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目的通过多层螺旋CT动态增强首过期灌注值和强化峰值来描述周围型肺癌、中央型肺癌和肺部转移瘤的灌注特征。资料与方法92例肺部肿瘤患者(包括48例周围型肺癌,31例中央型肺癌,13例单侧肺转移瘤)接受检查。注射对比剂同时屏气,在固定层面连续扫描30层(1层/s)。分别以整个肿瘤、肿瘤富强化区、肿瘤少强化区取感兴趣区来评价其时间密度曲线。通过Miles最大斜率法计算灌注值和强化峰值,依据肿瘤大小、位置(中央型/周围型或转移瘤)及病理类型的不同进行比较。结果大的肿瘤(直径>4cm)的灌注值及强化峰值明显低于小的肿瘤(直径≤4cm),其差异有统计学意义(P<0.0001)。不考虑大小因素,中央型肺癌的灌注值与周围型肺癌的灌注值差异有统计学意义。另外,两者的强化峰值差异亦有统计学意义;中央型肺癌与转移瘤灌注值及强化值差异有统计学意义,周围型肺癌与转移瘤灌注值及强化值差异则无统计学意义。非小细胞肺癌与小细胞肺癌的上述参数的差异均无统计学意义。结论肿瘤灌注值及强化峰值与肿瘤大小位置有关,但与病理类型无关,可以对不同大小、位置的肿瘤预后进行评估。
Objective To describe the perfusion characteristics of peripheral lung cancer, central lung cancer, and metastatic lung tumors by dynamically increasing first-pass perfusion values and enhancement peaks with multislice spiral CT. Materials and Methods 92 patients with lung cancer (including 48 peripheral lung cancers, 31 central lung cancers, and 13 unilateral lung metastases) were examined. Contrast agents were also instilled while maintaining a breath, and 30 layers (1 layer/s) were continuously scanned at a fixed level. The time-density curve was evaluated by taking the region of interest with the entire tumor, the tumor-enhanced region, and the tumor-less region. Perfusion values and peak enhancements were calculated using the Miles maximum slope method and compared based on tumor size, location (central/peripheral or metastatic), and pathological type. Results The perfusion and enhancement peaks of large tumors (>4cm in diameter) were significantly lower than those of small tumors (≤4cm in diameter). The difference was statistically significant (P<0.0001). Regardless of size, the perfusion value of central lung cancer was significantly different from that of peripheral lung cancer. In addition, the difference between the two enhancement peaks was also statistically significant; there was a statistically significant difference in perfusion values and enhancement values between central lung cancer and metastases, and there was no statistically significant difference in perfusion values and enhancement values between peripheral lung cancer and metastases. There was no statistically significant difference in the above parameters between non-small cell lung cancer and small cell lung cancer. Conclusion The tumor perfusion values and enhancement peaks are related to tumor size and location. However, regardless of the pathological type, the prognosis of tumors of different sizes and locations can be evaluated.