CAJ | 학술논문

CT灌注成像作为一种无创性的功能性影像学成像检查方法，能够反映出非小细胞肺癌的血管生成情况，并且通过血管的变化情况来评价非小细胞肺癌对抗血管生成治疗药物的治疗反应。相比以往的RECIST评价方式，CT灌注成像在治疗伊始就可以提供肿瘤变化情况的信息。基于非小细胞肺癌的血管生成原理，CT灌注成像的主要评价指标包括血流量、血容量、对比剂的平均通过时间、毛细血管通透性以及强化峰值等灌注参数。而CT灌注成像对于“血管正常化”的指标的分析将可以影响对非小细胞肺癌预后和疗效的预测评价。非小细胞肺癌的微血管管腔化程度以及血管内皮生长因子的表达与CT灌注成像评价指标之间也存在密切联系，而非小细胞肺癌的病理分级和组织学分型的不同也在CT灌注成像的评价中有着重要影响。由于技术层面的限制，灌注参数的可重复性较差，患者接受的放射剂量过大及造影使用的对比剂的毒性等，这种方法的应用推广仍然存在很大问题。相信随着更多分子影像标志物的出现和抗血管生成靶向治疗药物的发展，应用CT灌注成像的方法对非小细胞肺癌的抗血管生成治疗进行临床评价将可能有更大的发展空间。
CT관주성상작위일충무창성적공능성영상학성상검사방법，능구반영출비소세포폐암적혈관생성정황，병차통과혈관적변화정황래평개비소세포폐암대항혈관생성치료약물적치료반응。상비이왕적RECIST평개방식，CT관주성상재치료이시취가이제공종류변화정황적신식。기우비소세포폐암적혈관생성원리，CT관주성상적주요평개지표포괄혈류량、혈용량、대비제적평균통과시간、모세혈관통투성이급강화봉치등관주삼수。이CT관주성상대우“혈관정상화”적지표적분석장가이영향대비소세포폐암예후화료효적예측평개。비소세포폐암적미혈관관강화정도이급혈관내피생장인자적표체여CT관주성상평개지표지간야존재밀절련계，이비소세포폐암적병리분급화조직학분형적불동야재CT관주성상적평개중유착중요영향。유우기술층면적한제，관주삼수적가중복성교차，환자접수적방사제량과대급조영사용적대비제적독성등，저충방법적응용추엄잉연존재흔대문제。상신수착경다분자영상표지물적출현화항혈관생성파향치료약물적발전，응용CT관주성상적방법대비소세포폐암적항혈관생성치료진행림상평개장가능유경대적발전공간。
As a non-invasive functional radiographic imaging method, perfusion computed tomography (PCT) permits the evalu-ation of non-small-cell lung cancer (NSCLC) angiogenesis and response to therapy by demonstrating alterations in NSCLC vascularity. PCT performed shortly after initiating therapy may provide a better evaluation of physiological changes rather than conventional size as-sessment obtained by response evaluation criteria in solid tumors. Based on the angiogenesis principle of NSCLC, the main evaluation indexes of PCT are blood flow, blood volume, mean transit time, permeability surface, and peak enhancement index. The relationship between PCT and the indexes of "vascular normalization" may have implications for exploring the predictive model of efficacy and prognostic factors of NSCLC. The cavity of microvessel in NSCLC and expression of VEGF factors are closely related to PCT imag-ing. According to PCT assessment, pathological classification and histological type of NSCLC play significant roles. However, techni-cal limitations, reproducibility of blood flow parameters, radiation dose, and volume of contrast medium delivered to the patient are some issues in this type of investigation. With the development of PCT technology and anti-angiogenesis drugs for NSCLC, more mo-lecular imaging markers and standardized targeted therapies will be available. Such advancements will provide a wider space for the as-sessment of NSCLC treated with anti-angiogenic therapy using PCT.