| ObjectiveThrough comparing the perfusion parameter of same lesions in different parts of the lymph node , analyzing the features of perfusion CT and morphology in neck, chest, axillary, peripancreatic and groin area benign and malignant lymphadenopathy, explore the qualitative value of CT perfusion imaging with morphology in Each part of the body in the diagnosis of lymphadenopathy.MethodsTo the neck, chest, armpits and groins parts, peripancreatic lymph node enlargement is suspected patients 60 cases with CT perfusion and CT enhanced scan, Because different parts of lymph node scanning, Lymph nodes for each part of the main supplying artery perfusion scan start time and the organizational structure to strengthen different perfusion scan delay time and dose fluctuated, Pelvic lymph node perfusion than other parts of the extended delay time 5 seconds, armpits, chest and peripancreatic mAs higher than the neck and groin high 20 mAs, the various parts of the rest perfusion scan basically the same conditions; Enhanced scanning according to the corresponding parts of conventional dose CT. Perfusion images obtained after transferred to syngo Body PCT (Siemens, Germany) software post-processing, from perfusion parameters: blood flow (blood flow, BF), hemorrhagic (blood volume, BV), permeability (permeability, Per ), Patlak blood volume (Patlak blood flow, PBV). Drawn regions of interest using DynEva software time density curve (time density curve, TDC), the lymph nodes obtained under TDC TDC parameters, including: value of unenhanced CT, enhancement peak (peak enhancemet, PE), time to peak ( time to peak, TTP), the relative enhancement value (relative enhancement value, REV. REV = peak value - the value of unenhanced CT). Conventional enhanced scan image and the reconstructed image through the 3D post-processing software and Oncolongy lymph node lesions obtained the morphological indices, including: lymph node diameter (longtitude, L), width (transverse, T), borders, necrosis, calcification, and strengthen and so on. The pathology results will be divided into 54 cases of lymph node lesions of benign and malignant groups, statistical properties of the lymph nodes of different perfusion parameters, Two sample use t-test, the use of variance analysis of the various benign group and malignant group and the TDC parameters of the perfusion parameters were compared. According to different pathological types of malignant lymph nodes will be divided into 3 groups in lymphoma, thyroid cancer, lymph nodes, other cancer (squamous cell carcinoma, adenocarcinoma) lymph nodes, The benign group was divided into twogroups lymphadenitis and lymph node tuberculosis, Analysis of variance or rank sum test compared three groups of malignant lymph nodes in more than the difference in, p <0.05 as significantly different standards. More a kind of lymph node lesions in different parts of different perfusion parameters using variance analysis or rank sum test, p <0.05 as significantly different standards. Application x2 test or rank sum test on the morphological index in benign and malignant lymph nodes were significant differences between groups tested.Results(1)PathologyThe lymph nodes of 54 patients, 18 cases of benign and malignant group of 36 cases. Group were benign lymphadenitis in 8 cases, 10 cases of lymph node tuberculosis; 14 cases of malignant lymphoma in the malignant group, 8 cases of metastatic thyroid cancer, other cancer (squamous cell carcinoma, adenocarcinoma) metastatic tumors, 14 cases were nasopharyngeal carcinoma, breast, stomach, pancreatic and ovarian cancer due to metastasis.(2)between the three groups of malignant and benign lymph node comparison between the perfusion parametersMalignant lymph nodes, Thyroid carcinoma metastasis lymph nodes BF values (160.5±33.5) ml·100ml-1·min(-1, BV value (153.4±6.9) ml/1000ml and P-BV value (132.4±27.7) ml/1000ml significantly higher in lymphoma and other cancers (squamous cell carcinoma, adenocarcinoma) metastatic lymph nodes, the difference was statistically significant (p <0.05), Per value was no significant difference among 3 groups (p> 0.05); lymphoma and other cancers (squamous cell carcinoma, adenocarcinoma) metastatic lymph nodes was no significant difference in perfusion parameters among (p> 0.05). Benign lymphadenitis with lymph node tuberculosis in perfusion parameters BF, BV, Per, P-BV value of the difference was not statistically significant (P> 0.05).(3)malignant lesions compared with the kinds of lymph node perfusion parameters in different parts of the bodyLymphoma, and metastatic tumors in various parts of the value of perfusion parameters of BF, BV value, Per value, P-BV value of the difference was not statistically significant (P> 0.05).(4) benign and malignant lymph nodes Comparison of perfusion parametersPer values of malignant group (76.9±25.84) 0.5ml·100ml-1·min-1 higher than the benign group (51.1±23.8) 0.5ml·100ml-1·min-1, and the difference was statistically significant (P <0.05 ); neck Per value of perfusion parameters of malignant lymph nodes (95.96±16.79) 0.5ml·100ml-1·min-1 higher than the benign group (66.55±23.8) 0.5ml·100ml-1·min-1, and the difference was significance (P <0.05); Malignant axillary lymph node perfusion parameters District Per value (76.9±25.84) 0.5ml·100ml-1·min-1 higher than the benign group (51.1±23.8) 0.5ml·100ml-1·min-1, and the difference was significant (P <0.05).