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Objective: To take advantage of the 16-slice spiral CT perfusion imaging quantitative evaluation of peripheral non-small cell lung cancer tumor vasculature generation, and to explore the 16-slice spiral CT first expired perfusion strengthen indicators and tumor angiogenesis, and lung cancer TNM stage and its clinical application value. Materials and methods: 1, March 2008 to September 2009, the chest X-ray or CT chest scan found that patients with solitary pulmonary mass line multi-slice spiral CT (Multislice Computerized Tomography MSCT) confirmed by pathology perfusion imaging for non-small cell lung cancer (non-small Cell Lung Cancer NSCLC). All patients underwent MSCT perfusion scan without any anti-cancer therapy, perfusion scan Line 1 to 2 weeks after radical resection of lung cancer, surgical records and case reports complete, including the cleaning of lymph node metastasis. Qualified NSCLC of 32 cases, 20 males and 12 females, aged 27 to 72 years, with an average age of 55.69 years; lesion diameter 1.8 ~ 6.5cm, average 4.29cm. Squamous cell carcinoma in 10 cases, adenocarcinoma 19 cases (including alveolar cell carcinoma), adenosquamous carcinoma in 3 cases. All surgical dissection of the lymph nodes for pathological examination to determine whether, according to the the section microscope lymph whether the cancer cell invasion and lymph node of structural damage and capsular invasion, lymph node metastasis. 2 SIMENSE Sensation 16 spiral CT, conventional first scan, select and determine the lesion's largest center level and adjacent levels of 4 or 8 layer perfusion level Toggling-table technology (fixed multi-layer), cine mode line first expired perfusion scan, when the lesion diameter lt; 3cm layer thickness choice of 3mm, selection of 6 mm thickness lesion diameter ≥ 3cm when. Scan parameters: 120kV, 80mA, the scan time 0.5s / circle, data acquisition time 30s. Non-ionic contrast agent (300mgI/ml) 40 ml of high-pressure syringe the forearm superficial vein injection rate of 4ml / s delay 6s scan. 3, Volume Wizard workstation will scan the original image input: use random software DynEva analysis, outlined the region of interest (region of interest, ROI) for enhanced mass - density curve (Time-Density Curve, TDC), simultaneous recording and analyze the CT perfusion strengthen indicators: peak height (peak height, PH), mass and aorta peak ratio (mass / aorta, M / A), perfusion (perfusion value, PV). 4,32 patients with NSCLC after surgery, tissue samples routine HE staining pathological examination and immunohistochemical LSAB method (labeled the biotin streptavidin method) were stained using common Weidner microvessel density (Microvessel Density MVD) count. 5, the staging of lung cancer with reference to the 2009 International Society for the Study of Lung Cancer (IASLC) published the 7th edition of the TNM staging of lung cancer. Statistical analysis: The analysis of the application of SPSS 13.0 statistical software. The application of the Kappa analysis MSCT diagnosis of lung cancer staging and the pathological consistency. Analysis of lung cancer MSCT perfusion strengthen indicators, MVD and tumor T stage (tumor size, pleural invasion status), lymph node status, and the relationship of the surgical and pathological TNM staging group design t test or t 'test. Linear correlation analysis and evaluation the CT perfusion strengthen the relationship between indicators of lung cancer MVD. By receiver operating characteristic curve (Receiver Operating Characteristic curve to the ROC curve) analysis of histological methods MVD and MSCT perfusion to strengthen indicators PV evaluation TNM staging of lung cancer diagnostic performance and select the best diagnostic cutoff. Results: 1,32 patients with peripheral non-small cell lung cancer, the application of MSCT diagnosis of lung cancer TNM staging and the pathological comparison, correct in 22 cases, 10 cases of misdiagnosis, MSCT staging diagnosis Ⅰ period, II and stage Ⅲ ~ Ⅳ sensitivity 75%, 66.67%, 64%; specificity were 91.67%, 82.61%, 70.59%; accuracy were 87.50%, 78.13%, 65.63%; positive predictive value were 75%, 60%, 60.29%; negative predictive values ??were 91.67%, 86.36%, 66.67%, respectively. MSCT diagnosis of lung cancer TNM staging and pathological staging compared with the rate of 68.75% (22/32), the Kappa value = 0.566, p = 0.000, can be consistency between the two. 2, 32 cases of lung cancer CT perfusion strengthen indicators and MVD do correlation analysis (pearsoncorrelation coefficient test), results show that the PH, M / A, PV are and MVD was positive related (p lt; 0.05), including PV and MVD related coefficient (r = 0.703, P lt; 0.01). 3, this group of 32 patients with lung cancer, to 3cm as T1 and T2 the boundaries, which ≤ 3cm of six cases of lung cancer, the average diameter of 2.52cm; gt; 3cm of 26 cases of lung cancer, the average diameter of 4.67cm. Each perfusion strengthen indicators difference in lesion diameter (cm) ≤ 3 and GT; 3 between the differences were not statistically significant (both p gt; 0.05); MVD in the lesions diameter (cm) ≤ 3 and GT; not statistically significant (p gt; 0.05). Pleural involvement as T1 and (≥) T2 boundaries, involving the visceral and parietal pleura or pleural effusion in 11 cases, 21 cases involving the pleura; pleural involvement in patients with PV and MVD were higher than patients with pleural involvement, The differences were statistically significant (both p lt; 0.05); PH and M / A pleural involvement in patients with no difference between patients with pleural involvement, were not statistically significant (p gt; 0.05). 4, 32 patients with lung cancer, lymph node metastasis as N0 and N1, N2 boundaries, of which 16 cases with lymph node metastasis, no lymph node metastasis in 16 patients; lymph node metastasis in patients with PH, M / A, PV and MVD than those without lymph node metastasis, and the differences were statistically significant (p lt; 0.05). 5, this group of 32 patients with lung cancer, stage Ⅰ ~ Ⅱ and stage Ⅲ ~ Ⅳ were divided into two groups, namely lung cancer of stage Ⅰ ~ Ⅱ 17 cases, Ⅲ ~ Ⅳ 15 cases of lung cancer. The results showed that: Ⅲ to Ⅳ of lung cancer patients with PH, M / A, PV and MVD were higher than stage Ⅰ ~ Ⅱ patients with lung cancer, the differences were statistically significant (p lt; 0.05). 6, the select MVD the PV as indicators to determine the TNM staging of lung cancer, the area under the ROC curve AZ were 0.812 and 0.729, with MVD, PV determine the TNM staging of lung cancer diagnostic value, and u test, MVD and PV The AZ was no significant difference (p gt; 0.05). ROC curve selected MVD PV determine the best diagnostic threshold TNM staging of lung cancer, the results show that when to MVD GT; 71.5 / 0.74mm2 as lung cancer TNM staging diagnostic threshold, the sensitivity was 86.7%, specificity 76.5% diagnosis rate was 81.13%; when to PV GT; 1.16ml/min/ml as lung cancer TNM staging diagnostic threshold, a sensitivity of 73.3% and a specificity of 52.9%, the diagnosis was 62.5 %. Conclusion: CT perfusion strengthen indicators can reflect the non-small cell lung microvascular density characteristics of lung cancer CT perfusion strengthen indicators and MVD in lung cancer TNM staging cancer biological behavior there is a certain correlation between in vivo assessment of lung cancer TNM staging provides a new way and to assess lung cancer prognosis.
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