螺旋CT薄层靶扫描对孤立性肺结节与支气管关系的诊断价值与病理对照  

Spiral CT thin layer target scan in the diagnosis of solitary pulmonary nodule and bronchus relationship value and pathology

作　　者：方金忠 张文奇[1] 王和平[1] 陶云年 陈志军[2] 王兆宇[3] 宋惠玲[1] 

机构地区：[1]浙江省舟山医院定海院区放射科,浙江舟山316000 [2]浙江省舟山医院胸外科,浙江舟山316000 [3]浙江省舟山医院病理科,浙江舟山316000

出　　处：《医学影像学杂志》2016年第2期234-238,共5页Journal of Medical Imaging

摘　　要：目的分析孤立性肺结节(SPN)与支气管的关系,探讨其对SPN定性诊断的价值。方法对210例经手术或临床证实的SPN进行回顾性分析,所有病例均进行螺旋CT薄层靶扫描及多平面重建等后处理重组,通过观察SPN与支气管的关系,判断结节的性质,并与病理结果对照。结果 210例SPN中恶性结节176例,其中原位腺癌61例、微浸润腺癌44例、浸润性腺癌57例、鳞癌11例、腺鳞癌1例、小细胞癌1例、大细胞癌1例;良性结节34例,其中不典型腺瘤样增生9例、炎性肉芽肿8例、隐球菌感染5例、结核瘤3例、球形肺炎6例、错构瘤2例、硬化性血管瘤1例。210例SPN中与支气管有关系123例(占58.6%),其中恶性SPN中有111/176例(占63.1%),良性SPN中有12/34例(占35.3%)。SPN与支气管的关系分为四型:Ⅰ型,支气管于SPN边缘被阻塞、截断;Ⅱ型,支气管进入SPN时变尖或锥形截断;Ⅲ型,支气管被SPN包绕穿过,其管腔可狭窄、僵硬、扩张;Ⅳ型,支气管沿SPN边缘走行不中断,管腔正常或受压变扁。出现单一类型,恶性组101例,其中Ⅰ型11例、Ⅱ型39例、Ⅲ型34例、Ⅳ型17例;良性组12例,其中Ⅰ型1例、Ⅱ型1例、Ⅲ型5例、Ⅳ型5例;有10例恶性SPN同时出现2种类型,其中Ⅰ+Ⅳ型1例,Ⅱ+Ⅳ型4例,Ⅲ+Ⅳ型5例;原位腺癌(AIS)、微浸润腺癌(MIA)、浸润性腺癌(IAC)分别在Ⅰ型中0、0、2例,Ⅱ型2、12、29例,Ⅲ型10、14、15例,Ⅳ型13、3、8例;11例鳞癌中9例与支气管的关系为Ⅰ型;恶性结节多表现为Ⅰ型、Ⅱ型、Ⅲ型,鳞癌多表现为Ⅰ型,腺癌多表现为Ⅱ型、Ⅲ型;良性结节多表现为Ⅲ型、Ⅳ型。结论螺旋CT薄层靶扫描结合多平面重组等后处理重建技术,可以充分显示SPN与支气管的关系,对SPN定性诊断具有重要的价值,并可以反映一定的病理分型。Objective To analyze the relationship between the solitary pulmonary nodules（ SPN） and bronchus,and to discuss the value of qualitative diagnosis of SPN. Methods 210 cases of SPN confirmed by surgery or clinical were analyzed retrospectively,and all cases were performed by spiral CT thin layer target scanning and multi-planar reconstruction of post-processing reorganization,by observing the relationship between SPN and bronchus,judging the nature of the nodules,and comparing with the pathological results. Results 176 cases of malignant nodules were found in the 210 cases of SPN,including 61 cases of adenocarcinoma in situ,44 cases of minimally invasive adenocarcinoma,57 cases of infiltrating adenocarcinoma,11 cases of squamous cell carcinoma,1 case of adenosquamous carcinoma,1 case of small cell carcinoma,and large cell carcinoma in 1 case;Benign nodules were 34 cases,including 9 cases of atypical adenomatous hyperplasia,8 cases of inflammatory granuloma,5 cases of cryptococcus infection,3 cases of tuberculoma,6 cases of spherical pneumonia,2 cases of hamartoma,1 case of sclerosing hemangioma. Of 210 cases of SPN,123 cases were associated with bronchus（ 58. 6%）,malignant SPNS were found in 111 /176 cases（ 63. 1%）,and benign SPNS in 12 /34（ 35. 3%）. The relationship between SPN and bronchus was divided into four types,Type Ⅰ,the bronchus was blocked and interrupted at the edge of SPN; Type Ⅱ,bronchus was pointed or truncated conical when entering the SPN time-varying; Type Ⅲ,bronchus was around through the SPN package,and its lumen can be narrow,rigid and expansion; Type Ⅳ,bronchus walking along the SPN edge line without interruption,compression of lumen or normal flat. Found that single type,101 cases of malignant group,Including type Ⅰ11 cases,Type Ⅱ 39 cases,Type Ⅲ 34 cases,Type Ⅳ 17 cases; 12 cases of benign group,Including type Ⅰ1 case,Type Ⅱ 1 case,Type Ⅲ 5 cases,Type Ⅳ 5 cases; There are 10 cases of malignant SPNS appeared two types at the same time,Including Ⅰ ＋

关 键 词：孤立性肺结节 支气管 薄层 靶扫描 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]