Lai L Q, Lin G H, Chen W Y, Tu J F, Ji J S
Department of Intervention Department,Lishui Central Hospital, Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000,China.
Department of Radiology, Lishui Central Hospital, Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, China.
Zhonghua Nei Ke Za Zhi. 2023 May 1;62(5):539-544. doi: 10.3760/cma.j.cn112138-20220513-00366.
To evaluate the clinical value of dynamic volumetric CT perfusion combined with energy spectrum imaging in bronchial arterial chemoembolization (BACE) in patients with lung cancer. The data of 31 patients with lung cancer confirmed by pathology and treated with BACE in Lishui Central Hospital from January 2018 to February 2022 were retrospectively collected, including 23 men and 8 women, aged 31-84 (67) years. All patients received perfusion scans of lesion sites within 1 week before surgery and 1 month after surgery. We collected and compared the changes in preoperative and postoperative perfusion parameters such as blood flow (BF), blood volume (BV), mean through time (MTT), permeability surface (PS) and energy spectrum parameters including arterial phase CT value (CTA), venous phase CT value (CTV), arterial phase iodine concentration (ICA), venous phase of iodine concentration (ICV), arterial standardization iodine concentration (NICA), and intravenous standardized iodine concentration (NICV) to confirm the significance of these parameters in evaluating the short-term efficacy of BACE in the treatment of advanced lung cancer. Data normality was tested using the Kolmogorov-Smirnov test and normally distributed measurement data are expressed here as mean ± standard deviation; the independent-samples -test was used for comparisons between two groups. The measurement data that were not normally distributed are expressed as median (interquartile interval) [ (, )], and the comparison between the two groups used the Kruskal-Wallis test. Count data are expressed as cases (%), and comparisons between groups used the test. The objective response rate (ORR) and disease control rate (DCR) at 1 month after BACE were 54.8% (17/31) and 96.8% (30/31), respectively. CT perfusion parameters and energy spectrum parameters of patients before and after BACE treatment were compared. The results showed that BF, BV, MTT, ICA, ICV and NICV were significantly decreased after BACE treatment compared with before treatment, and the differences were statistically significant[58.06 (40.47,87.22) vs.23.57(10.92, 36.24) ml·min·100g,3.33(2.86,6.09) vs.2.12(1.96,3.61)ml/100g,2.70(2.19,3.88) vs.1.53 (1.12,2.25)s, 3.51 (3.11,4.14)vs.1.74 (1.26,2.50)mg/ml,2.00 (1.30,2.45) vs.1.32(0.92,1.76)mg/ml,0.51(0.42,0.57) vs.0.33(0.23,0.39)](all 0.05). At the same time, compared with the non-remission group, the study results showed that the difference of parameters in remission group before and after BACE was more obvious, including ΔBF, ΔBV, ΔMTT, ΔPS, ΔCTA, ΔCTV, ΔICA, ΔICV, ΔNICA, ΔNICV were significantly increased, and the difference was statistically significant [36.82(32.38, 45.34) vs.9.50(-1.43, 12.34) ml·min·100g,4.46(2.52, 5.79) vs.0.22(-0.76, 4.09) ml/100g,4.22(2.25, 6.77) vs.0.43(-2.53, 1.88) s,10.07 (2.89, 13.13) vs.-2.01(-6.77, 4.28) ml·min·100g,14.22(11.88, 20.57) vs.4.18(-5.25, 6.37) HU, 34.6(14.88, 43.15) vs.11.60(0.26, 25.05) HU,0.95(0.54, 1.47) vs.0.11(0.20, 0.59) mg/ml,1.57(1.10, 2.38) vs. 0.26(-0.21, 0.63) mg/ml,0.05(0.03, 0.08) vs.-0.02(-0.04, 0.01),0.18(0.13, 0.21)vs. 0.11(-0.06, 0.16)](all 0.05). CT perfusion combined with spectral imaging could effectively evaluate the changes in tumor vascular perfusion in patients with advanced lung cancer before and after BACE treatment, which has important value in judging the short-term efficacy after treatment.
评估动态容积CT灌注联合能谱成像在肺癌患者支气管动脉化疗栓塞术（BACE）中的临床价值。回顾性收集2018年1月至2022年2月在丽水市中心医院接受病理确诊并接受BACE治疗的31例肺癌患者的数据，其中男性23例，女性8例，年龄31 - 84（67）岁。所有患者在术前1周内及术后1个月接受病变部位的灌注扫描。我们收集并比较术前和术后灌注参数如血流量（BF）、血容量（BV）、平均通过时间（MTT）、通透表面积（PS）以及能谱参数包括动脉期CT值（CTA）、静脉期CT值（CTV）、动脉期碘浓度（ICA）、静脉期碘浓度（ICV）、动脉标准化碘浓度（NICA）和静脉标准化碘浓度（NICV）的变化，以证实这些参数在评估BACE治疗晚期肺癌短期疗效中的意义。采用Kolmogorov - Smirnov检验对数据正态性进行检验，正态分布的计量资料在此以均数±标准差表示；两组间比较采用独立样本t检验。非正态分布的计量资料以中位数（四分位数间距）[（，）]表示，两组间比较采用Kruskal - Wallis检验。计数资料以例数（%）表示，组间比较采用检验。BACE术后1个月的客观缓解率（ORR）和疾病控制率（DCR）分别为54.8%（17/31）和96.8%（30/31）。比较BACE治疗前后患者的CT灌注参数和能谱参数。结果显示，BACE治疗后BF、BV、MTT、ICA、ICV和NICV较治疗前显著降低，差异有统计学意义[58.06（40.47，87.22） vs. 23.57（10.92，36.24）ml·min·100g，3.33（2.86，6.09） vs. 2.12（1.96，3.61）ml/100g，2.70（2.19，3.88） vs. 1.53（1.12，2.25）s，3.51（3.11，4.14） vs. 1.74（1.26，2.50）mg/ml，2.00（1.30，2.45） vs. 1.32（0.92，1.76）mg/ml，0.51（0.42，0.57） vs. 0.33（0.23，0.39）]（均P < 0.05）。同时，与未缓解组相比，研究结果显示缓解组BACE前后参数差异更明显，包括ΔBF、ΔBV、ΔMTT、ΔPS、ΔCTA、ΔCTV、ΔICA、ΔICV、ΔNICA、ΔNICV均显著升高，差异有统计学意义[36.82（32.38，45.34） vs. 9.50（ - 1.43，12.34）ml·min·100g，4.46（2.52，5.79） vs. 0.22（ - 0.76，4.09）ml/100g，4.22（2.25，6.77） vs. 0.43（ - 2.53，1.88）s，10.07（2.89，13.13） vs. - 2.01（ - 6.77，4.28）ml·min·100g，14.22（11.88，20.57） vs. 4.18（ - 5.25，6.37）HU，34.6（14.88，43.15） vs. 11.60（0.26，25.05）HU，0.95（0.54，1.47） vs. 0.11（0.20，0.59）mg/ml，1.57（1.10，2.38） vs. 0.26（ - 0.21，0.63）mg/ml，0.05（0.03，0.08） vs. - 0.02（ - 0.04，0.01），0.18（0.13，0.21） vs. 0.11（ - 0.06，0.16）]（均P < 0.05）。CT灌注联合能谱成像可有效评估晚期肺癌患者BACE治疗前后肿瘤血管灌注的变化，对判断治疗后短期疗效具有重要价值。
