目的 探讨十二指肠肿瘤血流量 存在的异质性及容积灌注CT成像对降低 肿瘤异质性的影响。方法 纳入我院2013 年1月至2014年11月十二指肠结节病例的 132例，其中腺癌48例，间质瘤52例，淋 巴瘤32例。所有的病例均行单层面灌注CT 和容积灌注CT成像扫描，比较两者对十二 指肠恶性肿瘤的诊断效能，采用变异系数 评价两者在影像学异质性的差异，评价肿 瘤影像学异质性对十二指肠恶性肿瘤的影 响。结果 容积灌注CT成像与单层面灌注 CT诊断恶性结节的效能其敏感性、特异 性、准确性、阴性预测值、阳性预测值比 较均无明显差别(P>0.05)；中高分化组及 低分化组两个亚组的容积灌注CT成像的变 异系数也均小于单层面灌注CT的变异系 数，组间相比具有统计学差异(P<0.05)； 血流量差异性的大小相比具有统计学差异 (P<0.05)。结论 容积灌注CT成像与单层 面灌注CT检查在诊断效能上无明显差异， 稳定性好，肿瘤影像学异质性对评价十二 指肠肿瘤血流量有着一定影响，容积灌注 CT成像能够降低肿瘤异质性的影响。

Objective To investigate the heterogeneity of duodenum tumor blood flow and the effect of volumetric perfusion CT imaging to reduce the heterogeneity of tumor. Methods One hundred and thirty-two cases of duodenal nodules Inclusion in our hospital from January 2013 to November 2014, including 48 cases of adenocarcinoma, 52 cases of stromal tumors, 32 cases of lymphoma. All patients underwent single-level perfusion and CT volume perfusion CT imaging scan, compare the diagnostic performance of duodenal cancer, the use of the difference in coefficient of variation evaluate radiological heterogeneity evaluated different tumor imaging effect of duodenal cancer qualitative. Results The sensitivity, specificity, accuracy, negative predictive value and positive predictive value between volume perfusion CT Perfusion CT imaging and single-level performance in diagnosis of malignant nodules was not significantly different (P>0.05), the coefficient of variation volume perfusion CT imaging in the well-differentiated group and poorly differentiated group were less than that of single level of perfusion CT, which had a significant difference (P<0.05), the size difference of blood flow volume was statistically different (P<0.05). Conclusion The diagnostic efficiency between volume perfusion CT perfusion imaging and single level CT examination had no significant difference. The heterogeneity of tumor imaging had an impact on evaluation of blood flow in duodenal tumor. The volume of perfusion CT imaging can reduce tumor heterogeneity resistance.