隔离肺合并囊腺瘤的产前MRI与产后CT影像表现  

Prenatal MRI and postnatal CT manifestations of pulmonary sequestration with congenital cystic adenomatoid malformation

作　　者：陈文俊[1] 黄煌[1] 刘永熙[1] 杨朝湘[1] 江魁明[1] 郭庆禄[1] CHEN Wenjun;HUANG Huang;LIU Yongxi;YANG Chaoxiang;JIANG Kuiming;GUO Qinglu(Department of Radiology ,Guangdong Women and Children Hospital ,Guangzhou 510010 ,China)

机构地区：[1]广东省妇幼保健院放射科,广东广州510010

出　　处：《实用放射学杂志》2019年第1期89-93,共5页Journal of Practical Radiology

摘　　要：目的 探讨肺隔离症(PS)合并先天性肺囊性腺瘤样畸形(CCAM)胎儿期MRI和婴儿期CT的影像学特点。 方法 回顾性分析5例经产后病理证实的PS合并CCAM胎儿期及婴儿期影像资料,观察其MRI及CT表现,并与病理结果对照。 结果 (1)胎儿期MRI检查,5例均表现为一侧胸腔肿块(左侧4例,右侧1例),T1WI呈低信号,T2WI呈高信号,4例内部可见高信号囊泡影,1例内部未见高信号囊泡,其边缘出现片状稍低信号区;5例均可见一血管影与胸主动脉相连。(2)产后CT检查,1例叶内型PS(ILPS)合并CCAM Ⅲ型表现为左肺下叶囊实性病灶,可见多量大小不等含气囊腔,由胸主动脉分支血管及左下肺动脉双重供血。1例叶外型PS(ELPS)合并CCAM Ⅱ型及1例ELPS合并CCAM Ⅲ型表现为左侧胸腔囊实性肿块,1例ELPS合并CCAM Ⅱ型为右肺中叶后方实性肿块伴局部低密度囊泡形成,3例均由胸主动脉分支单支供血。1例ELPS合并CCAM Ⅲ型由左侧胸腔实性肿块及左肺下叶多囊性异常充气肺组织融合组成,实性肿块供血源自胸主动脉分支,左下肺动脉参与异常充气肺组织供血。 结论 接受体循环供血的肺叶或胸腔内肿块出现明显囊性变是PS合并CCAM产前MRI与产后CT较具特征性的影像表现,有助于诊断及鉴别诊断。Objective To investigate the fetal MRI and infant CT features of pulmonary sequestration (PS)with congenital cystic adenomatoid malformation(CCAM).Methods The fetal and infant imaging data of 5 surgical pathologically confirmed PS with CCAM were analyzed retrospectively.All patients underwent both fetal MRI and postnatal CT scans.Both CT and MRI manifestations were compared with pathological findings.Results (1)On fetal MRI,all cases were presented as an intrathoracic mass showed hypointense on T1WI and hyperintense on T2WI.4 cases were in left side,1 in the right.T2 WI revealed single or multiple cyst in 4 cases,1 case without cyst formation showed a slightly hypomtense region in the mass.Feeding arteries were derived from thoracic aorta in all cases. (2)On postnatal CT scans,a cystic-solid mass with multiple saccular structure containing air located in the left inferior lobe,which was shown in the case of intralobar PS(ILPS)with CCAM type Ⅲ ,the feeding arteries arised both from thoracic aorta and left inferior lobar pulmonary artery.1 case of extralobar PS(ELPS)with CCAM type Ⅱ and another case of ELPS with CCAM type Ⅲ were manifested as a cystic-solid mass in the left hemithorax.1 case of ELPS with CCAM type Ⅱ showed a solid mass with regional cystic components behind the right middle lobe.The blood supply of these 3 cases were contributed by single artery originated from thoracic aorta.The last case of ELPS with CCAM type Ⅲ was composed by an intrathoracie solid mass supplied with arterial systemic originating from the thoracic aorta and a hyperinflation lesion with a quantity of tiny cysts in the left inferior lobe supported by the left inferior lobar pulmonary artery.Conclusion Significant cystic changes occur in an intralobar or intrathoracic mass that derives a systemic blood supply is a characteristic manifestation for PS with CCAM on prenatal MRI and postnatal CT imaging,therefore being helpful to the diagnosis and differentiation.

关 键 词：肺隔离症 先天性肺囊性腺瘤样畸形 磁共振成像 计算机体层成像 

分 类 号：R563[医药卫生—呼吸系统] R445.2[医药卫生—内科学]