CT 肺灌注在肺結(jié)節(jié)診斷中的應(yīng)用研究
張金娥 梁長虹 趙振軍 林華歡 曾輝 何暉 茹光騰
【摘要】 目的 研究CT 灌注成像對良、惡性肺結(jié)節(jié)的診斷價值。方法 前瞻性研究88 例直
徑2 ～4 cm 的肺結(jié)節(jié)的多層螺旋CT 灌注表現(xiàn)。其中肺癌62 例, 良性病變26 例( 炎性假瘤12 例, 結(jié)
核球10 例, 錯構(gòu)瘤3 例, 曲菌球1 例) 。采用8 層螺旋CT 灌注成像, 電影模式, 層厚5 mm, 4 層/ 圈, 掃
描時間1s / r, 數(shù)據(jù)采集時間40 s。碘普胺( 300 mg I /ml) 50 ml, 用高壓注射器經(jīng)前臂淺靜脈注射, 流率
4 ml / s, 延遲5. 6 s。CT Perfusion 2 軟件分析測量結(jié)節(jié)的血流量( BF) 、血容量( BV) 、平均通過時間
( MTT) 、表面通透性( PS) 和擬合時間-密度曲線。結(jié)果 良、惡性結(jié)節(jié)的BV 值( 分別為5. 33、
10. 00 ml /100 g) 和PS 值( 分別為13. 11、44. 94 ml·100 g - 1 ·min - 1 ) 差異有統(tǒng)計學(xué)意義( F 值分別為
29. 368 和48. 027, P 值均為0. 000) 。以BV≥6 ml /100 g 作為惡性病變的閾值, 其敏感度87. 3%, 特
異度100. 0% , 陽性預(yù)測值100. 0% , 陰性預(yù)測值65. 4% , 準(zhǔn)確度89. 9% 。以PS≥30 ml ·100 g - 1 ·
min - 1 作為惡性結(jié)節(jié)的閾值, 則敏感度96. 4% , 特異度75. 0% , 陽性預(yù)測值87. 1%, 陰性預(yù)測值
87. 2% , 準(zhǔn)確度88. 6%。以BV≥6 ml / 100 g 同時PS≥30 ml·100 g- 1 ·min - 1 作為惡性結(jié)節(jié)的閾值,
則敏感度96. 8% , 特異度92. 3% , 陽性預(yù)測值96. 8%, 陰性預(yù)測值92. 3% , 準(zhǔn)確度95. 5% 。肺癌的擬
合時間-密度曲線和主動脈的關(guān)系密切, 起始端與主動脈同步, 峰值在主動脈峰值區(qū)域或稍后, 85. 5%
( B 型+ C 型, 53 / 62) 呈緩慢下降或平臺型。結(jié)論 多層螺旋CT 灌注對肺結(jié)節(jié)的良惡性鑒別診斷有
較大幫助。
【關(guān)鍵詞】 硬幣病變, 肺; 體層攝影術(shù), X 線計算機; 灌流
Ut ility of CT perfusion in pulmona ry nodules ZHANG Jin-e, LIANG Chang-hong, ZHAO Zhen-jun,
LIN Hua -huan, ZENG Hui, HE Hui, RU Guang-teng. Depa rtment of Ra diology, Gua ngdong Provincia l
People′s Hospital, Guangzhou 510080, China
【Abstr act 】 Objective To evaluate the diagnosis value of CT perfusion in pulmonary nodules.
Methods A prospective study was undertaken in eighty-eight patients with the diameter of 2 - 4 cm of
pulmonary nodules using MSCT perfusion. They were proved with pathology as peripheral lung cancer in
62 cases, benign nodules in 26 cases( 12 cases of inflammatory pseudotumor, 10 cases of tubercle nodule,
3 cases of hamartoma, 1 case of aspergilloma) . Using 8-row detector spiral CT, cine scan, slice thickness
5 mm/4 slices, scan time was 1 second per circle, acquisition time was 40 seconds. Ultravist( 300 mg I /ml)
was administered at a delay of 5. 6 seconds rate of 4 ml / s from forearm superficial for a total of 50 ml and a
vein by hyperbaric injection. The CT data were transferred to a workstation ( Sun Microsystems, Advantage
Windows 4. 0, GE Medical Systems ) and analyzed by a CT Perfusion 2-body tumor software. The timedensity
curve and parameters which include blood flow( BF) , blood volume( BV) , mean transit time( MTT)
and permeability ( PS) of CT perfusion were analyzed. Results The differences of BV and PS were
statistically significant between lung cancer to benign nodules ( F = 29. 368, P = 0. 000 and F = 48. 027, P =
0. 000) . When BV≥6 ml /100 g was set as the diagnostic threshold, the sensitivity, specificity, positive
predict value, negative predict value and accuracy were 87. 3% , 100. 0% , 100. 0% , and 65. 4% ,
respectively. When PS≥ 30 ml · 100 g - 1 · min - 1 was set as the diagnostic threshold, the sensitivity,
specificity, positive predict value, negative predict value and accuracy were 96. 4% , 75. 0% , 87. 1% ,
87. 2% , and 88. 6%, respectively. When BV≥6 ml /100 g and PS≥30 ml·100 g - 1 ·min - 1 were set as
the diagnostic threshold, the sensitivity, specificity, positive predict value, negative predict value and
accuracy were 96. 8% , 92. 3% , 96. 8%, 92. 3% , and 95. 5% , respectively. The time-density curve of
lung cancer was correlation to that of aorta. The beginning of the curve was synchronization and the location
of the peak was same or slightly delayed in lung cancer to aorta. The time-density′s form ( type B + type C)
of lung cancer ( 85. 5% ) was descent slowly or flat. Conclusion MSCT perfusion is helpful to the
diagnosis and differential diagnosis of aorta pulmonary nodules.
【Key wor ds】 Coin lesion, pulmonary; Tomography, X-ray computed; Perfusion

CT 肺灌注在肺結(jié)節(jié)診斷中的應(yīng)用研究胸部.rar