胸部CT灌注成像对周围型肺癌分期及肿瘤坏死的评估价值
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摘要
目的探讨胸部CT灌注成像对周围型肺癌分期及肿瘤坏死的评估价值。方法选取68例证实为周围型肺癌的患者,进行CT灌注成像扫描,选取肿瘤检测到的最大层面分析,同时比对患者CT灌注成像扫描各项参数[强化峰值(PE)、血容量(BV)、灌注值(PER)、达峰值时间(TTP)],分析不同肺癌分期肿瘤坏死患者胸部CT灌注成像参数值的差异。结果T2期PER、PE、BV较T1期显著降低,T3期BV、PE、PER较T2期显著升高,T4期BV、PE、PER较T3期显著降低,差异均有统计学意义(P <0. 05);在肿瘤坏死层面上,坏死组PER、PE、BV较未坏死组显著降低(P <0. 05),而TTP则显著增高(P <0. 05)。不同组织学类型的周围型肺癌的灌注参数结果显示,小细胞癌的BV、PE、TTP值较腺癌和鳞癌稍低,腺癌的BV、PE、TTP、PER稍低于鳞癌,但差异均无统计学意义(P> 0. 05)。结论胸部CT灌注成像参数分析可间接鉴定肿瘤分期和坏死情况,为患者病情的无创检测提供了新的检测方向与临床依据。
Objective To explore value of thoracic CT perfusion imaging in evaluation of staging and tumor necrosis of peripheral lung cancer. Methods A total of 68 patients diagnosed as peripheral lung cancer were performed CT perfusion imaging. The maximum level of tumor was selected. The CT perfusion imaging indicators [the CT perfusion imaging( PE),blood volume( BV),perfusion value( PER) and peak time( TTP) ]were analyzed between different lung cancer stages and tumor necrosis patients. Results Perfusion parameters such as PER,PE and BV were significantly decreased in T2 stage compared with T1 stage; BV,PE and PER in T3 significantly increased compared with T2,and BV,PE and PER significantly decreased in T4 stage compared with T2( P <0. 05). The levels of PER,PE and BV in the necrotic group were significantly lower,while the TTP was significantly increased when compared with non-necrotic group( P < 0. 05). Perfusion parameters of peripheral lung cancer in different tissues showed that the BV,PE,TTP and PER values of small cell carcinoma were slightly lower than those of adenocarcinoma and squamous cell carcinoma,and those parameter values in adenocarcinoma were slightly lower than the squamous cell carcinoma,but no difference was observed( P > 0. 05). Conclusion CT perfusion imaging indicators can indirectly identify tumor staging and necrosis,which provide a evidence for noninvasive detection.
Objective To explore value of thoracic CT perfusion imaging in evaluation of staging and tumor necrosis of peripheral lung cancer. Methods A total of 68 patients diagnosed as peripheral lung cancer were performed CT perfusion imaging. The maximum level of tumor was selected. The CT perfusion imaging indicators [the CT perfusion imaging( PE),blood volume( BV),perfusion value( PER) and peak time( TTP) ]were analyzed between different lung cancer stages and tumor necrosis patients. Results Perfusion parameters such as PER,PE and BV were significantly decreased in T2 stage compared with T1 stage; BV,PE and PER in T3 significantly increased compared with T2,and BV,PE and PER significantly decreased in T4 stage compared with T2( P <0. 05). The levels of PER,PE and BV in the necrotic group were significantly lower,while the TTP was significantly increased when compared with non-necrotic group( P < 0. 05). Perfusion parameters of peripheral lung cancer in different tissues showed that the BV,PE,TTP and PER values of small cell carcinoma were slightly lower than those of adenocarcinoma and squamous cell carcinoma,and those parameter values in adenocarcinoma were slightly lower than the squamous cell carcinoma,but no difference was observed( P > 0. 05). Conclusion CT perfusion imaging indicators can indirectly identify tumor staging and necrosis,which provide a evidence for noninvasive detection.
