螺旋CT及其图像后处理技术对中央型肺癌气管、支气管树肿瘤侵犯的评价  

The capacity of spiral CT and post-imaging processing techniques in evaluation of the tracheobronchial tree involvement from central lung cancer

作　　者：王建卫[1] 吴宁[1] 黄遥[1] 朱强[2] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤医院影像诊断科,北京100021 [2]北京大学临床肿瘤学院医学影像科

出　　处：《中华放射学杂志》2002年第7期583-587,共5页Chinese Journal of Radiology

基　　金："九五"国家重点科技 (攻关 )项目 (96 92 0 0 6 0 5 4)

摘　　要：目的　利用螺旋CT及其多平面重建 (MPR)和容积再现技术 (VRT)对中央型肺癌 (CLC)气管、支气管树的肿瘤侵犯进行评价并与横断面图像对比 ,以探讨其临床应用价值。方法　 4 6例CLC的患者行前瞻性CT检查 ,采用直接增强扫描 ,在工作站得到气管、支气管树MPR和VRT图像。气管、支气管树肿瘤侵犯的诊断标准分为 5级。盲法阅片 ,对比影像诊断结果与手术及病理结果 ,进行统计学分析。结果　重建图像质量很好、好、差分别占 5 0 0 % (2 3/46 ) ,4 1 3% (19/46 ) ,8 7% (4/46 )。横断面图像与MPR +VRT对气管、支气管树肿瘤侵犯评价的敏感度分别为 82 %和 93% (χ2 =5 5 31,P =0 0 19) ,特异度分别为 83 9%和 90 3% (χ2 =0 .5 74 ,P =0 .70 7) ,准确度分别为 82 4 %和 92 4 % (χ2 =5 85 9,P =0 0 15 )。结论　MPR +VRT对CLC气管、支气管树肿瘤侵犯的敏感度、准确度均高于横断面 ,特异度提高了 6 4 %。特别是对于显示气管、支气管交界部位 ,肿瘤与隆突的关系以及肿瘤沿支气管外膜侵犯方面MPR +VRT的作用更加突出。Objective To assess the imaging processing techniques including multiplanar reconstructions (MPR) and volume rendering technique (VRT) in the evaluation of the tracheobronchial tree involvement from central lung cancer (CLC), and to compare the reconstructed images with the transverse images Methods In a prospective series, 52 spiral CT examinations were performed on a Picker 6000 scanner for suspected CLC Contrast medium was injected at a rate of 4 ml/s with a power injector The scanning delay was 20 seconds The study volume was from the arch of the aorta to the inferior pulmonary veins done in a single breath hold, using 3 mm collimation, pitch of 1 0 and reconstructed at 1 mm intervals 6 patients were excluded after operations Three radiologists compared transverse CT scans, MPR and VRT images in a blind way, and then the findings were compared with the surgical and pathological results Results Reconstructed image quality was graded as excellent (50 0%) or good (41 3%), whereas motion related artifacts led to poor image quality in 8 7% of the cases In the evaluation of the neoplastic invasions among 131 branches/cases of tracheobronchus, MPR+VRT was more sensitive than transverse CT scans (93% vs 82%), more specific (90 3% vs 83 9%); and more accurate (92 4% vs 82 4%) The difference in sensitivity and accuracy was statistically significant (χ 2=5 531, P =0 019 and χ 2=5 859, P =0 015, respectively) Conclusions MPR+VRT improve the recognition of neoplastic invasion of the tracheobronchial tree, especially at the conjunction of trachea with the main bronchus and the main bronchus with the lobe bronchus The relationship between the neoplasms and carina, and the tumor invasion along the ectoblast of the bronchus were better displayed in MPR and VRT images than in transverse CT scans

关 键 词：螺旋CT 中央型肺癌气管 支气管树 肿瘤侵犯 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]