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目的探讨多层螺旋CT首过期灌注强化指标和肿瘤微血管密度(MVD)在肺癌TNM分期的临床价值。资料与方法对32例周围型肺癌患者行CT灌注扫描,依据首过期肿块强化的时间-密度曲线(TDC)计算肿瘤的灌注强化指标,按病理结果分为:≤3 cm肺癌组和>3 cm、≤7 cm肺癌组,累及胸膜组和未累及胸膜组;有淋巴结转移组和无淋巴结转移组;TNM分期按Ⅰ~Ⅱ期和Ⅲ~Ⅳ期分两组,并对肿瘤MVD计数。各组观察指标的差异采用t检验或t’检验;将CT灌注强化指标分别与MVD做相关性分析;利用受试者工作特征(ROC)曲线分析MVD和CT灌注强化指标评价肺癌TNM分期的诊断效能。结果 (1)肿块的强化峰值(PH)、肿块与主动脉PH之比(M/A)、灌注值(PV)和MVD在肿块直径≤3 cm与>3 cm、≤7 cm之间[分别为(33.73±20.56)HU、(31.26±13.22)HU;(0.28±0.10)、(0.24±0.14);(1.58±0.83)ml.min-1.ml-1、(1.45±0.81)ml.min-1.ml-1;(73.00±15.03)个/0.74 mm2、(66.42±12.93)个/0.74 mm2]差异均无统计学意义(P>0.05)。(2)累及胸膜组的PV和MVD均高于未累及胸膜组[分别为(1.83±0.90)ml.min-1.ml-1、(1.15±0.56)ml.min-1.ml-1;(73.40±10.70)个/0.74 mm2、(62.59±13.65)个/0.74 mm2],差异均有统计学意义(P<0.05)。PH和M/A在累及胸膜组与未累及胸膜组之间[分别为(38.27±15.09)HU、(25.94±11.49)HU;(0.27±0.15)、(0.19±0.11)]差异均无统计学意义(均P>0.05)。(3)肺癌淋巴结转移组的肿块PH、M/A、PV和MVD均高于无淋巴结转移组[分别为(38.76±14.32)HU、(21.44±6.48)HU;(0.28±0.14)、(0.14±0.07);(1.73±0.89)ml.min-1.ml-1、(1.10±0.47)ml.min-1.ml-1;(72.58±10.49)个/0.74 mm2、(60.46±14.15)个/0.74 mm2],差异均有统计学意义(P<0.05)。(4)肺癌Ⅲ~Ⅳ期组PH、M/A、PV和MVD均高于肺癌Ⅰ~Ⅱ期组[分别为(38.61±15.01)HU、(25.65±11.12)HU;(0.30±0.14)、(0.16±0.09);(1.86±0.94)ml.min-1.ml-1、(1.13±0.46)ml.min-1.ml-1;(75.00±8.76)个/0.74 mm2、(61.18±13.51)个/0.74 mm2],差异均有统计学意义(P<0.05)。(5)PH、M/A、PV均与MVD呈正相关,其中PV与MVD的相关系数最高(r=0.703,P<0.01)。(6)利用ROC曲线分析,MVD、PV判断肺癌TNM分期有诊断价值[曲线下面积(AZ)分别为0.812和0.729,P>0.05];当以MVD>71.5个/0.74 mm2或PV>1.16 ml.min-1.ml-1作为判断肺癌TNM分期的诊断阈值时,其敏感性、特异性、诊断符合率分别为86.7%、76.5%、81.13%和73.3%、52.9%、62.5%。结论肺癌CT灌注强化指标PV和MVD与肺癌TNM分期存在一定相关性,通过确定PV及MVD的临界值有助于肺癌TNM分期的量化诊断。
Objective To investigate the clinical value of multi-slice spiral CT perfusion enhancement and tumor microvessel density (MVD) in the TNM staging of lung cancer. Materials and Methods CT perfusion scanning was performed on 32 patients with peripheral lung cancer and the perfusion enhancement indexes were calculated according to the time-density curve (TDC) of the first stage of tumor expulsion. According to the pathological results, they were divided into: ≤3 cm lung cancer group and> 3 cm , ≤7 cm lung cancer group, involving pleural group and non-involved pleural group; with lymph node metastasis group and no lymph node metastasis group; TNM stage Ⅰ ~ Ⅱ and Ⅲ ~ Ⅳ divided into two groups, and the tumor MVD count. The differences between the groups were analyzed by t-test or t-test. CT-perfusion enhancement was correlated with MVD. The ROC curve was used to evaluate the diagnostic value of MVD and CT perfusion in TNM staging of lung cancer efficacy. Results The enhancement peak (PH), the ratio of mass to aorta PH (M / A), perfusion value (PV) and MVD were less than or equal to 3 cm and less than or equal to 7 cm (33.73 ± 20.56) HU, (31.26 ± 13.22) HU; (0.28 ± 0.10), (0.24 ± 0.14); (1.58 ± 0.83) ml.min-1.ml- 1, (1.45 ± 0.81) ml.min -1.ml-1; (73.00 ± 15.03) /0.74 mm2, (66.42 ± 12.93) /0.74 mm2] respectively. There was no significant difference between them (P> 0.05). (2) The PV and MVD in the pleural group were significantly higher than those in the non-pleural group [(1.83 ± 0.90) ml.min-1.ml-1, (1.15 ± 0.56) ml.min-1.ml- (73.40 ± 10.70) /0.74 mm2, (62.59 ± 13.65) /0.74 mm2], the differences were statistically significant (P <0.05). There was no significant difference in PH and M / A between the pleural group and the non-involved pleural group [(38.27 ± 15.09) HU, (25.94 ± 11.49) HU; (0.27 ± 0.15), (0.19 ± 0.11)] Significance (all P> 0.05). (3) The tumor mass, lymph node metastasis, lymph node metastasis of lung cancer were higher than those without lymph node metastasis (38.76 ± 14.32 HU, (21.44 ± 6.48) HU, (0.28 ± 0.14), (0.14 ± 0.07); (1.73 ± 0.89) ml.min-1.ml-1, (1.10 ± 0.47) ml.min-1.ml-1; (72.58 ± 10.49) /0.74mm2, (60.46 ± 14.15) /0.74 mm2], the differences were statistically significant (P <0.05). (4) The PH, M / A, PV and MVD of stage Ⅲ ~ Ⅳ lung cancer patients were higher than that of stage Ⅰ ~ Ⅱ lung cancer patients [(38.61 ± 15.01) HU, (25.65 ± 11.12) HU and (0.30 ± 0.14) (0.16 ± 0.09); (1.86 ± 0.94) ml.min-1.ml-1, (1.13 ± 0.46) ml.min-1.ml-1; (75.00 ± 8.76) /0.74 mm2, (61.18 ± 13.51 ) /0.74 mm2], the differences were statistically significant (P <0.05). (5) PH, M / A and PV were positively correlated with MVD, and the correlation coefficient between PV and MVD was the highest (r = 0.703, P <0.01). (6) The diagnostic value of MVD and PV in determining TNM staging of lung cancer by ROC curve analysis [area under the curve (AZ) 0.812 and 0.729 respectively, P> 0.05]; when MVD> 71.5 /0.74 mm2 or PV> 1.16 ml .min-1.ml-1 was 86.7%, 76.5%, 81.13%, 73.3%, 52.9% and 62.5% respectively for the diagnosis of TNM staging in lung cancer. Conclusion The CT perfusion enhancement indexes PV and MVD of lung cancer have some correlation with TNM staging of lung cancer. The determination of the critical value of PV and MVD contributes to the quantitative diagnosis of TNM staging of lung cancer.