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目的探讨CT灌注成像在肾细胞癌诊断及鉴别诊断的价值。方法本研究共包括39例肾细胞癌、12例良性肿瘤患者,均有完整的临床和病理资料。所有病例行肾脏常规CT平扫后,选定灌注扫描层面,以4.0ml/s的速度团注对比剂50ml,注射对比剂后延迟6s,采用Siemens Bodyperfusion体部灌注扫描序列,对选定相邻2层部位进行连续动态增强扫描。利用SIEMENS Per-fusion CT/VA11A软件对灌注扫描图像进行后处理,生成表示腹部器官血流的伪彩灌注图。将各图转入ROI Evaluation子菜单,利用感兴趣区法(region of interest)测量血流量(blood flow)、血流容积(blood volume)、无血管血流量(flowwithout vessels)、组织强化峰值(peak enhancement)、灌注起始时间(time to start)和峰值时间(time to peak)。结果肾细胞癌的血流值、血流容积、无血管血流量和组织强化峰值均高于/大于良性肾肿瘤,而灌注起始时间小于良性肾肿瘤;采用Siemens Perfusion CT/VA11A软件得到的肾细胞癌、肾良性肿瘤的灌注值分别为(1.52±0.68)、(0.65±0.32)ml.min-1.ml-1。结论CT灌注成像可较好地检测肾脏肿瘤的血流动力学情况,有助于术前判断肾脏肿瘤性质。
Objective To investigate the value of CT perfusion imaging in the diagnosis and differential diagnosis of renal cell carcinoma. Methods A total of 39 cases of renal cell carcinoma and 12 cases of benign tumors were included in the study. All of them had complete clinical and pathological data. All patients underwent conventional CT scan of the kidneys, the selected perfusion scan level, the group with a speed of 4.0ml / s bolus injection of contrast agent 50ml, delayed 6s after injection of contrast agent, the use of Siemens Body peripheral perfusion scanning sequence, the selected adjacent 2-tier site for continuous dynamic enhanced scan. The perfusion scan images were post-processed using SIEMENS Per-fusion CT / VA11A software to generate pseudo-color perfusion maps representing the blood flow in the abdominal organs. The graphs were transferred to the ROI Evaluation submenu and the blood flow, blood volume, flowwithout vessels, peak of tissue enhancement enhancement, time to start, and time to peak. Results The peak values of blood flow, blood volume, blood flow and tissue enhancement in renal cell carcinoma were higher than those in benign renal tumors, and the initial time of perfusion was smaller than that of benign renal tumors. The renal perfusion obtained with Siemens Perfusion CT / VA11A software The perfusion values were (1.52 ± 0.68) and (0.65 ± 0.32) ml.min-1.ml-1 in patients with benign and malignant tumors. Conclusion CT perfusion imaging can better detect the hemodynamics of renal tumors and help to determine the renal tumor characteristics before surgery.