引文
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[13]赵涤非,邹勤舟,张福正,等.体部立体定向放射治疗周围型肺癌46例近期疗效观察[J].实用临床医药杂志,2013,17(21):178-180.
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[16]云永兴,王立非,杨根东,等. H7N9病毒性肺炎胸部CT随访分析[J].中国中西医结合影像学杂志,2017,15(3):277-279.
[17]连相尧,胡潺潺,张立广,等.胸部恶性肿瘤三维适形放疗患者行强化CT模拟定位联合SPECT放疗计划的疗效及安全性观察[J].健康周刊,2017(5):1-4.
[18]生守鹏,马良,张洪海,等.亚砷酸及洛铂动脉灌注序贯治疗肝癌腹腔淋巴结转移1例[J].中国介入影像与治疗学,2017,14(8):517.
[19]张相国,梁思贤,韩非,等.鼻咽癌疗前原发灶及区域淋巴结坏死与3DRT预后关系[J].中华放射肿瘤学杂志,2016,25(12):1285-1289.
[20]刘殊,王士勇,张璐,等.肿瘤坏死与结肠癌预后的关系[J].现代肿瘤医学,2016,24(10):1582-1585.
[21]仝云蕾,陈铭,龚瑜,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合甲氨蝶呤治疗银屑病及其对白细胞介素17A和肿瘤坏死因子α的影响[J].中华皮肤科杂志,2017,50(9):636-640.
[22] Bayramoglu A,Gunes H V,Metintas M,et al. The association of MMP-9 enzyme activity,MMP-9 C1562T polymorphism,and MMP-2 and-9 and TIMP-1,-2,-3,and-4 gene expression in lung cancer[J]. Genet Test Mol Biomarkers,2009,13(5):671-678.
[23]戚焕鹏,李建彬,张英杰,等.四维CT与自主呼吸控制辅助三维CT确定周围型肺癌大体肿瘤体积位移的比较[J].中华肿瘤杂志,2013,35(7):514-517.
[24]徐建.多层螺旋CT在周围型肺癌患者临床TNM分期诊断中的应用价值[J].中外医学研究,2015,13(34):84-85.
[25]高樱,王霁朏,周旭辉,等.多层螺旋CT分析周围型肺癌形态学特征-MPR正交重组切面结合MIP[J].中山大学学报:医学科学版,2016,37(6):925-929.
[26]刘澜涛,代光政,田翠丽,等.多层螺旋CT在周围型肺癌和局灶性机化性肺炎鉴别诊断中的价值[J].临床与病理杂志,2017(7):1438-1444.
[27]万大平,刘栋云.多层螺旋CT与X线平片诊断早期周围型肺癌的临床对比研究[J].医学综述,2015,21(5):927-929.
[2]郑勇,孔江明,高文军.螺旋CT扫描对周围型肺癌的诊断价值[J].中国基层医药,2011,18(20):2798-2799.
[3] Li B G,Ma D Q,Xian Z Y,et al. The value of multislice spiral CT features of cavitary walls in differentiating between peripheral lung cancer cavities and single pulmonary tuberculous thick-walled cavities[J]. Br J Radiol, 2012, 85(1010):147-152.
[4]谭理连,周洁,李志铭,等.周围型肺癌病理、CT表现与血清肿瘤标志物CA50关系研究[J].中国CT和MRI杂志,2011,9(1):1-3,9.
[5] Khan K A,Kennedy M P,Moore E,et al. Radiological characteristics,histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis[J]. Lung,2015,193(1):71-77.
[6]王昊,陈华,顾恒乐,等.周围型肺癌并纵隔淋巴结转移放疗中分野锁定准直器调强计划对肺组织保护的研究[J].中华放射肿瘤学杂志,2017,26(3):320-323.
[7]林国成,曹劲松. CTP评估周围型肺癌组织学类型、分期及肿瘤坏死的价值[J].中国CT和MRI杂志,2016,14(4):38-40,44.
[8] Li J,Chen P,Mao C M,et al. Evaluation of diagnostic value of four tumor markers in bronchoalveolar lavage fluid of peripheral lung cancer[J]. Asia Pac J Clin Oncol,2014,10(2):141-148.
