CAJ | 학술논문

目的探讨SPECT肺灌注与CT异机融合图像评价Ⅲ期非小细胞肺癌(NSCLC)患者区域肺功能的意义.方法选择Ⅲ期NSCLC患者32例,治疗前行肺功能测试和胸部CT扫描,并在相同体位下行SPECT肺灌注显像,两套图像均传至Philips Pinnacle3放射治疗计划系统,依据外标记点进行手动异机图像融合.参考CT与SPECT肺灌注融合图像,按灌注缺损区与肿瘤病灶的大小关系分为4级:0级为无灌注受损;1级为肿瘤及其周围局部肺灌注受损;2级为1叶肺灌注受损;3级为超过1叶肺灌注受损.采用SPSS 13.0软件,行PearsonX2检验.结果 32例Ⅲ期NSCLC患者中,31例有程度不等的肺灌注缺损,其中1级13例,2级8例,3级10例.中央型NSCLC患者肺灌注缺损较周围型NSCLC患者严重,差异有统计学意义(X2=10.495,P＜0.05).8例患者肺功能测试有不同程度的异常.CT与SPECT肺灌注融合图像阳性率96.9%(31/32),较肺功能测试阳性率25.0%(8/32)高,差异有统计学意义(X2=34.724,P＜0.05).结论 SPECT肺灌注与CT异机融合图像能更好显示Ⅲ期NSCLC患者区域肺组织的功能状况,为此类患者制订手术方案、预测术后肺功能、优化放疗计划等提供更多的信息.
목적 탐토SPECT폐관주여CT이궤융합도상평개Ⅲ기비소세포폐암(NSCLC)환자구역폐공능적의의.방법 선택Ⅲ기NSCLC환자32례,치료전행폐공능측시화흉부CT소묘,병재상동체위하행SPECT폐관주현상,량투도상균전지Philips Pinnacle3방사치료계화계통,의거외표기점진행수동이궤도상융합.삼고CT여SPECT폐관주융합도상,안관주결손구여종류병조적대소관계분위4급:0급위무관주수손;1급위종류급기주위국부폐관주수손;2급위1협폐관주수손;3급위초과1협폐관주수손.채용SPSS 13.0연건,행PearsonX2검험.결과 32례Ⅲ기NSCLC환자중,31례유정도불등적폐관주결손,기중1급13례,2급8례,3급10례.중앙형NSCLC환자폐관주결손교주위형NSCLC환자엄중,차이유통계학의의(X2=10.495,P＜0.05).8례환자폐공능측시유불동정도적이상.CT여SPECT폐관주융합도상양성솔96.9%(31/32),교폐공능측시양성솔25.0%(8/32)고,차이유통계학의의(X2=34.724,P＜0.05).결론 SPECT폐관주여CT이궤융합도상능경호현시Ⅲ기NSCLC환자구역폐조직적공능상황,위차류환자제정수술방안、예측술후폐공능、우화방료계화등제공경다적신식.
objective The aim of this study was to assess the value of fusion SPECT perfusion and CT images acquired separately at 2 time-points in evaluating regional lung function of patients with stage Ⅲ non-small cell lung cancer(NSCLC).Methods Thirty-two patients with untreated stage Ⅲ NSCLC underwent pulmonary function test(PFT),CT and SPECT imaging.Two series of images were registered by software fusion based on external markers by Philips Pinnacle3 planning treatment system.The SPECT/CT fu sion images were graded by comparing lung perfusion defect with the area of radiological abnormality.Grade O:no lung perfusion defect in the area of radiological abnormality.Grade 1:the area of lung perfusion defect was similar to the size of radiological abnormality.Grade 2:the area of lung perfusion defect was bigger than that of radiological abnormality.and extended to 1 pulmonary lobe.Grade 3:the area of lung perfusion defect exceeded 1 pulmonary lobe.Statistically significant difference was evaluated by Pearson X2-test using SPSS 13.0 software.Results In 32 patients with stage Ⅲ NSCLC,31 patients had lung perfusion defects.There were 13 patients with grade 1,8 with grade 2,10 with grade 3.There was statistically significant difference between central lung cancer and peripheral lung cancer(X2=10.495,P＜0.05);8 patients had PFT abnormality.There was also statistically significant difference between the positive rate of SPECT/CT fusion images and PFT[96.9%(31/32)vs 25.0%(8/32),X2=34.724,P＜0.05].Conclusion The fusion of SPECT lung perfusion and CT images acquired separately at 2 different time-points is a feasible technique for assessing the regional lung function of patients with stageⅢNSCLC,thereby offering more information for surgical planning,prediction of postoperative lung function and optimization of radiation treatment plans.