【作者】 张强； 李春静； 刘兆信； 杨爱玲； 田庄；

【Author】 Zhang Qiang Li Chun-Jing Liu Zhao-Xin Yang Ai-Ling Tian Zhuang Baotou No. 7 Hospital, Radiotherapy Department of Baotou Tumor Hospital, Baotou P. C: 014430

【机构】 包头第七医院包头肿瘤医院放射科；

【摘要】 目的:评价螺旋CT增强扫描检测非小细胞肺癌 (NSCLC)血管生成及血流动力学特点,进一步认识和解释影像学发现,并且探讨影像学检查是否作为一种无创的活体状态下反映肿瘤血管生成的工具和方法,为肿瘤研究和临床诊断及治疗提供更多信息。方法:对病理证实的152例非小细胞肺癌(NSCLC)其中男性97例,女性55例。年龄37～79岁, 平均年龄56岁。进行螺旋CT双期增强扫描,层厚2．0mm～ 5．0mm,层距3．0mm～5．0mm,螺距0．75或1．0;对比剂采用双北碘海醇100 ml,以2．0ml／s速率团注,注药后动脉期25 s扫描,静脉期50s扫描。SCT观察项目、指标:(1)癌灶峰值(PV)=增强后最大CT值-平扫CT值(2)癌灶肉眼可辩异常扭曲扩张新生血管。并对病灶增强形态表现与组织学相对照,对其相关性进行分析。结果:1．本组非小细胞肺癌(NSCLC)病例中:低分化腺癌23例、中分化腺癌38例、高分化腺癌3例,低分化鳞癌43例、中分化鳞癌37例、高分化鳞癌6例、肺泡癌2例。鳞癌男性>女性,腺癌女性>男性。 2．影像学分析:癌灶CT强化峰值(PV)低分化>中分化>高分化,其中63例45—70HU,78例20-45HU,11例10-20HU。 (1)异常小动脉67例,(2)异常血湖(窦)显影23例,(3) 花蕊状35例(4)实质均匀强化52例,(5)实质不均匀强化 89例,(6)实质轻度强化11例。生长方式:低分化癌灶呈侵润性生长,无包膜或少许包膜,中分化癌灶呈侵润性生长与膨胀性生长并存,大部分有包膜、少许无包膜,高分化癌灶呈膨胀性生长,有完整包膜。3．临床治疗:手术切除+化疗+ 放疗39例、化疗+放疗43例、介入+化疗13例、介入40例、介入+放疗17例。完全缓解69．7％(106／152),部分缓解25． 7％(39／152),未缓解4．6％(7／152)。结论:根据螺旋CT 双期增强扫描来准确检出和量化癌灶血管生成,为临床治疗非小细胞肺癌(NSCLC)方案的制定和肿瘤综合治疗有很高的指导价值。更多还原

【Abstract】 Objective: To evaluate the examination of NSCLC vein formation and the dynamic characteristics of blood stream through enforced SCT scanning, further understand and explain the iconographical discovery, discuss whether iconographic examination can be adopted as a tool and method to reflect the vein formation of tumors in the state of intact living objects and provide more in- formation for the research on and clinical diagnosis of tumor. Methods: Double period enhanced SCT scanning is done to 152 NSCLC cases identified pathologically, including 97 males and 5 females aged between 37-79, with an average age of 56. The stratum thickness is 2.0-5.0mm, stratum distance 3.0-5.0mm and pitch of screws 0.75 or 1. 0.100ml of SHUANG BEIIOHEXOL INJECTION is used as contrast reagent and injected at the rate of 2.0ml/s. After injection, scanning is done artery period 25s and 50s vein period. Items and indexes for SCT observation: (1) Peak value of cancer focus (PV)= maximum enforced CT value-ordinary CT value; (2) Abnormally distorted and expanded renascent veins of cancer focus that can be distinguished with naked eyes. Compare the enforced morphologic manifestation of cancer focus with histology and analyze their pertinence. Results: 1. Among the NSCLC cases, 23 are of low differentiation adenocarcinoma, 38 medium differentiation adenocarcinoma and 3 high differentiation adenocarcinoma, 43 cases are of low differentiation squama cancer, 37 medium differentiation squama cancer, 6 high differentiation squama cancer and 2 cases are of alveolus cancer. More males suffer from squama cancer than females and more females suffer from adenocarcinoma than males. 2. Iconographic analysis: The enforced CT peak value (PV) of the low differentiation is bigger than that of the medium differentiation, which is bigger than the high differentiation. 63 cases are 45-70HU, 78 cases are 20-45HU and 11 cases are 10-20HU. (1) 67 case are of abnormal arteriola, (2) 23 cases are of abnormal hemal sinus development, (3) 35 cases are pistil-like, (4) 52 cases are of evenly enforced parenchyma, (5) 89 cases are of unevenly enforced parenchyma, (6) 11 cases are of low-grade enforced parenchyma. Mode of growth: Low differentiation cancer focus assumes the mode of intrusion growth, without envelop or with little envelop; medium differentiation cancer focus assumes the mode of intrusion and expansion growth, most with envelop and a few without envelop; high differentiation cancer focus assumes the mode of expansion growth, with intact envelop. 3. Clinical treatment: Surgical resection, combining chemical therapy and radiotherapy for 39 cases, chemical therapy and radiotherapy for 43 cases; interposition treatment and chemical therapy for 13 cases, interposition treatment for 40 cases; interposition treatment and radiotherapy for 17 cases. The percentage of the totally relieved is 69.7% (106/ 152), that of the partially relieved 25,7% (39/152) and that of the un-relieved 4.6% (7/更多还原