[9]周坦峰,吴伟.周围型肺癌与结核瘤影像诊断及鉴别诊断的临床研究[J].临床肺科杂志,2016,21(5):958-960.
[10]董志坚,齐敏.多层螺旋CT应用于周围型肺癌TNM分期诊断中的意义[J].实用癌症杂志,2017,32(5):793-795.
[11]梁远凤,李琦,罗天友.能谱CT平扫定量分析鉴别诊断周围型肺癌与结核球[J].中国医学影像技术,2017,33(8):1206-1210.
[12] Son C,Kang E J,Roh M S. Strategic management of transthoracic needle aspirates for histological subtyping and EGFR testing in patients with peripheral lung cancer:An institutional experience[J]. Diagn Cytopathol,2015,43(7):532-538.
[13]赵涤非,邹勤舟,张福正,等.体部立体定向放射治疗周围型肺癌46例近期疗效观察[J].实用临床医药杂志,2013,17(21):178-180.
[14]李传贵,邹殿俊,朱晓龙,等.胸部CT平扫联合灌注成像在中央型肺癌患者肺部病变形态观察及早期诊断中的应用价值[J].中国医药导刊,2017,19(7):675-676.
[15]高垒,杨青,胡亚彬,等.双入口CT灌注评价肺腺癌和肺鳞癌血供特征[J].中国医学影像技术,2017,33(3):419-422.
[16]云永兴,王立非,杨根东,等. H7N9病毒性肺炎胸部CT随访分析[J].中国中西医结合影像学杂志,2017,15(3):277-279.
[17]连相尧,胡潺潺,张立广,等.胸部恶性肿瘤三维适形放疗患者行强化CT模拟定位联合SPECT放疗计划的疗效及安全性观察[J].健康周刊,2017(5):1-4.
[18]生守鹏,马良,张洪海,等.亚砷酸及洛铂动脉灌注序贯治疗肝癌腹腔淋巴结转移1例[J].中国介入影像与治疗学,2017,14(8):517.
[19]张相国,梁思贤,韩非,等.鼻咽癌疗前原发灶及区域淋巴结坏死与3DRT预后关系[J].中华放射肿瘤学杂志,2016,25(12):1285-1289.
[20]刘殊,王士勇,张璐,等.肿瘤坏死与结肠癌预后的关系[J].现代肿瘤医学,2016,24(10):1582-1585.
[21]仝云蕾,陈铭,龚瑜,等.重组人Ⅱ型肿瘤坏死因子受体-抗体融合蛋白联合甲氨蝶呤治疗银屑病及其对白细胞介素17A和肿瘤坏死因子α的影响[J].中华皮肤科杂志,2017,50(9):636-640.
[22] Bayramoglu A,Gunes H V,Metintas M,et al. The association of MMP-9 enzyme activity,MMP-9 C1562T polymorphism,and MMP-2 and-9 and TIMP-1,-2,-3,and-4 gene expression in lung cancer[J]. Genet Test Mol Biomarkers,2009,13(5):671-678.
[23]戚焕鹏,李建彬,张英杰,等.四维CT与自主呼吸控制辅助三维CT确定周围型肺癌大体肿瘤体积位移的比较[J].中华肿瘤杂志,2013,35(7):514-517.
[24]徐建.多层螺旋CT在周围型肺癌患者临床TNM分期诊断中的应用价值[J].中外医学研究,2015,13(34):84-85.
[25]高樱,王霁朏,周旭辉,等.多层螺旋CT分析周围型肺癌形态学特征-MPR正交重组切面结合MIP[J].中山大学学报:医学科学版,2016,37(6):925-929.
[26]刘澜涛,代光政,田翠丽,等.多层螺旋CT在周围型肺癌和局灶性机化性肺炎鉴别诊断中的价值[J].临床与病理杂志,2017(7):1438-1444.
[27]万大平,刘栋云.多层螺旋CT与X线平片诊断早期周围型肺癌的临床对比研究[J].医学综述,2015,21(5):927-929.