还原