| Objective : To explore the feasibility of Toshiba 320 row volume CT perfusion to distinguish systemic blood and pulmonary circulation blood supply of lung cancer by analyzing 40 lung cancers confirmed with pathology underwent DI-CTP(Dual input CT perfusion)scan and post-processing analysis.To prospectively evaluate the dual blood supply of lung adenocarcinomas and squamous cell carcinomas by using dual-input perfusion CT and to provide guidance for clinical interventional therapy.Methods: 40 patients with lung cancer confirmed with pathology by surgery,CT guided biopsy or fiberoptic bronchoscopy underwent DI-CTP in the Affiliated Hospital of Qingdao University between Between May 2015 and September 2016 were included in this retrospective study.Two experienced radiologists made measurements of pulmonary flow(PF),Bronchial flow(BF)and Perfusion index[PI,PI = PF/(PF + BF)]based on the ROI around(outlining)visible tumor avoiding visible necrosis,calcification and fat components as much as possible by using a dual-input post-processing analysis software.The location and volume of the tumor was also recorded.Interobserver agreements were assessed with intraclass correlation coefficients(ICC).The time density curve(TCD)of the lesions was observed.Differences in CTP parameters between lung adenocarcinomas and squamous cell carcinomas,the central lung cancer and the peripheral lung cancer were analyzed.Correlation between the tumor volume and CTP parameters was analyzed,values of P <0.05 were accepted as significance.Results: 1.Good agreement was found between the two observers,the ICC for BF,PF and PI was 0.97,0.93 and 0.91,respectively.2.The time-density curve(TDC)of 37 cases of lung tumor had two ascending slopes representing pulmonary and bronchial circulation respectively.The latter was steeper than the former.There were several rising slopes in the rest 3 cases of lesions,whose TDC is ascending on the whole.3.The average of PF,BF and PI of all 40 cases was [(54.26±21.07)ml/(min·100 ml)],[(64.41±22.06)] ml/(min·100 ml)and(43.38±16.07)%,respectively.Tumor histology was consistent with adenocarcinoma in 23 cases and squamous cell carcinoma in 17 cases.The PF,BF and PI of adenocarcinoma were [(51.56±22.19)ml/(min ·100 ml)],[(66.09±18.08)ml/(min·100 ml)] and(38.80±14.88)%,respectively.The PF,BF and PI of squamous cell carcinoma were [(57.90±21.12)ml/(min·1 00ml)],[(62.13±26.96)ml/(min·100 ml)] and(49.58±15.95)%.Lung adenocarcinomas showed lower PI than squamous cell carcinomas(t =-2.196,P<0.05).No statistically significant difference was found for BF and PF between two types of lung cancer(P>0.05,t =-0.911,0.556).4.There were 17 peripheral lung cancers and 23 central lung cancers,The PF,BF and PI of peripheral lung cancers were [(47.57±24.31)ml/(min ·100ml)],[(65.84±19.12)ml/(min·100 ml)] and(48.15±7.14)%,respectively.The PF,BF and PI of peripheral lung cancers were [(53.80±20.03)ml/(min ·100 ml)],[(60.84±18.30)ml/(min·100 ml)],(43.20±5.74)%.The PI of the peripheral lung cancers was higher than that of the central lung cancer(t =-2.305,P<0.05).There was no significant difference of BF and PF between the central lung cancer and the peripheral lung cancer(P>0.05,t=0.842,-0.851).5.Tumor volume was only negatively associated with PI(r =-0.39,P=0.01).Conclusion 1.Lung cancer mainly fed by the body circulation blood supply.The double input CT perfusion technique has good repeatability,which can be used to distinguish the blood supply of pulmonary circulation and systemic circulation.2.The PI of lung adenocarcinoma and lung squamous cell carcinoma were different,with PI depending both on tumor size and location.Significance To explore the difference of blood supply in different types of lung cancer,in order to provide guidance for clinical prediction and interventional therapy. |
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