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目的研究64层容积CT(VCT)灌注成像对肺内肿物的诊断价值及CT引导下肺穿刺活检的临床应用。资料与方法采用64层VCT灌注成像技术,前瞻性研究56例体积1.47cm3～115.68cm3肺肿物的血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)和拟合时间-密度曲线(TDC)。结果主动脉第一时相为14～28s,平均20s。结核性与恶性肿物之间的BV值、BF值、MTT值和PS值的差异有统计学意义(P<0.05)。以BV≥6ml/100g作为恶性结节的阈值,其敏感性为92.86%、特异性为85.71%、准确性为91.07%;以PS≥15ml.100g-1.min-1作为恶性结节的阈值,则敏感性为100%、特异性为92.86%、准确性为98.21%。以BV≥6ml/100g同时PS≥15ml.100g-1.min-1作为恶性结节的阈值,则敏感性为92.86%、特异性为100%、准确性为94.64%。肺癌的拟合TDC和主动脉的关系密切,峰值在主动脉峰值区域或稍后,61.90%(B型,26/42)呈下降型。肺癌的灌注值与肿瘤大小无关,而与肿瘤的组织学类型有关。结论VCT灌注成像对肺肿物的良、恶性鉴别诊断有较大帮助。CT导引下经皮穿刺活检诊断准确率高,并发症轻,值得临床推广。
Objective To study the diagnostic value of 64-slice volume CT (VCT) perfusion imaging in lung masses and the clinical application of CT guided pulmonary biopsy. MATERIALS AND METHODS 64-slice VCT perfusion imaging was used to prospectively study the changes of blood flow volume (BF), blood volume (BV), mean transit time (MTT) and surface permeability of 56 patients with volume of 1.47cm3 ~ 115.68cm3 PS) and fitting time-density curve (TDC). Results The first phase of the aorta was 14-28s with an average of 20s. BV value, BF value, MTT value and PS value between tuberculous and malignant tumor had statistical significance (P <0.05). BV≥6ml / 100g as malignant nodules threshold, the sensitivity was 92.86%, specificity was 85.71%, the accuracy was 91.07%; PS ≥ 15ml.100g-1.min-1 as the malignant nodules threshold , The sensitivity was 100%, the specificity was 92.86% and the accuracy was 98.21%. With BV≥6ml / 100g and PS≥15ml.100g-1.min-1 as the threshold of malignant nodules, the sensitivity was 92.86%, the specificity was 100% and the accuracy was 94.64%. Lung cancer fit TDC and aorta are closely related, the peak in the aortic peak area or later, 61.90% (B, 26/42) showed a decline. The perfusion value of lung cancer has nothing to do with the size of the tumor, but with the histological type of the tumor. Conclusions VCT perfusion imaging is helpful for differential diagnosis of benign and malignant pulmonary masses. CT guided percutaneous biopsy diagnosis of high accuracy, light complications, it is worth clinical promotion.