CT引导下经皮肺活检在弥漫性实质性肺疾病的临床应用  

The diagnostic value of CTguided percutaneous needle lung biopsy in diffuse parenchymal lungdiseases

作　　者：彭敏[1] 许文兵[1] 施举红[1] 蔡柏蔷[1] 田欣伦[1] 柳涛[1] 张弘[1] 肖毅[1] 刘巍[2] 冯瑞娥[1] 刘鸿瑞[1] 朱元珏[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸内科,100730 [2]中国医学科学院北京协和医学院北京协和医院放射科,100730

出　　处：《中华结核和呼吸杂志》2012年第3期171-175,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨CT引导下经皮切割针肺活检在影像学表现为弥漫性实质性肺疾病诊断中的作用和应用范围。方法选择2000年1月至2008年12月北京协和医院行CT引导下经皮肺活检、胸部cT表现为双肺弥漫病变且临床资料完整的弥漫性实质性肺疾病患者248例。排除胸部cT为单发病变及单肺病变的病例。回顾分析所有病例的病史、血免疫学、支气管镜、胸部高分辨CT及肺活检病理等检查结果。结果男114例，女134例，年龄13-78岁，平均年龄（50±16）岁。248例中经皮肺活检获得病理形态学诊断130例（52．4％），确诊疾病分别为肺部感染性疾病46例（35．4％），肺部肿瘤33例（25．4％），闭塞型细支气管炎伴机化性肺炎／机化性肺炎（BOOP／OP）29例（22．3％），血管炎8例（6．2％），肉芽肿病变6例（4．6％），结节病3例（2．3％），弥漫性肺泡损伤和肺淀粉样变各2例（1．5％），以及肺泡蛋白沉积症（PAP）1例（0．7％）。经皮肺活检未确定诊断的118例患者中有37例进行了开胸或胸腔镜肺活检，36例确定诊断，分别为非特异性间质性肺炎（NSIP）12例，寻常型间质性肺炎（UIP）3例，感染6例，肿瘤3例，淋巴细胞间质性肺炎（LIP）、肺血管炎和过敏性肺炎（HP）各2例，结节病、ABPA、肺透明样肉芽肿病、肺尘埃沉积症、Castleman病及淋巴增殖性疾病各1例。经皮肺活检未确定诊断的118例患者中有69例结合临床及其他检查获得诊断。结论约半数弥漫性实质性肺疾病患者通过CT引导下经皮肺活检能够获得特定的病理形态学诊断，尤其是影像学表现为双肺弥漫病变的感染及肿瘤病例确诊阳性率较高，但对于特发性间质性肺炎诊断价值有限，应结合患者的临床实际情况选择应用。This study was to evaluate the efficacy and limitation of CT-guided percutaneous cutting needle lung biopsy in the diagnosis of diffuse parenchymal lung diseases （DPLD）. Methods A total of 481 patients admitted in Peking Union Medical College Hospital from January 2000 to December 2008 underwent CTgnided percutaneous cutting needle lung biopsy. The patients were evaluated by clinical history, physical examination and lung HRCT. Those with localized opacity or lesions in a single lung in the CT scan were excluded. Finally, 248 patients with DPLD in HRCT were enrolled for this study. Results The study patients included 114 males and 134 females, and the mean （ ＋ SD） age at diagnosis was 50 ：t： 16 （ range from 13 - 78 ） years. Confirmed diagnosis by percutaneous needle lung biopsy was obtained in 130 patients （ 52.4% ） , including pulmonary infection （ 35.4% , 46/130 ） , pulmonary malignant diseases （25.4% , 33/130） , bronchiolitis obliterans organizing pneumonia/organizing pneumonia （22. 3%, 29/130 ）, pulmonary vasculitis （ 6.2%, 8/130 ）, granulomatous lesions （ 4. 6%, 6/130 ）,pulmonary sarcoidosis （ 2. 3% , 3/130 ）, acute interstitial pneumonia （ 1.5% , 2/130 ） , pulmonary amyloidosis （1.5%, 2/130）, and pulmonary alveolar proteinosis （0. 8%, 1/130）. Open lung biopsy/ video-assisted thoracoscopic surgery was performed in 37 out of 118 eases for which the diagnosis was undetermined by percutaneous lung biopsy. Confirmed diagnosis was obtained in 36 patients, including non- specific interstitial pneumonia （NSIP, 33.3%, 12/36）, usual interstitial pneumonia （UIP, 8.3%, 3/36）, pulmonary infection （16. 7%, 6/36） , neoplasm （8. 3%, 3/36） , lymphoid interstitial pneumonia, pulmonary vasculitis （ 5.6% 2/36 ） , hypersensitivity pneumonitis （ 5.6% , 2/36 ）, and pulmonary sarcoidosis, allergic bronchopulmonary aspergillosis, pulmonary hyalinizing granuloma, pneumoconiosis, Castleman＇ s disease, and lymphoproliferative disorder （1 case respect

关 键 词：体层摄影术 X线计算机 活组织检查 针吸 肺疾病 间质性 弥漫性实质性肺疾病 

分 类 号：R816.4[医药卫生—放射医学]