孤立性肺结节CT灌注的血流特征及应用研究_临床医学论文.docVIP

孤立性肺结节CT灌注的血流特征及应用研究_临床医学论文 孤立性肺结节CT灌注的血流特征及应用研究_临床医学论文 【摘要】 目的 应用多层螺旋CT灌注成像研究孤立性肺结节的血流灌注特点并评价其在鉴别诊断结节良恶性中的应用价值。方法 对44例孤立性肺结节患者行灌注扫描，分别测得结节血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面通透性（PS）值及拟合时间－密度曲线（TDC），并可在时间－密度曲线的基础上，测定孤立性肺结节增强前后的CT值、增强峰值、增强净增值、达峰时间等形态学指标。结果 肺恶性结节的BF、BV、PS值及增强峰值、增强净增值、达峰时间均高于肺良性结节，有显著性差异（P值均＜0.05）。良、恶性结节的TDC形态不同。净增值25Hu可作为恶性结节的诊断阈值。 结论 CT灌注成像可反映孤立性肺结节内的血流动力学特点，并可用于无创性诊断和评价孤立性肺结节。 【关键词】 孤立性肺结节 体层摄影术 线计算机 灌注 [Abstract] Objective To investigate the blood flow features of solitary pulmonary nodule(SPN) using CT perfusion imaging and to evaluate the clinical value in differential diagnosis between benign and malignant SPN. Methods A total of 44 patients with solitary pulmonary nodules underwent perfusion scan with 16-slice spiral CT (LightSpeed; GE Medical Systems) scanner.The parameters of CT perfusion including blood volume (BV), blood flow (BF), mean transit time (MTT), permeability surface (PS) and time-density curve (TDC) were analyzed.The peak height in density, net enhancement, enhancement value and time to peak enhancement were measured. Results BV, BV and PS values in Pulmonary malignancy nodules were highter than those in pulmonary benign nodules.The peak height in density, net enhancement and time to peak enhancement was significantly higher than that of benign nodules. The TDC appeared to be different between malignant and benign nodules. 25Hu of net enhancement could be the cutoff value of a maligant nodule. Conclusion CT perfusion imaging can reflect blood low features of SPNs and has been proved to be an alternate non-invasive option in the evaluation and management of SPN. [Key words] solitary pulmonary nodule; X-ray computed; tomography; perfusion 孤立性肺结节（solitary pulmonary nodule,SPN）是多种良、恶性病变的共同表现。其鉴别诊断一直是影像诊断的难点。CT灌注成像（CT perfusion imaging,CTPI）可反映良、恶性SPN的血流灌注特点，本研究主要评价CTPI成像鉴别诊断良、恶性SPN的临床应用。 资料与方法 1.一般资料 病例入选标准：（1）未经治疗的直径≤3.0cm肺内孤立性结节，无明显的钙化、卫星病灶；（2）无严重心、肝、肾病变者，碘过敏实验阴性者；（3）无严重肺功能障碍，检查合作。SPN的大小根据X线前后位片及侧位片测量的结节最大直径平均值≤3.0cm，或CT检查纵隔窗结节最大直径