肺癌侵犯肺静脉干的CT、MRI表现及与病理的相关性研究  

Invasion of pulmonary venous trunk by lung cancer: correlation of CT and MRI appearances with pathologic findings

作　　者：缪竞陶[1] 朱培菊[1] 张尚福[1] 何之彦[1] 周清华[1] 

机构地区：[1]华西医科大学附属第一医院放射科 病理科 胸外科

出　　处：《中华放射学杂志》1997年第1期20-24,共5页Chinese Journal of Radiology

摘　　要：目的：探讨肺癌侵犯肺静脉干（ｐｕｌｍｏｎａｒｙｖｅｎｏｕｓｔｒｕｎｋ，ＰＶＴ）的病理方式及其与ＣＴ、ＭＲＩ表现的相关性。材料和方法：观察３１例肺癌侵犯ＰＶＴ的大体及显微病理改变，盲法判断ＣＴ、ＭＲＩ表现并与病理对照。结果：病理表现分为三组：５例癌肿与管壁一侧相贴，主要侵犯外膜；１６例癌肿沿管壁环形堆积式浸润；１０例癌肿沿管壁长轴匍匐式浸润。ＣＴ、ＭＲＩ表现亦分为三组：肿块与一侧管壁相贴，管腔通畅；肿块包埋ＰＶＴ，管腔狭窄或闭塞；肿块位于心包外段，同时心包内段ＰＶＴ增粗、信号异常。ＣＴ、ＭＲＩ征象与病理表现Ｋａｐｐａ值各为０．３７及１．００。结论：肺癌以相贴、环形堆积浸润、纵向匍匐浸润等方式侵犯ＰＶＴ，ＭＲＩ征象与之密切相关。因此，ＭＲＩ是术前判断癌肿侵犯ＰＶＴ方式的重要手段。Purpose: To study the spread pathway of neoplastic invasion of pulmonary vein trunk (PVT) and the correlation of CT and MR imaging features with pathologic findings. Materials and methods: The CT and MRI findings in 31 lung cancer patients with proved PVT involvment were blindly analysed and compared with the corresponding macroscopic and microscopic appearances. Results: Pathologic appearances of neoplastic spread along PVT were classified into three types: The cancer abutted the PVT wall side by side and mostly invaded the adventitia in 5 cases; The cancer circularly encased and infiltrated PVT wall, causing remarkable narrowing of PVT lumen and occlusion in 16 cases; Longitudinal and creeping infiltration along the PVT wall was observed in 10 cases. Correspondingly, CT and MRI findings were also classified into three groups: The mass was closely attached to one side of PVT wall but the signal of blood flow was normal; The PVT was encased by mass becoming either narrowed or obliterated; The mass was attached to or encased the PVT outside pericardium, in addition, the pericardial segment of PVT became widened on CT and the signal of blood flow was abnormal on MRI. The Kappa values between pathologic appearance and imaging findings on CT and MRI were 0.37 and 1.00 respectively. Conclusion: Lung cancer invaded PVT by means of attaching to or infiltrating the vessel wall either circumferentially or longitudinal in a cree ping pattern. MRI findings correlated better than CT with the pathological patterns. The authors suggested that MRI study is a useful imaging modality for preoperative assessment of PVT status in patients with lung cancer.

关 键 词：肺肿瘤 成像 病理学 CT NMR 

分 类 号：R734.202[医药卫生—肿瘤]