Kundu Kriti, Kumar Aman, Malik Rajesh, Sarawagi Radha, Khurana Alkesh, Sharma Jitendra, Bhagat Abhinav C, Patel Ankur
Radiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Cureus. 2024 Jul 1;16(7):e63618. doi: 10.7759/cureus.63618. eCollection 2024 Jul.
Contrast-enhanced CT scan is the standard imaging for the characterization and evaluation of focal parenchymal lung lesions. It relies on morphology and enhancement patterns for the characterization of lung lesions. However, there is significant overlap among imaging features of various malignant and benign lesions. Hence, it is often necessary to obtain tissue diagnosis with invasive percutaneous or endoscopic-guided tissue sampling. It is often desirable to have non-invasive techniques that can differentiate malignant and benign lung lesions. CT perfusion is an emerging CT technology that allows functional assessment of tissue vascularity through various parameters and can help in differentiating benign and malignant focal lung lesions.
The purpose of this study was to assess the role of the CT perfusion technique in differentiating malignant and benign focal parenchymal lung lesions.
In this prospective observational study, CT perfusion was performed on 41 patients with focal parenchymal lung lesions from December 2020 to June 2022. The four-dimensional range was planned to cover the entire craniocaudal extent of the lesion, followed by a volume perfusion CT (VPCT) of the lesion. A total of 27 dynamic datasets were acquired with a scan interval of 1.5 seconds and a total scan time of 42 seconds. CT perfusion parameters of blood flow (BF), blood volume (BV), and k-trans of the lesion were measured with mathematical algorithms available in the Syngo.via CT perfusion software (Siemens Healthcare, Erlangen, Germany).
The median BV in benign lesions was found to be 5.5 mL/100 g, with an interquartile range of 3.3-6.9 and a p-value < 0.001. The median BV in malignant lesions was found to be 11.35 mL/100 g, with an interquartile range of 9.57-13.21 and a p-value ≤ 0.001. The median BF for benign lesions was 45.5 mL/100 g/min, with an interquartile range of 33.8-48.5 and a p-value ≤ 0.001. The median BF for malignant lesion was 61.77 mL/100 g/min, with an interquartile range of 33.8-48.5 and a p-value ≤ 0.001. The median k-trans in the case of benign lesions was found to be 4.2 mL/100 g/min, with an interquartile range of 3.13-6.8 and a p-value ≤ 0.001. The median k-trans in the case of the malignant lesion was found to be 12.05 mL/100g/min, with an interquartile range of 7.20-33.42 and a p-value < 0.001. Our study has also shown BV to have an accuracy of 92.68%, sensitivity of 93.3%, and specificity of 90.01%.
Our study has shown that CT perfusion values of BV, BF, and k-trans can be used to differentiate between benign and malignant focal lung parenchymal lesions. K-trans is the most sensitive parameter while BV and BF have greater accuracy and specificity.
对比增强CT扫描是用于局灶性肺实质病变的特征描述和评估的标准影像学检查。它依靠形态学和强化模式来对肺病变进行特征描述。然而，各种恶性和良性病变的影像学特征之间存在显著重叠。因此，通常需要通过侵入性的经皮或内镜引导下组织采样来获得组织诊断。人们一直希望有能够区分恶性和良性肺病变的非侵入性技术。CT灌注是一种新兴的CT技术，它可以通过各种参数对组织血管进行功能评估，并有助于区分良性和恶性局灶性肺病变。
本研究的目的是评估CT灌注技术在区分恶性和良性局灶性肺实质病变中的作用。
在这项前瞻性观察研究中，于2020年12月至2022年6月对41例局灶性肺实质病变患者进行了CT灌注检查。四维范围计划覆盖病变的整个头足范围，随后对病变进行容积灌注CT（VPCT）检查。共采集了27个动态数据集，扫描间隔为1.5秒，总扫描时间为42秒。使用Syngo.via CT灌注软件（德国西门子医疗公司，埃尔朗根）中可用的数学算法测量病变的血流量（BF）、血容量（BV）和k转移常数（k-trans）等CT灌注参数。
发现良性病变的BV中位数为5.5 mL/100 g，四分位间距为3.3 - 6.9，p值<0.001。恶性病变的BV中位数为11.35 mL/100 g，四分位间距为9.57 - 13.21，p值≤0.001。良性病变的BF中位数为45.5 mL/100 g/min，四分位间距为33.8 - 48.5，p值≤0.001。恶性病变的BF中位数为61.77 mL/10 g/min，四分位间距为33.8 - 48.5，p值≤0.001。良性病变的k-trans中位数为4.2 mL/100 g/min，四分位间距为3.13 - 6.8，p值≤0.001。恶性病变的k-trans中位数为12.05 mL/100g/min，四分位间距为7.20 - 33.42，p值<0.001。我们的研究还表明BV的准确率为92.68%，敏感性为93.3%，特异性为90.01%。
我们的研究表明，BV、BF和k-trans的CT灌注值可用于区分良性和恶性局灶性肺实质病变。k-trans是最敏感的参数，而BV和BF具有更高的准确性和特异性。
