双输入模型CT灌注成像在肺...节经皮穿刺活检中的临床应用_郭成伟.pdf

介入放射学杂志2023年2月第32卷第2期J Intervent Radiol 2023,Vol.32,No.2management of postoperative lymphorrhea J.Langenbecks ArchSurg,2021,406:945-969.4 Nadolski GJ,Itkin M.Feasibility of ultrasound-guided intranodallymphangiogram for thoracic duct embolization J.J Vasc IntervRadiol,2012,23:613-616.5 Lv S,Wang Q,Zhao W,et al.A review of the postoperativelymphatic leakage J.Oncotarget,2017,8:69062-69075.6 王少雷，刘德华，魏宏，等.CT引导下穿刺引流技术治疗妇科恶性肿瘤术后症状性淋巴囊肿的临床应用 J.介入放射学杂志，2021，30：177-1807 杨正强，李肖.淋巴介入：一个从诊断到治疗的新领域 J.中华放射学杂志，2020，54：1041-10438 Kinmonth JB.Lymphangiography in man;a method of outlininglymphatic trunks at operation J.Clin Sci,1952,11:13-20.9 苏万春，孙宇光，夏松，等.淋巴管造影指导治疗颈部乳糜瘘J.中华普通外科杂志，2019，34：1052-105310信建峰，孙宇光，夏松，等.直接淋巴管造影术在原发性乳糜尿诊断中的应用 J.中华医学杂志，2013，93：2212-221411Pan F,Loos M,Do TD,et al.The roles of iodized oil-basedlymphangiographyandpost-lymphangiographiccomputedtomography for specific lymphatic intervention planning inpatients with postoperative lymphatic fistula:a literature reviewand case series J.CVIR Endovasc,2020,3:79.12 Nadolski GJ,Chauhan NR,Itkin M.Lymphangiography andlymphatic embolization for the treatment of refractory chylousascites J.Cardiovasc Intervent Radiol,2018,41:415-423.13 Hur S,Jun H,Jeong YS.Novel interventional radiologicalmanagement for lymphatic leakages after gynecologic surgery:lymphangiography and embolizationJ.Gland Surg,2021,10:1260-1267.14 陈钦谕，刘珍银，牛传强，等.腹腔乳糜瘘介入栓塞治疗1例J.介入放射学杂志，2021，30：749-75015 Pieper CC,Hur S,Sommer CM,et al.Back to the futureJ.Invest Radiol,2019,54:600-615.16龚涛，李金贵，曹家玮，等.经皮淋巴结穿刺淋巴造影术对乳糜漏的诊治效果 J.中华放射学杂志，2020，54：1056-106017 Geeroms B,Demaerel P,Wauters J,et al.Devastating cerebralLipiodolembolization related to therapeutic lymphangiographyfor refractory chylothorax in a patient with Behcets disease J.Vasa,2018,47:427-430.18 Sheybani A,Gaba RC,Minocha J.Cerebral embolization ofethiodized oil following intranodal lymphangiographyJ.SeminIntervent Radiol,2015,32:10-13.（收稿日期：2021-12-19）（本文编辑：边佶）临床研究Clinical research 双输入模型CT灌注成像在肺结节经皮穿刺活检中的临床应用郭成伟，颜林军，李长云，李晓燕，张乐，杨卓，蒋博民，赵立威【摘要】目的分析双输入模型 CT 灌注成像（dual-input body CT perfusion imaging，DI-CTP）在肺结节经皮CT穿刺活检中的临床应用价值。方法收集94例接受DI-CTP引导经皮穿刺活检肺结节患者的临床资料，分析DI-CTP引导肺结节穿刺阳性率及病理诊断准确率，比较DI-CTP引导穿刺活检与肺动脉灌注指数（PI）对肺结节的诊断效能。结果94例患者中，良性结节30例，恶性结节（周围型肺癌）64例。DI-CTP引导穿刺活检病理诊断准确率为89.36%（84/94），穿刺活检阳性率为96.80%（91/94）；DI-CTP引导穿刺活检诊断肺结节的敏感度和特异度均高于PI，差异有统计学意义（=5.83、4.02，均P0.01）。