孤立性肺结节与支气管及血管关系的CT研究  

Relationship of Solitary Pulmonary Nodule to Bronchi and Blood Vessels:A Study with CT

作　　者：刘干辉[1] 陈振松[1] 万仁平[1] 黄伟[1] 孟志华[1] 石广兴[1] 雷淑妃 

机构地区：[1]粤北人民医院放射科,广东韶关512025

出　　处：《南昌大学学报（医学版）》2012年第9期23-26,F0003,共5页Journal of Nanchang University：Medical Sciences

基　　金：韶关市卫生局立项(Y09119);韶关市科技计划(韶科2009-17)

摘　　要：目的研究孤立性肺结节(solitary pulmonary nodule,SPN)与支气管及血管的关系及病理基础,探讨其临床诊断价值,提高对SPN定性诊断的准确性。方法 84例SPN均经手术、病理组织学或临床随访证实,其中恶性结节组56例,良性结节28例。采用多层螺旋CT行层厚为10mm轴位扫描及层厚分别为0.75mm及2.0mm螺旋靶扫描,并分别采用骨算法及标准算法重建。所得原始数据经后处理,重点显示SPN中相关的支气管及血管关系及其类型。并与手术病理组织学进行对照研究。结果螺旋靶扫描结合各种工作站图像后处理方法,能极好地显示SPN与相关支气管及血管的关系及结构特征。84例SPN中与支气管有关系的80例,其中恶性结节54例,良性结节26例,Ⅰ型、Ⅱ型、Ⅲ及Ⅴ型在良、恶性结节组间差异有统计学意义(均P<0.05);Ⅳ型在良、恶性结节组间差异无统计学意义(P>0.05)。未显示与支气管有关系的4例(其中良、恶性结节各2例)。84例SPN与血管有关系的84例,其中恶性结节56例,表现为Ⅰ型或Ⅱ型关系在良、恶性结节中的差异有统计学意义(均P<0.05),表现为Ⅲ型或Ⅳ型关系在良、恶性结节中的差异无统计学意义(P>0.05)。结论多层螺旋CT薄层靶螺旋扫描及动态多层扫描结合多种后处理方法能清晰显示SPN与支气管及血管关系及分型;不同类型关系可反映不同性质结节;三者关系对SPN良、恶性病变的诊断和鉴别诊断具有重要价值。Objective To explore the pathological basis of solitary pulmonary nodule（SPN） and its relationship to bronchi and blood vessels, and to investigate the diagnostic value of SPN to im- prove the accuracy of qualitative diagnosis of SPN. Methods Axial images were reconstructed from a multi-slice spiral CT（MSCT） scan with 10 mm axial resolution and 0.75 and 2.0 mm slice thickness,and soft tissue and bone algorithm was used for image reconstruction in 84 cases of SPN confirmed by surgery,pathology or clinical follow-up （56 cases of malignant nodules and 26 cases of benign nodules）. The patterns of SPN and its relationship to bronchi and blood vessels were analyzed and compared with surgical histopathology. Results The structural features of SPN and its relationship to bronchi and blood vessels were clearly displayed by spiral target scan and various image processing methods. Among the 84 cases of SPN,80 cases showed a correlation with bronchi （54 cases of malignant nodules and 26 cases of benign nodules） ,and there were sig-nificant differences in type Ⅰ , Ⅱ , Ⅲ and V , but not type IV, between malignant nodules and be- nign nodules （P〈0.05）. No relationship between SPN and bronchi was found in 4 cases （2 cases of malignant nodules and 2 cases of benign nodules）. All the 84 cases of SPN showed a correlation with blood vessels （56 cases of malignant nodules） , there were sinificant differences in type I and Ⅱbetween maliganant nodules and benign nodules （P〈0. 05）, and there were no significant differences in type lII and IV between malignant nodules and benign nodules （P〉0.05）. Conclu- sion MSCT target scan and dynamic multi-slice scan with various image reconstructions can clearly display the types of SPN and its relationship to bronchi and blood vessels. Different rela- tionships may reflect different nodules and have important value in the diagnosis and differential diagnosis of benign and malignant lesions in SPN.

关 键 词：孤立性肺结节 支气管 血管 病理学 体层摄影术 X线计算机 

分 类 号：R445.3[医药卫生—影像医学与核医学]