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目的:探讨肺部肿块的CT血流灌注的特征及临床价值。方法:对35例患者(男21例,女14例;平均年龄,64.7岁,年龄范围,24～83岁)进行CT灌注检查。使用64排螺旋CT,先平扫有问题的结构区域,然后选定肿块扫描层面,使用高压注射器,经肘静脉注入50mL·300mg·100mL-1的优维显,速率为4mL·s-1,延迟5s后,以电影模式行多层灌注扫描,持续35～40s。使用Perfusion3灌注软件测量血容量及表面透过性乘积。3个独立样本(肺癌组、结核组及炎症组)两两进行统计学分析(t检验)。结果:恶性肿块20例(4例鳞癌,12例腺癌,1例未分化癌,3例转移癌),炎性肿块8例,结核灶7例。肺癌、结核灶及炎性肿块的灌注均值(BV和PS)分别为:(8.43±2.44)mL·100g-1,(24.30±5.80)mL·min-1·100g-1;(1.90±0.60)mL·min-1·100g-1,(1.19±0.37)mL·min-1·100g-1;(19.73±6.65)mL·100g-1,(30.01±9.06)mL·min-1·100g-1。肺癌组与结核灶组及炎性肿块组与结核灶组之间的灌注均值均有显著差异(p<0.05);肺癌组与炎性肿块组之间的BV均值有显著差异(p=0.014,t=2.639),但二者PS均值无统计学意义(p=0.506,t=0.674)。结论:利用灌注值可以区分肺癌与结核灶、炎性肿块与结核灶,虽然单独依靠灌注值很难区分肺癌与炎性肿块,但是血流灌注仍间接反映了肺部肿块的生物学行为。
Objective: To investigate the characteristics and clinical value of CT perfusion in pulmonary masses. Methods: Thirty-five patients (21 males and 14 females; average age, 64.7 years, age range, 24-83 years old) underwent CT perfusion examination. The 64-slice spiral CT was used to scan the problematic structure area first. Then, the mass scan level was selected. The high-pressure syringe was used to inject 50 mL · 300 mg · 100 mL-1 prednisone at the elbow vein at a rate of 4 mL · s-1, Delayed 5s, multi-layer perfusion scan in movie mode for 35 ~ 40s. Perfusion3 perfusion software was used to measure the product of blood volume and surface permeability. Three independent samples (lung cancer group, tuberculosis group and inflammation group) were statistically analyzed (t test). Results: 20 cases of malignant tumor (squamous cell carcinoma in 4 cases, adenocarcinoma in 12 cases, undifferentiated carcinoma in 1 case and metastatic carcinoma in 3 cases), 8 cases of inflammatory mass and 7 cases of tuberculosis. The mean perfusion values (BV and PS) of lung cancer, tuberculosis and inflammatory mass were (8.43 ± 2.44) mL · 100g-1 and (24.30 ± 5.80) mL · min-1 · 100g- mL · min -1 · 100g -1 · (1.19 ± 0.37) mL · min -1 · 100g -1 · (19.73 ± 6.65) mL · 100g -1 · (30.01 ± 9.06) mL · min -1 · 100g -1 . There was significant difference in mean perfusion between lung cancer group and tuberculosis group, inflammatory mass group and tuberculosis group (p <0.05). There was significant difference in BV mean between lung cancer group and inflammatory mass group (p = 0.014, t = 2.639), but the mean of PS between the two groups had no statistical significance (p = 0.506, t = 0.674). Conclusion: Perfusion value can differentiate between lung cancer, tuberculosis focus, inflammatory mass and tuberculosis focus. Although it is difficult to differentiate between lung cancer and inflammatory mass by perfusion alone, perfusion still indirectly reflects the biological behavior of lung mass.