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目的探讨多层螺旋CT灌注成像技术对肺混杂性磨玻璃结节(m GGN)实性部分血供的评估价值。方法回顾性分析2011年3月至2015年5月在河北工程大学附属医院、邯郸市第一医院及邢台市人民医院经病理证实的m GGN患者97例,采用多层螺旋CT灌注成像技术分析m GGN实性部分血供,比较CT灌注参数对良、恶性病变的诊断价值。结果共纳入97例m GGN患者,其中80例为恶性病变,17例为良性病变。m GGN恶性病变中血容量(BV)、峰值增强影像(PEI)及表面通透性(PS)均高于良性病变,而灌注峰值时间低于良性病变且差异有统计学意义(P<0.05)。微浸润腺癌(MIA)、浸润性腺癌(IAC)患者的BV、PEI以及PS显著高于浸润前病变(P<0.05),IAC中BV、PS显著高于MIA组(P<0.05)。非条件多因素Logistic回归分析结果显示,病理类型中IAC、MIA及浸润前病变,BV、PEI及PS均与m GGN呈正相关。受试者工作特征曲线显示,BV+PS+PEI三者联合时,敏感性、特异性、阳性预测值、阴性预测值以及诊断准确率分别为95.28%、86.65%、91.10%、87.52%及91.76%,其曲线下面积显著高于单一检测指标(P<0.05)。结论多层螺旋CT灌注成像技术可用于评估m GGN的血供,CT灌注参数联合应用可用于鉴别良、恶性病变。
Objective To evaluate the value of multislice spiral CT perfusion imaging in evaluating the blood supply of m GGN in the lung. Methods A retrospective analysis of 97 pathologically confirmed mGGN patients from March 2011 to May 2015 in Hebei University of Engineering Hospital, Handan No.1 Hospital and Xingtai People’s Hospital was performed. The multi-slice spiral CT perfusion imaging was used to analyze m GGN solid part of the blood supply, CT perfusion parameters in the diagnosis of benign and malignant lesions. Results A total of 97 patients with mGGN were included, of which 80 were malignant and 17 were benign. m, BV, PEI and PS in benign and malignant lesions were higher than those in benign lesions, while the peak perfusion time was lower than that in benign lesions (P <0.05) . BV, PEI and PS in patients with micro-invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) were significantly higher than those before infiltration (P <0.05). BV and PS in IAC were significantly higher than those in MIA group (P <0.05). Unconditional multivariate Logistic regression analysis showed that pathological types of IAC, MIA and pre-infiltration, BV, PEI and PS were positively correlated with m GGN. The receiver operating characteristic curve showed that the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of BV + PS + PEI were 95.28%, 86.65%, 91.10%, 87.52% and 91.76 %, The area under the curve was significantly higher than a single detection index (P <0.05). Conclusion Multi-slice spiral CT perfusion imaging can be used to evaluate the blood supply of mGGN. The combination of CT perfusion parameters can be used to identify benign and malignant lesions.