目的 研究胸部CT灌注成像 (CTP)对周围型肺癌组织学类型、分期及 肿瘤坏死的评估价值。方法 选取我院 52例病理证实为周围型肺癌的患者为研 究对象，CT观察大小、形态、密度等情 况，计算患者CT灌注参数，包括灌注值 (PER)、强化峰值(PE)、血容量(BV)、对 比剂达峰值时间(TTP)，分析不同组织学 类型、分期以及肿瘤坏死患者的CT灌注 值差异。结果 临床分期：T1与T2比较， PER、PE、BV显著较高(P＜0.05)，TTP显 著较低(P＜0.05)，T2与T3比较，PER、 PE、BV显著较低(P＜0.05)，而T2、T3患 者TTP比较无统计学意义(P＞0.05)；组 织学类型：小细胞癌PER、PE、BV分别 为(64.52±34.36)、(60.20±31.74)、 (34.12±16.36)较高(P＞0.05)，腺癌 ＞鳞癌，但比较均无统计学意义(P＞ 0.05)；肿瘤坏死：未坏死组PER、PE、BV 与坏死组比较显著较高(P＜0.05)，TTP与 坏死组比较显著较低(P＜0.05)。结论 胸 部CT灌注扫描对周围型肺癌患者分期、组 织学类型及肿瘤坏死有一定的鉴别价值， 尤其对于肿瘤是否出现坏死的反映明显， 可为周围型肺癌早期诊断、术前分期及预 后评价等提供重要的临床依据。

Objective To study the value of chest CT perfusion imaging(CTP) in the evaluation of histological type, staging and tumor necrosis of peripheral lung cancer. Methods 52 cases of patients with peripheral lung cancer confirmed by pathology in our hospital were selected as the research objects. The size, shape, density, etc. were observed by CT. CT perfusion parameters were calculated, including perfusion value(PER), enhanced peak value (PE), blood volume (BV) and time to peak (TTP) of contrast agents. The differences in CT perfusion values in patients of different histological types, staging and tumor necrosis were analyzed. Results For clinical staging, compared with T1 and T2, PER, PE and BV were significantly higher (P<0.05) and TTP was significantly lower (P<0.05). Compared T2with T3, PER, PE and BV were significantly lower (P<0.05). The difference in TTP between T2 and T3was not statistically significant (P>0.05); In terms of histological types, PER, PE and BV of small cell carcinoma [(64.52±34.36), (60.20±31.74), (34.12±16.36)] were higher (P>0.05) and adenocarcinoma was higher than squamous carcinoma but the comparison was not statistically significant (P>0.05); In terms of tumor necrosis, PER, PE and BV in the mom-necrosis group were significantly higher than those in necrosis group (P<0.05) while TTP was significantly lower than that in the necrosis group (P<0.05). Conclusion Chest CT perfusion scan is of certain value in diagnosis of the staging, histological types and tumor necrosis of patients with peripheral lung cancer, especially for the diagnosis of tumor necrosis of peripheral lung cancer which can be clearly shown. It can provide important clinical basis for the early diagnosis, preoperative staging and evaluation of prognosis of peripheral lung cancer.