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目的运用多层螺旋CT(MSCT)获取脑肿瘤的灌注图像,评估CT灌注成像对脑肿瘤的诊断价值。方法对38例脑肿瘤患者行MSCT灌注成像,采用电影模式(1 s/周),扫描层厚5 mm,共4层,80 kV,200 mA,重组层厚10 mm,共2层。采用高压注射器注射非离子型碘对比剂50 ml (300 mg I/ml),流率3．5 ml/s,延迟5 s,数据采集45 s。38例脑肿瘤包括9例Ⅰ～Ⅱ级星形细胞胶质瘤(组1),10例Ⅲ～Ⅳ级星形细胞胶质瘤(组2),9例转移瘤(组3),10例脑膜瘤(组4)。分别测量38例脑肿瘤的血流量(BF)、血容积(BV)、表面通透性(PS),并进行统计学分析。结果组1～4的(BF)~(1/2)分别为(5．99±1．03)、(7．55±1．57)、(7．72±2．02)、(11．40±2．13)ml·min~(-1)·kg~(-1)；组1与组2比较t=6．89,组1与组3比较t=4．59,组1与组4比较t=11．03,组2与组4比较t=10．58,组3与组4比较t=7．65,P值均＜0．05；组2与组3比较t=1．17,P＞0．05。组1～4的(BV)~(1/2)分别为(1．01±0．19)、(1．42±0．38)、(1．25±0．33)、(1．60±0．24)ml·kg~(-1)；组1与组2比较t=7．15,组1与组3比较t=3．71,组1与组4比较t=5．93,组2与组3比较t=2．94,组2与组4比较t=2．72,组3与组4比较t=4．46,P值均＜0．05。组1～4的(PS)~(1/2)分别为(1．70±0．37)、(3．63±0．95)、(4．29±1．30)、(5．69±1．03)ml·min~(-1)·kg~(-1)；组1与组2比较t=11．53,组1与组3比较t=10．61,组1与组4比较t=16．77,组2与组3比较t=3．69,组2与组4比较t=9．94,组3与组4比较t=5．52,P值均＜0．05。结论MSCT脑灌注成像能科学地量化脑肿瘤的血液动力学改变,并有助于肿瘤的术前分级、原发与转移性恶性肿瘤的判断以及脑内与脑外肿瘤的鉴别诊断。
Objective To evaluate the diagnostic value of CT perfusion imaging in brain tumor by using multi-slice spiral CT (MSCT) to acquire perfusion images of brain tumors. Methods MSCT perfusion imaging was performed in 38 patients with brain tumors. The film thickness was 5 mm, totaling 4 layers, 80 kV, 200 mA, and reconstructed layer thickness of 10 mm in 2 layers with film mode (1 s / week). High-pressure syringe injection of non-ionic iodine contrast agent 50 ml (300 mg I / ml), flow rate 3.5 ml / s, delayed 5 s, data acquisition 45 s. Thirty-eight brain tumors included 9 grade Ⅰ-Ⅱ astrocytoma (group 1), 10 grade Ⅲ-Ⅳ astrocytic glioma (group 2), 9 metastases (group 3), and 10 Meningioma (group 4). The blood flow (BF), blood volume (BV) and surface permeability (PS) of 38 cases of brain tumor were measured and analyzed statistically. Results (BF) ~ (1/2) were (5.99 ± 1.03), (7.55 ± 1.57), (7.72 ± 2.02), (11. 40 ± 2.13) ml · min ~ (-1) · kg -1; group 1 and group 2 compared t = 6.89, group 1 and group 3 compared t = 4.59, group 1 and group 4 compared t = 11.03, group 2 and group 4 compared t = 10.58, group 3 and group 4 compared t = 7.65, P values were <0.05; group 2 and group 3 compared t = 1. 17, P> 0.05. (BV) ~ (1/2) of group 1 ~ 4 were (1.01 ± 0.19), (1.42 ± 0.38), (1.25 ± 0.33) and ± 0.24) ml · kg -1; t = 7.15 in group 1 and group 2, t = 3.71 in group 1 and group 3, t = 5.93 in group 1 and group 4, Group 2 and Group 3 compared t = 2.94, Group 2 and Group 4 compared t = 2.72, Group 3 and Group 4 compared t = 4.46, P <0.05. (PS) ~ (1/2) in group 1 ~ 4 were (1.70 ± 0.37), (3.63 ± 0.95), (4.29 ± 1.30), (5.69 ± 1.03) ml · min ~ (-1) · kg -1; t = 11.53 in group 1 and group 2, t = 10.61 in group 1 and group 3, Compared t = 16.77, group 2 and group 3 compared t = 3.69, group 2 and group 4 compared t = 9.94, group 3 and group 4 compared t = 5.52, P <0.05 . Conclusion MSCT perfusion imaging can scientifically quantify the hemodynamic changes of brain tumors and contribute to the preoperative classification of tumors, the judgment of primary and metastatic malignancies and the differential diagnosis of intracranial and extracerebral tumors.