64层螺旋CT三维重建在气管主支气管肿瘤诊断中的应用  

Tracheobronchial tumor：evaluation by using 64-slice spiral CT with multiplanar and three-dimensional reconstructions

作　　者：张蕴[1] 荐志洁[1] 赵婷婷[1] 石志红 朱柏 

机构地区：[1]西安交通大学医学院第一附属医院1医学影像科,陕西西安710061 [2]呼吸内科,陕西西安710061

出　　处：《实用放射学杂志》2012年第2期202-206,共5页Journal of Practical Radiology

摘　　要：目的探讨64层螺旋CT三维重建在气管、主支气管肿瘤诊断中的应用价值。方法39例均接受64层螺旋CT胸部扫捕，工作站行气管、支气管三维重建，仿真内窥镜，多平面重组，最小密度投影重建。分析气管、支气管肿瘤的CT表现，并与手术病理和支气管镜检结果进行比较。结果肿瘤位于气管9例．左主支气管13例，右主支气管15例，病变广泛2例。所有病例均见管腔内充盈缺损影，致管腔1级狭窄1例，2级狭窄O例，3级狭窄14例，4级狭窄24例。管壁无增厚2例，管壁增厚14例。壁厚伴向轮廓外突出23例。宽基底32例，窄基底7例。边缘光滑2例，边缘不规则37例。良性肿瘤3例：良性问叶瘤、平滑肌瘤、多形性腺瘤各l例。恶性病变36例小细胞未分化癌8例，腺癌l例，鳞状细胞癌25例，黏液表皮样癌1例．甲状腺乳头状癌1例。与病理比较本研究正确诊断率为97．44％，与支气管镜检比较仿真内窥镜对病变近端的娃示与支气管镜所见均一致。结论64层螺旋CT三维重建是气管、主支气管良恶性肿瘤诊断与鉴别诊断、支架植入计划和疗效评价的方便、无创、准确的检查方法。Objective To evaluate the roles of 64-slice spiral CT with muhiplanar and three-dimensional reconstructions in the di- agnosis of traeheobronchial tumor. Methods 39 cases were undergone CT scan for chest using T（）SHIBA Aquilion 64 or PHII.IPS Brilliance 64 system. The post-processing techniques included volume rendering（VR）,virtual bronchoscopy（VB）, multiplanar re construction（MPR）, minimum intensity projection（MinlP） in Vitrea 2 workstation. The CT manifestations were analyzed, and compared with the results of the operation and bronchoscopy. Results The tumor located in trachea in 9 cases, right main bronchus in 1,5 cases, left main bronchus in 13 cases. The tumors were in large airway widely in 2 cases. All of cases showed the filling defect in airway. The degree of lumen stenosis was the first grade in 1 case, the second grade in 0 case, the third grade in 14 cases, the forth grade in 24 cases. The thickening of the walls of the trachea or bronchus in 14 cases, both thickening of the walls and t, xtralu- minal extensions in 23 cases, there was not any thickening of the walls in 2 cases. The edge of the tumor showed smooth in 2 cases, irregular in 37 cases. Benign tumor was in 3 cases, including benign mesenchymoma, leiomyoma, and pleomorphic adenoma in 1 case,respectively. Malignant tumor was in 36 cases, including small cell carcinoma in 8 cases, adenocarcinoma in 1 case, squamous cell carcinoma in 25 cases, mucoepidermoid carcinoma in 1 case, papillary thyroid cancer in 1 case. The diagnostic accuracy was 97.44% using of 64-slice spiral CT with multiplanar and three-dimensional reconstructions. Conclusion 64-slice spiral CT with multiplanar and three-dimensional reconstructions is a valuable method in the diagnosis and the differential diagnosis of the tracheo- bronchial benign and malignant tumors, stent planning and follow-up.

关 键 词：气管 支气管 体层摄影术 X线计算机 仿真内窥镜 三维重建 

分 类 号：R734.1[医药卫生—肿瘤] R814.42[医药卫生—临床医学]