CAJ | 학술논문

目的应用16层MSCT灌注成像定量评价肺癌肿瘤血管生成,并探讨CT灌注成像强化指标和肿瘤微血管密度(MVD)与肺癌淋巴结转移的关系及其价值.方法对53例周围型肺癌行CT灌注扫描,根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,根据病理结果分为有淋巴结转移组和无淋巴结转移组,并对肿瘤MVD计数.淋巴结转移组与无转移组各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ROC曲线分析MVD和CT灌注强化指标评价肺癌淋巴结转移的诊断效能.结果 (1)肺癌淋巴结转移组(26例)MVD计数高于无淋巴结转移组(27例),MVD分别为(64.69±16.34)、(42.67±16.78)个/0.74 mm~2(t=4.84,P<0.01).淋巴结转移组肿块的强化峰值(PH)、肿块与主动脉PH之比(M/A)、灌注值(PV)均高于无淋巴结转移组[PH分别为(41.79±15.50)、(29.99±10.91)HU;M/A分别为0.24±0.09、0.15±0.06;PV分别为(2.14±1.09)、(1.27±0.53)ml·min~(-1)·ml~(-1)];差异均有统计学意义(t值分别为3.21、3.95、3.66,P均<0.01).(2)PH、M/A、PV均与MVD呈正相关,其中PV与MVD的相关系数最高(r=0.716,P<0.01).(3)利用ROC曲线分析,MVD、PV判断肺癌淋巴结转移有较高的诊断价值(曲线下面积分别为0.828、0.849,P>0.05);当以MVD>52个/0.74 mm~2或PV>1.52 ml·min~(-1)·m~l(-1)作为强烈提示肺癌淋巴结转移的可能性时,其敏感性、特异性、诊断符合率均较高(分别为80.8%、81.5%、81.1%和84.6%、85.2%、84.9%).结论 CT灌注强化指标PV及MVD与肺癌淋巴结转移存在密切关系,PV可作为术前判断肺癌淋巴结转移的重要指标之一.
목적 응용16층MSCT관주성상정량평개폐암종류혈관생성,병탐토CT관주성상강화지표화종류미혈관밀도(MVD)여폐암림파결전이적관계급기개치.방법 대53례주위형폐암행CT관주소묘,근거수과기종괴강화적시간-밀도곡선(TDC)계산종류적관주강화지표,근거병리결과분위유림파결전이조화무림파결전이조,병대종류MVD계수.림파결전이조여무전이조각관찰지표적차이채용t검험혹t'검험;장CT관주강화지표분별여MVD주상관성분석;이용ROC곡선분석MVD화CT관주강화지표평개폐암림파결전이적진단효능.결과 (1)폐암림파결전이조(26례)MVD계수고우무림파결전이조(27례),MVD분별위(64.69±16.34)、(42.67±16.78)개/0.74 mm~2(t=4.84,P<0.01).림파결전이조종괴적강화봉치(PH)、종괴여주동맥PH지비(M/A)、관주치(PV)균고우무림파결전이조[PH분별위(41.79±15.50)、(29.99±10.91)HU;M/A분별위0.24±0.09、0.15±0.06;PV분별위(2.14±1.09)、(1.27±0.53)ml·min~(-1)·ml~(-1)];차이균유통계학의의(t치분별위3.21、3.95、3.66,P균<0.01).(2)PH、M/A、PV균여MVD정정상관,기중PV여MVD적상관계수최고(r=0.716,P<0.01).(3)이용ROC곡선분석,MVD、PV판단폐암림파결전이유교고적진단개치(곡선하면적분별위0.828、0.849,P>0.05);당이MVD>52개/0.74 mm~2혹PV>1.52 ml·min~(-1)·m~l(-1)작위강렬제시폐암림파결전이적가능성시,기민감성、특이성、진단부합솔균교고(분별위80.8%、81.5%、81.1%화84.6%、85.2%、84.9%).결론 CT관주강화지표PV급MVD여폐암림파결전이존재밀절관계,PV가작위술전판단폐암림파결전이적중요지표지일.
Objective To evaluate the clinical value of CT perfusion (CTP) imaging for providing quantitative information about angiogenesis in patients with lung carcinoma and investigate the correlation of CTP enhancement parameters and histological microvessel density (MVD) with lymphatic involvement in peripheral lung carcinoma. Methods Fifty-three patients with pathology-proved peripheral lung carcinoma underwent CT perfusion scan before operation. The enhancement parameters of CTP were calculated based on the time-density curves (TDC) of fist pass phase. All cases were classified into two groups according to pathologic results: tumor with and without lymph node involvement. Two-sample t test was used for the statistics. The ROC curve was used to assess the efficiency of the enhancement parameters of CT perfusion and MVD for predicting lymphatic involvement. Results Tumors with lymph node involvement had significantly higher value of MVD than those without lymph node involvement (64.69±16.34 and 42.67± 16.78, respectively,t=4.84,P<0.01). Tumors with lymph node involvement had significantly higher value of CTP enhancement parameters (PH, M/A, PV) than those without lymph node involvement [PH= (41.79±15.50) and (29.99±10.91) HU,M/A =0.24±0.09 and 0.15±0.06, PV=(2.14±1.09) and (1.27±0.53) ml·min~(-1)·ml~(-1), t=3.21,3.95, 3.66, P<0.01, respectively]. The CTP enhancement parameters (PH, M/A, PV) of lung cancer correlated positively with the MVD, the highest correlation coefficient was between the PV and MVD (r=0.716, P<0.01). MVD and PV had higher values for predicting lymph node involvement in ROC curve analysis. The sensitivity, specificity and accuracy for predicting lymph node involvement were 80.8%, 81.5% and 81.1% or 84.6% ,85.2% and 84.9% respectively if MVD>52/0.74 mm~2 or PV>1.52 ml·min~(-1)·ml~(-1). Conclusion The CT perfusion PV and histological MVD have good correlation with lymph node involvement in peripheral lung carcinoma and are important predicting parameters before operation.