Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China.
Department of Pathology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, 312000, China.
BMC Med Imaging. 2021 Oct 30;21(1):158. doi: 10.1186/s12880-021-00692-3.
To investigate value of the quantitative perfusion parameters of dynamic triple-phase enhanced CT in differential diagnosis of pulmonary lesions, and explore the correlation between perfusion parameters of lung cancer with microvessel density (MVD) and vascular endothelial growth factor (VEGF).
73 consecutive patients with lung lesions who successfully underwent pre-operative CT perfusion examination with dynamic triple-phase enhanced CT and received a final diagnosis by postoperative pathology or a clinical follow-up. The cases were divided into malignant and benign groups according to the pathological results. CT perfusion parameters, such as Median, Mean, Standard deviation (Std), Q10, Q25, Q50, Q75, Q90 of pulmonary artery perfusion (PAP), bronchial artery perfusion (BAP), perfusion index (PI) and arterial enhancement fraction (AEF) were obtained by performing computed tomography perfusion imaging (CTPI). Computed tomography perfusion (CTP) parameters were compared between malignant and benign lesions. The receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CTP parameters in diagnosing malignant lesions. The correlations between CTP parameters with MVD and VEGF were analysed in 36 lung cancer patients who had extra sections be used for immunohistochemistry staining of CD34 and VEGF.
BAP (Mean, Std, Q90) and PI Std of benign lesions were higher than malignant lesions (p < 0.05), and PAP (Q10, Q25), PI (Median, Mean, Q10, Q25, Q50) of malignant lesions were higher than the benign (p < 0.05). The area under the ROC curve of PI Mean, PI Q10 and PI Std was 0.722 (95% CI = [0.595-0.845]), 0.728 (95% CI = [0.612-0.844]) and 0.717 (95% CI = [0.598-0.835]) respectively. Partial perfusion parameters of BAP and AEF Q10 were positively correlated with MVD (p value range is < 0.001-0.037, ρ value range is 0.483-0.683), and partial perfusion parameters of PI were negatively correlated with MVD (p value range is 0.001-0.041,ρvalue range is - 0.523-- 0.343). Partial perfusion parameters of BAP and AEF Q10 were positively correlated with VEGF (p value range is 0.001-0.016, ρvalue range is 0.398-0.570), meanwhile some perfusion parameters of PAP and PI were negatively correlated with VEGF (p value range is 0.001-0.040, ρ value range is - 0.657-0.343).
Quantitative parameters of dynamic triple-phase enhanced CT can provide diagnostic basis for the differentiation of lung lesions, and there were connection with tumor angiogenesis and vascular endothelial growth factor expression.
探讨动态三期增强 CT 定量灌注参数在肺病变鉴别诊断中的价值，并探讨肺癌的灌注参数与微血管密度（MVD）和血管内皮生长因子（VEGF）之间的相关性。
对 73 例成功进行术前 CT 灌注动态三期增强扫描的肺病变患者进行回顾性分析，术后病理或临床随访最终诊断为肺癌。根据病理结果将病例分为恶性和良性两组。通过计算机断层灌注成像（CTPI）获得肺动脉灌注（PAP）、支气管动脉灌注（BAP）、灌注指数（PI）和动脉增强分数（AEF）的中值、平均值、标准差（Std）、Q10、Q25、Q50、Q75、Q90 等 CT 灌注参数。比较良、恶性病变的 CT 灌注参数。采用受试者工作特征（ROC）曲线评估 CTP 参数诊断恶性病变的诊断效率。对 36 例肺癌患者的额外切片进行 CD34 和 VEGF 的免疫组织化学染色，分析 CTP 参数与 MVD 和 VEGF 的相关性。
良性病变的 BAP（平均值、Std、Q90）和 PI Std 高于恶性病变（p<0.05），恶性病变的 PAP（Q10、Q25）、PI（中值、平均值、Q10、Q25、Q50）高于良性病变（p<0.05）。PI 平均值、PI Q10 和 PI Std 的 ROC 曲线下面积分别为 0.722（95%CI[0.595-0.845]）、0.728（95%CI[0.612-0.844]）和 0.717（95%CI[0.598-0.835]）。BAP 和 AEF Q10 的部分灌注参数与 MVD 呈正相关（p 值范围为<0.001-0.037，ρ 值范围为 0.483-0.683），PI 的部分灌注参数与 MVD 呈负相关（p 值范围为 0.001-0.041，ρ 值范围为-0.523-0.343）。BAP 和 AEF Q10 的部分灌注参数与 VEGF 呈正相关（p 值范围为 0.001-0.016，ρ 值范围为 0.398-0.570），同时 PAP 和 PI 的部分灌注参数与 VEGF 呈负相关（p 值范围为 0.001-0.040，ρ 值范围为-0.657-0.343）。
动态三期增强 CT 定量灌注参数可为肺病变的鉴别诊断提供依据，并与肿瘤血管生成和血管内皮生长因子表达有关。
