孤立性肺结节与血管和支气管关系:多层螺旋CT与病理对照初步研究  

Study of the Relationship between Solitary Pulmonary Nodule,Blood Vessels and Bronchus by Multi-Slice Spiral CT

作　　者：胡星[1] 刘含秋[1] 张家文[1] 金先桥[2] 

机构地区：[1]复旦大学附属华山医院放射科 [2]复旦大学附属华山医院呼吸科

出　　处：《中国医学计算机成像杂志》2015年第2期105-110,共6页Chinese Computed Medical Imaging

摘　　要：目的：研究孤立性肺结节（SPN）与周围血管和支气管的关系,结合SPN的三维CT成像,以期提高对肺结节的良恶性诊断准确率。方法：对经手术和病理证实的26例SPN（其中恶性结节18例,良性结节8例,病灶直径（3.7~31.4mm,平均11.8mm）进行回顾性分析,所有患者做肺部CT常规5mm加局部薄层（1.25mm）重建,观察病灶及周围血管和气管形态并进行分类,经工作站多平面重建（MPR）和曲面重建（CPR）及SPN三维重建软件nodule assessment构成空间三维形态。将分析结果与手术病理对照。结果：手术病理证实良性8例（35.71%）,恶性18例（64.29%）。SPN-血管关系分为6型：Ⅰ型,斜形方向血管在病灶边缘截断,末端杵状增粗。Ⅱ型,血管在病灶边缘截断,笔直走行,末端不呈杵状增粗。Ⅲ型,血管进入结节切迹处。Ⅳ型,一支血管穿过结节。Ⅴ型,血管受压呈弧形改变,血管紧贴结节边缘走行。Ⅵ型,为混合型。SPN-气管关系分为6型：Ⅰ型,支气管在SPN边缘中断;Ⅱ型,支气管进入SPN后中断;Ⅲ型,支气管穿过SPN;Ⅳ型,支气管紧贴SPN边缘走行;Ⅴ型,多支支气管向SPN汇聚;Ⅵ型,为混合型。其次,SPN三维重建nodule assessment对SPN形态及SPN与肺血管和胸壁的关系显示更直观,三维CT重建均见肺血管供应症。结论：多层螺旋CT薄层扫描能清楚显示SPN与肺血管和支气管的关系,两者对SPN良恶性性质的诊断和鉴别诊断有重要价值。SPN三维CT重建技术,更能直观反映结节的形态学特征。Purpose：Through studying the relationship between solitary pulmonary nodule,blood vessels and bronchus by multi-slice spiral CT（MSCT）,to improve the diagnostic accuracy of benign and malignant lung nodules.Methods：Twenty-six cases of SPN confirmed by surgery and pathology results（malignant nodules in 18 cases,benign nodules in 8 cases,diameter of lesions was 3.7-31.4mm,average11.8mm） were retrospectively analyzed.Routine（5mm slice thickness） lung CT images of all patients were reconstructed with local thin（1.25mm） thickness.The form of the bronchus and blood vessels around the lesions was observed and classified.With the help of multi-planar reconstruction（MPR） and curveplanar reconstruction（CPR） and by 3D reconstruction software（nodule assessment）,we compared the analysis results with surgical pathology results.Results：Surgical pathology results confirmed that 8 cases were benign（35.71%）,and 18 cases were malignant（64.29%）.The SPN-vessel relationship was identified as 6 types with MSCT.Type I：Vessels were obstructed abruptly by the SPN,the end of the vessels were drumstick thickening;Type II：Vessels were displaced,and the end was not drumstick thickening;TypeⅢ：Vascular notch sign was demonstrated;Type Ⅳ：Vessels penetrated into SPN;Type Ⅴ：Vessels ran at the periphery of SPN with intact lumen or compressed by SPN;Type Ⅵ：Mixed type（2 or more types as mentioned above）.The SPN-bronchus relationship was identified as 6 types with MSCT.Type Ⅰ：The bronchus was interrupted by the SPN;Type Ⅱ：Bronchus was interrupted when penetrated into SPN;TypeⅢ：Bronchus was contained within the SPN;Type Ⅳ：Bronchus was compressed by the SPN;Type Ⅴ：The bronchus got together to SPN;Type Ⅵ：Mixed type（2 or more types as mentioned above）.In addition,the shape of SPN and the relationship between SPN and vessels or chest wall could be displayed by 3d reconstruction.Conclusion：MSCT can clearly display the relationship between SPN,vessels and bronchus,

关 键 词：孤立性肺结节 血管 支气管 病理学 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R816.4[医药卫生—内科学]