结论DI-CTP灌注伪彩图及定量参数分析为肺结节穿刺活检提供了直观影像学依据，提高了肺DOI：10.3969/j.issn.1008-794X.2023.02.013基金项目：国家卫健委医药卫生科技发展研究中心项目（GWJJ2021100304），河北省医学科研计划项目（20221908、20210445）；保定市科技计划项目（2141ZF121）作者单位：071000河北保定陆军第82集团军医院医学影像诊断科（郭成伟、张乐、杨卓），超声科（李长云）；京西医疗区综合内科（颜林军）；解放军总医院第一医学中心肿瘤内科（李晓燕）；保定市第一中医院（蒋博民）；保定市人民医院放射科（赵立威）通信作者：郭成伟E-mail:161介入放射学杂志2023年2月第32卷第2期J Intervent Radiol 2023,Vol.32,No.2结节穿刺活检阳性率、病理诊断准确性及鉴别诊断效能。【关键词】肺癌；体层摄影术，肺结节；经皮活检术；CT灌注成像中图分类号：R816.41文献标志码：B文章编号:1008-794X（2023）-02-0161-06The clinical application of dual-input body CT perfusion imaging in percutaneous puncture biopsyof pulmonary nodulesGUO Chengwei,YAN Linjun,LI Changyun,LI Xiaoyan,ZHANG Le,YANG Zhuo,JIANG Boming,ZHAO Liwei.Department of Medical Imaging,No.82 Army Hospital,Baoding,HebeiProvince 071000,ChinaCorresponding author:GUO Chengwei,E-mail:【Abstract】ObjectiveTo discuss the clinical application value of dual-input body CT perfusionimaging（DI-CTP）in CT-guided percutaneous puncture biopsy of pulmonary nodules.MethodsTheclinical data of 94 patients,who received DI-CTP-guided percutaneous puncture biopsy of pulmonarynodules,were retrospectively analyzed.The positive rate of pulmonary nodules and the accuracy rate ofpathological diagnosis were calculated,and the diagnostic efficacy for pulmonary nodules of DI-CTP-guidedbiopsy was compared with that of pulmonary artery perfusion index（PI）.Results Among the 94 patients,benign nodule was seen in 30,and malignant nodules（peripheral lung cancer）was found in 64.InDI-CTP-guided biopsy,the accuracy rate of pathological diagnosis was 89.36%（84/94）and the positive rateof pulmonary nodules was 96.80%（91/94）.The sensitivity and specificity for diagnosing pulmonary nodulesby DI-CTP-guided puncture biopsy were significantly higher than those by PI,and the differences betweenthe two were statistically significant（both P0.01）.Conclusion The pseudo-color image and quantitativeparameter analysis of DI-CTP perfusion provide a visual imaging basis for the puncture biopsy of pulmonarynodules,which improves the positive rate of pulmonary nodule puncture biopsy,pathological diagnosisaccuracy and differential diagnosis efficacy.【Key words】lung cancer;tomography;pulmonary nodule;percutaneous biopsy;CT perfusion imaging常规影像学检查如CT、PET-CT等对肺结节的鉴别诊断发挥了重要作用，但对于临床精准治疗、辅助化疗、靶向及免疫治疗后的评估仍均需准确的组织病理学检测1-3。CT引导穿刺活检是肺周围性病变常用的获取病理组织的方法，但肺结节多由坏死的肺组织和炎性组织等混杂而成，假阴性率为20%30%4-5。本研究回顾性分析肺结节穿刺活检成功的94例患者的临床资料，探讨双输入模型 CT灌 注 成 像（dual-input body CT perfusion imaging，DI-CTP）在经皮CT引导穿刺活检中的应用价值。1材料与方法1.1病例资料选择2016年6月至2019年10月陆军第82集团军医院经皮CT肺部穿刺活检成功的患者94例，男53例，女41例，年龄4573岁。其中恶性结节（周围型肺癌）64例，良性结节30例。纳入标准：纤维支气管镜检查及痰细胞筛查阴性患者；术前CT图像评估显示有可选择的穿刺进针路径；术前凝