论文部分内容阅读
目的利用 CT 灌注成像观察转移性肺癌的血供。方法选取符合入选标准的肺部转移瘤患者19例,通过 DSA 导引下分别行支气管动脉和选择性肺动脉插管,插管后将患者平移至多层螺旋 CT(MSCT)下分别行转移瘤的双导管增强的同层动态螺旋 CT 扫描,其中支气管动脉内对比剂流率为1.5 ml/s,总量6～8 ml,肺动脉导管内对比剂流率3 ml/s,总量40 ml,2次扫描间隔为10 min。扫描后采用功能 CT 软件分别在转移瘤内选取3个不同感兴趣区,即高强化区、低(不)强化区和整个瘤体区进行灌注值和高峰强化值(PEI)测量,并描绘时间-密度曲线,同时测量转移瘤最大直径。结果经肺动脉和支气管动脉途径增强后肿瘤结节灌注值分别是133.70(29.00～346.75)和2.30(0～24.25)ml·min~(-1)·ml~(-1),两者间差异具有统计学意义(Z=-6.281,P<0.01);PEI 值分别是100.00(20.75～428.60)和11.30(1.05～26.00)HU,差异也有统计学意义(Z=-5.776,P<0.01)。3个不同感兴趣区的肿瘤结节,经两种不同途径增强后灌注值和 PEI 值间差异均具有统计学意义(P<0.05);经肺动脉和经支气管动脉途径增强后灌注值与肿瘤结节直径均无相关关系(r 值分别为-0.167和0.104,P>0.05),而经肺动脉和经支气管动脉途径增强后肿瘤结节 PEI 值与结节直径均呈正相关(r 值分别为0.421和0.405,P<0.05)。结论转移性肺癌血供主要来自于肺动脉,同时支气管动脉也参与了肿瘤的血供,随着肿瘤的不断增大,肺动脉和支气管动脉血供均不断增多。功能CT 为活体状态下评价肺部转移瘤的肿瘤血管生成提供了良好的研究途径。
Objective To observe the blood supply of metastatic lung cancer by CT perfusion imaging. Methods Twenty-nine patients with metastatic lung tumors were enrolled in this study. Bronchial artery and selective pulmonary artery catheterization were performed under the guidance of DSA. After intubation, the patients were transplanted to double-staged CT (MSCT) Catheter enhanced dynamic CT scans of the same layer, in which bronchial artery contrast medium flow rate of 1.5 ml / s, a total of 6 ~ 8 ml, pulmonary artery catheter contrast medium flow rate of 3 ml / s, a total of 40 ml, twice Scan interval is 10 min. After scanning, functional CT software was used to select three different regions of interest, namely, hyperextension zone, low and non-enhancement zone and whole tumor zone, respectively, for perfusion and peak enhancement (PEI) measurements, - Density curve, while measuring the maximum diameter of metastases. Results The tumor nodule perfusion values were 133.70 (29.00 ~ 346.75) and 2.30 (0 ~ 24.25) ml · min ~ (-1) · ml -1 after pulmonary artery and bronchial artery route respectively. The difference between them was Statistical significance (Z = -6.281, P <0.01). The PEI values were 100.00 (20.75-42.8.60) and 11.30 (1.05-26.00) HU, respectively. The difference was also statistically significant (Z = -5.776, P <0.01). The tumor nodules in three different regions of interest were significantly enhanced by two different routes of enhancement after perfusion and PEI (P <0.05). After perfusion of pulmonary artery and transbronchial artery, (R = -0.167 and 0.104, respectively, P> 0.05). However, there was a positive correlation between the diameter of the nodules and the diameter of the nodules (r = 0.421 and n = 0.405, P <0.05). Conclusions The blood supply of metastatic lung cancer mainly comes from the pulmonary artery. At the same time, the bronchial artery is also involved in the blood supply of the tumor. As the tumor grows, the blood supply to the pulmonary artery and bronchial artery are increasing. Functional CT provides a good way to evaluate tumor angiogenesis in lung metastases in vivo.