(5) benign and malignant lymph nodes TDC curve shapeBenign (inflammatory, TB) lymph node TDC curve low and flat type (50%) and rapid rise with gradual decline (33.3%); lymphoma TDC curve low and flat type (76.4%) dominated; thyroid cancer lymph nodes TDC to speed downhill-type 1 (62.5%) dominated; other cancer (squamous cell carcinoma, adenocarcinoma) metastatic lymph node TDC to speed rise with gradual decline (35.7%) dominated.(6) three groups of malignant lymph nodes compared curve parameters between the TDCGroup of malignant lymph nodes, Thyroid carcinoma metastasis lymph nodes PE value (100.2±32.4) Hu was significantly higher than lymphoma, (70.6±12.5 )Hu and other cancer (squamous cell carcinoma, adenocarcinoma) metastatic lymph nodes (73.2±33.1) HU, REV value ( 60.0±29.3) Hu was significantly higher than lymphoma (30.8±22.3) Hu and other cancer (squamous cell carcinoma, adenocarcinoma) metastatic lymph nodes (33.1±21.1) Hu, and the difference was statistically significant (p <0.05); TTP value of difference No statistically significant (P>0.05). Lymphoma and other cancers (squamous cell carcinoma, adenocarcinoma) metastatic lymph nodes were no significant differences between the various parameters.(7) lymph node lesions with the kind of curve parameters in different parts of TDCComparisonLymphoma in the axillary part of TTP values (120.8±52.1) s longer than the neck (97.3±18.1) s, peripancreatic (74.1±9.1) s, groin (102.1±23.8) s, the difference was significant (P <0.05) ; metastatic axillary lymph nodes TTP values (149.0±10.9) s longer than the neck (100.5±27.6) s, peripancreatic (118.0±15.4) s, groin (101.7±26.6) s, the difference was significant (P <0.05); other parts of the comparison between the 22, the TTP was no significant difference between values (P> 0.05). TDC curves of other parameters PE, REV value of the difference was not statistically significant (P> 0.05).(8)benign and malignant lymph nodes compared TDC curve parametersBenign lymph node TTP values (117.2±29.6) s longer than malignant lymph node TTP values (96.1±28.1) s , difference has statistics meaning (P<0.05), neck benign lymph node TTP values (102.36±24.87) s longer than forming (88.61±19.77) s malignantly essential points , armpit benign lymph node TTP values (129.95±27.69) s longer than forming (95.34±30.98) s malignantly , difference has statistics meaning (p<0.05) at present, Other parametric TDC curve PE , REV value difference have no statistics significance (P>0.05).(9) conventional scan in the diagnosis of the role of lymph nodeLymph nodes of the edge of the lymph nodes is necrosis, calcification, and extent of lymph node enhancement of malignant lymph nodes in the three groups are different (p <0.05); enhanced scan arteries between the three groups of malignant lymph nodes than the degree of venous phase was significantly enhanced (p < 0.05); benign and malignant lymph nodes between the enhanced scan vein of strengthening the degree of difference was notsignificant (P> 0.05).Conclusion1. In a comparison of CT perfusion parameters, thyroid cancer,lymph node metastasis in malignant lymph nodes have certain specific perfusion parameters, the value of its BF, BV value, PBV value, PE, and REV were significantly higher than the value of lymphoma and other cancers metastatic lymph node ; CT perfusion parameters of lymphoma and other cancers of the lymph nodes between the identification of little significance. Between benign lymph node tuberculosis lymphadenitis and no significant difference between CT perfusion parameters.2. The same kind of lymph node lesions in different parts of the nature of the CT perfusion parameters of contrast, lymphoma, Other cancer metastasis lymph nodes in the BF value of different parts of the body, BV value, PBV value, PE no difference between value and REV values, only longer TTP values in the armpit other parts.3. Per values of malignant lymph nodes is higher than benign lymph nodes, TTP values of less than benign lymph nodes; benign and malignant lymph nodes between the different parts of the contrast CT perfusion parameters obtained results.4. TDC curve shape in contrast, the benign lymph nodes with low, flat type and speed rise with gradual decline mainly, lymphoma with low-profile type mainly , Thyroid carcinoma metastasis lymph nodes to speed downhill-type rise mainly to other lymph node metastasis rate rise with gradual decline mainly.5. the conventional enhanced scanCT perfusion imaging carried out after, lymph node malignancy in the arterial phase enhancement greater than the venous phase enhanced the differential diagnosis.6. CT perfusion imaging combined with morphological indicators will help to identify lymph node lesions of benign or malignant. |
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