Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland).
Department of Ultrasound, Guangdong Women's and Children's Hospital, Guangzhou, Guangdong, China (mainland).
Med Sci Monit. 2019 May 11;25:3485-3494. doi: 10.12659/MSM.914206.
BACKGROUND Numerous studies have explored diagnosis of pulmonary nodules using perfusion computed tomography (CT); however, findings were not always consistent between studies. Th e present study aimed to summarize evidence on the diagnostic value of perfusion CT for distinguishing between lung cancer and benign lesions. MATERIAL AND METHODS We performed a systematic literature search on lung cancer and benign pulmonary lesions performed with perfusion CT. The searches were undertaken in English or Chinese language in Medline, PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure database from Jan 2010 to Nov 2018. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) of blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface (PS) were calculated using Review Manager 5.3. Publication bias, sensitivity, specificity, and the area under the curve (AUC) were calculated using Stata12.0. RESULTS Fourteen studies comprising 1032 malignant and 447 benign pulmonary lesions were analyzed. Lung cancer had higher BV, BF, MTT, and PS values than benign lesions. SMDs and 95% CIs of BV, BF, MTT, and PS were 2.29 (1.43, 3.16), 0.50 (0.14, 0.86), 0.55 (0.39, 0.72), and 1.21 (0.87, 1.56), respectively. AUC values of BV and PS were 0.92 (0.90, 0.94) and 0.83 (0.80, 0.86), respectively. CONCLUSIONS CT perfusion imaging is a valuable technique for the diagnosis of pulmonary nodules. Lung cancer had higher perfusion and permeability than benign lesions. The evidence suggests blood volume is the best surrogate marker for characterizing the blood supply, while permeability surface has a high specificity in quantifying the vascular permeability.
许多研究都探讨了使用灌注 CT 对肺结节进行诊断；然而，研究结果并不总是一致的。本研究旨在总结灌注 CT 对鉴别肺癌与良性病变的诊断价值的证据。
我们对 2010 年 1 月至 2018 年 11 月在 Medline、PubMed、Embase、Cochrane 图书馆、Web of Science 和中国国家知识基础设施数据库中以英文或中文进行的肺癌和良性肺部病变的灌注 CT 进行了系统的文献检索。使用 Review Manager 5.3 计算血容量（BV）、血流量（BF）、平均通过时间（MTT）和渗透性表面积（PS）的标准化均数差（SMD）和 95%置信区间（CI）。使用 Stata12.0 计算发表偏倚、敏感性、特异性和曲线下面积（AUC）。
共纳入 1032 例恶性和 447 例良性肺部病变的 14 项研究。肺癌的 BV、BF、MTT 和 PS 值高于良性病变。BV、BF、MTT 和 PS 的 SMD 和 95%CI 分别为 2.29（1.43，3.16）、0.50（0.14，0.86）、0.55（0.39，0.72）和 1.21（0.87，1.56）。BV 和 PS 的 AUC 值分别为 0.92（0.90，0.94）和 0.83（0.80，0.86）。
CT 灌注成像技术是一种有价值的诊断肺结节的技术。肺癌的灌注和通透性均高于良性病变。有证据表明，血容量是表征血液供应的最佳替代标志物，而渗透性表面积在量化血管通透性方面具有较高的特异性。
