肺结节或肿块320排动态容积CT双入口灌注成像与病理的对照

摘要

目的:探讨肺结节或肿块性病变320排动态容积CT双入口灌注成像与病理基础的关系,研究肺内不同组织学类型病变灌注特点与血流动力学规律.方法:搜集本院2016年8月-2017年2月的50例经手术切除(41例)、穿刺活检(9例)病理组织学证实的肺内结节或肿块性病变患者,包括肺腺癌12例,肺鳞癌8例,小细胞肺癌6例,急性炎症9例,慢性炎症7例,肺结核8例.所有患者行320排动态容积CT灌注扫描,得到相关的灌注参数结果与病理结果进行对照分析.结果:肺内良性与恶性结节或肿块的支气管动脉血流量(BAF)、灌注指数(PI)差异均具有统计学意义(P＜0.05).肺内良性与恶性结节或肿块的肺动脉血流量(PAF)值差异无统计学意义(P＞0.05).PI鉴别良恶性肿瘤的最佳阈值为57.65,敏感度为90.0％,特异度为66.7％,阳性预测值87.5％,阴性预测值85.5％.肺结节或肿块的灌注结果与其病理类型有关.结论:肺结节或肿块的灌注结果与病理类型具有密切的关系,恶性病变以支气管动脉供血为主,良性病变以肺动脉供血为主.320排动态容积CT肺双入口灌注扫描成像技术在鉴别肺部病变的良恶性中具有重要的作用.%Objective:The aim of this study was to investigate the correlation between the 320-detector row dynamic volume CT perfusion imaging and histologic characteristics of pulmonary nodules or masess,and to study their perfusion findings and hemodynamics characteristics of different histological types.Methods:Fifty cases of pulmonary nodule or mass with pathological confirmation by surgery (n=41) or biopsy (n=9) from August 2016 to February 2017,including adenocarcinoma 12,squamous cell 8,small cell 6,atute pneumonia 9,chronic pneumonia 7 and tuberculosis 8 were collected.All patients underwent 320-detector row dynamic dual-input volume CT lung perfusion scan.The results of the perfusion parameters were obtained and compared with pathology results.Results:There was a significant difference in bronchial artery flow (BAF) and perfusion index (PI) between benign and malignant lesions (P＜0.05),but no significant difference was found in pulmonary artery flow (PAF) of between benign and malignant nodules (P＞0.05).The best threshold for differentiating malignant nodules from benign ones was 57.65,with sensitivity of 90.0％,specificity 66.7％,positive predictive value 87.5％,and negative predictive value 85.5％.The perfusion characteristics of lung nodule and mass were correlated with pathology results.Conclusion:There is a close correlation between the perfusion characteristics and pathological tissues in pulmonary nodules and masses.The malignant lesions are obviously supplied by the bronchial artery.The 320-row dynamic dual-input volume CT lung perfusion imaging plays an important role in the differential diagnosis of benign and malignant lesions.