Department of Radiology, the 309th Hospital of Chinese People's Liberation Army, 17 Heishanhu Road, Haidian District, Beijing, 100091, People's Republic of China.
Eur Radiol. 2013 Sep;23(9):2469-74. doi: 10.1007/s00330-013-2842-x. Epub 2013 Jun 22.
To assess diagnostic performance of dual-input CT perfusion for distinguishing malignant from benign solitary pulmonary nodules (SPNs).
Fifty-six consecutive subjects with SPNs underwent contrast-enhanced 320-row multidetector dynamic volume CT. The dual-input maximum slope CT perfusion analysis was employed to calculate the pulmonary flow (PF), bronchial flow (BF), and perfusion index [Formula: see text]. Differences in perfusion parameters between malignant and benign tumours were assessed with histopathological diagnosis as the gold standard. Diagnostic value of the perfusion parameters was calculated using the receiver-operating characteristic (ROC) curve analysis.
Amongst 56 SPNs, statistically significant differences in all three perfusion parameters were revealed between malignant and benign tumours. The PI demonstrated the biggest difference between malignancy and benignancy: 0.30 ± 0.07 vs. 0.51 ± 0.13 , P < 0.001. The area under the PI ROC curve was 0.92, the largest of the three perfusion parameters, producing a sensitivity of 0.95, specificity of 0.83, positive likelihood ratio (+LR) of 5.59, and negative likelihood ratio (-LR) of 0.06 in identifying malignancy.
The PI derived from the dual-input maximum slope CT perfusion analysis is a valuable biomarker for identifying malignancy in SPNs. PI may be potentially useful for lung cancer treatment planning and forecasting the therapeutic effect of radiotherapy treatment.
• Modern CT equipment offers assessment of vascular parameters of solitary pulmonary nodules (SPNs) • Dual vascular supply was investigated to differentiate malignant from benign SPNs. • Different dual vascular supply patterns were found in malignant and benign SPNs. • The perfusion index is a useful biomarker for differentiate malignancy from benignancy.
评估双输入 CT 灌注在鉴别良恶性孤立性肺结节（SPN）中的诊断性能。
对 56 例 SPN 患者连续进行了对比增强 320 排多层动态容积 CT 检查。采用双输入最大斜率 CT 灌注分析计算肺血流量（PF）、支气管血流量（BF）和灌注指数[公式：见文本]。以组织病理学诊断为金标准，评估灌注参数在良恶性肿瘤之间的差异。使用受试者工作特征（ROC）曲线分析计算灌注参数的诊断价值。
在 56 个 SPN 中，恶性和良性肿瘤之间的所有三种灌注参数均存在统计学显著差异。PI 显示了恶性肿瘤和良性肿瘤之间最大的差异：0.30±0.07 与 0.51±0.13 ，P<0.001。PI 的 ROC 曲线下面积为 0.92，是三种灌注参数中最大的，其诊断恶性肿瘤的灵敏度为 0.95，特异性为 0.83，阳性似然比（+LR）为 5.59，阴性似然比（-LR）为 0.06。
从双输入最大斜率 CT 灌注分析得出的 PI 是鉴别 SPN 恶性肿瘤的有价值的生物标志物。PI 可能对肺癌的治疗计划和预测放疗治疗效果有用。
• 现代 CT 设备可评估孤立性肺结节（SPN）的血管参数。• 研究了双血管供应以区分恶性和良性 SPN。• 发现恶性和良性 SPN 之间存在不同的双血管供应模式。• 灌注指数是鉴别良恶性的有用生物标志物。
