周围型肺孤立性病灶支气管形态改变的影像特征与病理对照研究  

Radiologic-pathologic Study on Bronchial Changes in Peripheral Solitary Pulmonary Lesions

作　　者：孙鹏飞[1,2] 肖湘生[1] 李惠民[1] 于红[1] 刘士远[1] 

机构地区：[1]上海长征医院影像科,上海200003 [2]兰州大学第二医院影像科,甘肃兰州730030

出　　处：《癌症》2008年第12期1293-1296,共4页Chinese Journal of Cancer

基　　金：上海市科委重点课题(No.06DZ19503)~~

摘　　要：背景与目的:目前,周围型肺孤立性病灶的诊断及鉴别诊断是胸部影像学研究的重点和难点,而支气管改变是肺孤立性病灶、特别是周围型肺癌形态学改变的基础,本研究拟通过周围型肺孤立性病灶支气管改变的影像与病理对照研究来探讨多层螺旋CT(multi-slice CT,MSCT)评价周围型肺孤立性病灶支气管改变的价值。方法:30例肺孤立性病灶患者进行MSCT扫描及后处理重建,分析病灶的支气管改变,并与术后病理对照。结果:30例患者中,CT支气管征阳性30例(100%),术后病理显示支气管及病变19例(63.3%)、未显示11例(36.7%)。15例支气管截断、壁增厚者中,11例肺癌病理可见管壁有肿瘤侵犯;7例支气管壁无增厚者中,5例肺癌病理未见肿瘤侵犯支气管。5例肺癌显示支气管充气征,其中1例病理显示支气管在病灶内截断、管壁有肿瘤侵犯,1例支气管呈上皮增生性改变。3例支气管在病灶边缘走行者中,1例肺癌病理显示管壁有侵犯。结论:MSCT能够较准确地评价周围型肺孤立性病灶支气管的形态学改变,有助于肺孤立性病灶的诊断和鉴别诊断。BACKGROUND ＆ OBJECTIVE, At present, the diagnosis and differential diagnosis of peripheral solitary pulmonary lesions is a hotspot in researches of thoracic imageology, and bronchial changes is the morphologic basis of peripheral solitary pulmonary nodules, especially peripheral lung cancer. This study was to investigate the value of multi-slice CT （MSCT） in evaluating bronchial changes of peripheral solitary pulmonary lesions through a radiologic-pathologic study. METHODS. Thirty patients with solitary pulmonary lesions were scanned using MSCT. Image data were reconstructed to display bronchial changes, and were compared with the results of postoperative pathology. RESULTS, CT bronchial sign was positive in all patients. The bronchus on pathologic section was showed in 19 （63.3%） patients, but not in 11 （36.7%） patients. Among the 15 patients with bronchial cutoff and bronchial wall thickening on CT, 11 lung cancer patients had bronchial wall invasion on pathology. Among the seven patients with normal bronchial wall on CT, five lung cancer patients had no bronchial wall invasion on pathology. Among the five lung cancer patients with air bronchogram, one had bronchial wall invasion, and one showed bronchial epithelial hyperplasia. Among the three patients with bronchus distributed at the periphery of the lesion, one lung cancer patient had bronchial wall invasion on pathology. CONCLUSlON：MSCT can evaluate accurately the bronchial changes of peripheral solitary pulmonary lesions, and may be helpful for diagnosis and differential diagnosis of solitary pulmonary lesions.

关 键 词：肺肿瘤 肺孤立性病灶 支气管 多层螺旋CT 病理学 诊断 

分 类 号：R816.4[医药卫生—放射医学]