CT肿瘤血管成像对周围型肺癌的诊断价值  

The diagnostic significance of CT tumor angioimaging on the peripheral lung cancer

作　　者：滑炎卿[1] 张国桢[1] 丁其勇[1] 倪国兴[2] 陆孝禹[3] 

机构地区：[1]上海华东医院放射科,200040 [2]上海华东医院外科,200040 [3]上海华东医院病理科,200040

出　　处：《中华放射学杂志》2004年第7期701-705,共5页Chinese Journal of Radiology

基　　金：上海市卫生系统"百人计划"专项基金 (97BR0 3 4)

摘　　要：目的　揭示CT肿瘤血管成像的病理机制 ,探讨其在周围型肺癌诊断和鉴别诊断中的价值。方法　搜集 112例有病理结果的周围型孤立性肺结节 (SPN)患者的CT图像 ,在现行评价SPN性质的原则基础上 ,以显示病灶肿瘤血管成像作为诊断肺癌的另 1条指标。全部病例均作了螺旋CT扫描 ,分别行病灶平扫和增强三期扫描 (少数早期病例增强仅做了二期扫描 ) ,薄层重建图像、局部放大及非线性窗观察等后处理。手术标本先做大切片 ,选择与CT肿瘤血管成像对应的部位取材 ,经常规固定、石蜡包埋和薄层切片 ,分别行HE染色和血管内皮细胞免疫组织化学染色 (CD34) ,观察肿瘤血管的形态、分布 ,半定量评价肿瘤血管的贫富。统计分析采用四格表法 ,分别求得CT肿瘤血管成像在周围型肺癌诊断中的敏感性、特异性和阳性预测值。结果　病灶直径在 1～ 3cm之间 ,手术病理报告各型支气管肺癌 89例 ,结核瘤 11例 ,类癌 5例 ,错构瘤 4例 ,炎性假瘤 3例。CT表现明确有肿瘤血管成像者 4 4例 ,占 39% (44 /112 ) ,其中病理诊断肺腺癌 2 7例 ,孤立结节型细支气管肺泡癌 6例 ,大细胞癌 5例 ,小细胞未分化癌 4例 ,炎性假瘤 2例。统计显示在周围型肺癌中肿瘤血管成像的敏感性为 4 7 2 % (42 /89) ,特异性为 91 3% (2 1/2 3) ,阳性预测值为 95 5 %Objective To explore the pathologic mechanism of CT tumor angioimaging,and to investigate its diagnostic significance on solitary pulmonary nodule (SPN).Methods The plain and contrast tri-phase scanning in 1 cm slice-thickness (pitch=1) with spiral CT in 112 patients with SPN on the peripheral lung were retrospectively studied.The thin slice image reconstruction,non-linear window display,and target magnification as well as other postprocessing were retrospectively done on the raw data.In this group,the age of patients ranged from 49 to 80 years with the middle age of 53 years,and 73 males and 39 females were included.The pathological slices of surgical specimen correlated with the CT tumor angioimaging were respectively studied by using the HE and immunohistochemistrical stains.The sensitivity,specificity,and positive predictive value of tumor angioimaging in peripheral lung cancers were respectively calculated.Results The SPNs were from 1 to 3 cm in diameter.There included different types of lung cancer (n=89),tuberculosis tumor (n=11),carcinoid tumor (n=5),pulmonary hamartoma (n=4),and inflammatory pseudotumor (n=3),respectively.The tumor angioimaging was exhibited with CT in 44 cases out of all patients,including adenocarcinoma (27 cases),bronchioloalveolocarcinoma (6 cases),mega-cell carcinoma (5 cases),small cell undifferentiated carcinoma (4 cases),and inflammatory pseudotumor (2 cases) ,respectively.The tumor angioimaging sign on CT images was displayed as multiple enhanced vessels radiating from the lesion center to periphery in small lesions (diameter≤2 cm) or surrounding the tumor as the sunshine-like in larger ones (diameter>2 cm).Immunohistochemistrical stain slice of operative specimen showed a lots of vascular endothelial cells and small vessels,which correlated with the tumor angioimaging area on CT images.The sensitivity,specificity,and positive predictive valve of tumor angioimaging in the lung cancers were 47.2%,91.3%,and 95.5%,respectively.Conclusion The “tumor angioimaging” sign can

关 键 词：CT 肿瘤血管成像 周围型肺癌 诊断 

分 类 号：R734.2[医药卫生—肿瘤]