右肺上叶肺静脉分型的多层螺旋CT评价及临床应用探讨  

Evaluation and clinical application of multi-slice spiral CT in right upper lobe pulmonary vein classification

作　　者：王娟 贺文[1] WANG Juan;HE Wen(Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100000, P.R.China)

机构地区：[1]首都医科大学附属北京友谊医院,北京100000

出　　处：《医学影像学杂志》2020年第3期383-387,共5页Journal of Medical Imaging

摘　　要：目的探讨MSCT对健康人右肺上叶肺静脉解剖及引流模式分型,为解剖性肺段切除术靶静脉解剖分型提供帮助。方法收集200例肺部无异常胸部CT平扫影像资料,通过VR重建获得静脉\支气管融合图,观察并统计各静脉分型出现率。结果右上肺静脉根据中央静脉存在与否分为三类1)中央静脉型(Iab型、Ⅰb型);2)半中央静脉型;3)无中央静脉型,其出现率分别为81%(162/200)、7%(14/200)、12%(24/200)。中央静脉型特点为见沿纵隔向上延伸的V.ant,在B2与B3分叉处见V.cent横断面;半中央静脉型特点为纵隔侧不存在V.ant,在B3后外方见V.cent;无中央静脉型特点为中央静脉缺如,多见终末静脉(V2t),管径粗大,并可见多个属支。结论MSCT所得静脉\支气管融合图能清楚显示肺静脉解剖分型,5mm轴位MIP图优于显示肺静脉细微解剖,可作为其解剖识别常规手段。Objective To apply multi-slice spiral CT(MSCT)to classify the anatomy and drainage pattern of the right upper lobe pulmonary vein in healthy people,and to expound the distribution characteristics of the corresponding types on the axial images,so as to provide help for the anatomical classification of the target vein in anatomical segmentectomy.Methods 200 cases of non-abnormal chest CT images were collected,and the veno-bronchial fusion maps were obtained by VR reconstruction.The occurrence rate of veno-bronchial classification was observed and counted.Reconstructing 5 mm axis MIP map,three key observation levels were selected 1)aortic arch level;2)aortic arch level 1/2 from the right upper lobe bronchial opening level;and 3)right upper lobe bronchial opening level;identifying the corresponding types.Results According to the presence or absence of central veins,right superior pulmonary veins were classified into three types 1)central vein type(Iab type,I type b);2)semi-central vein type,and 3)no central vein type.The occurrence rates were 81%(162/200),7%(14/200)and 12%(24/200),respectively.The central venous type was characterized by V.ant extending upward along the mediastinum and V.cent cross section at the bifurcation of B2 and B3;the semi-central venous type was characterized by the absence of V.ant on the mediastinal side and V.cent behind and outside B3;and the absence of central venous type was characterized by the absence of central vein,the presence of terminal vein(V2t),large diameter and multiple generic branches.Conclusion The veno-bronchial fusion maps obtained by MSCT can clearly show the anatomical classification of pulmonary veins.The 5 mm axial MIP maps are superior to the fine anatomy of pulmonary veins and can be used as a routine means of anatomical identification.

关 键 词：肺段 右肺上叶 静脉引流 支气管 体层摄影术 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R561[医药卫生—放射医学]