正常肺高分辨CT表现的解剖基础研究

笔者搜集８例尸体的正常肺标本，共１４侧肺。采用标本高分辨ＣＴ（ＨＲＣＴ）图像、软Ｘ线照片及组织学切片对照的研究方法。结果表明：（１）ＨＲＣＴ图像能清楚显示ＨＲＣＴ图像的基本影像单位─—次级肺小叶。小叶间隔分布趋势为：胸膜下比中央部丰富，且上、中（舌）叶比下叶丰富；中央部以肺尖和下叶各基底段支气管血管束内侧丰富；纵隔面、膈面比肋面丰富。（２）我们将肺的横断层面分为周边部与中央部，周边部范围为胸膜下１．５ｃｍ。（３）全肺五个代表层面分别为：主动脉弓、右上叶前段支气管、右中叶支气管、下肺静脉干和肺底隔上层面。这五个代表层面反映了肺的概貌。     

两肺上叶前段支气管及肺动脉的X线研究

作者基于２００例正常成人后前位胸片和３０侧（左右各１５例）成人肺脏标本，对两肺上叶前段支气管和肺动脉断面的出现率、形态、大小和位置进行了观测。上叶前段支气管断面旁的软组织厚度正常为３ｍｍ～５ｍｍ，若超过５ｍｍ，应视为肺门异常的一种征象。上叶前段肺动脉断面一般位于相应支气管断面的内侧，在有肺充血、肺动脉高压的心脏病人胸片上，其断面径随之扩大。     

主动脉弓左侧静脉变异的MSCT诊断价值

目的 探讨主动脉弓左侧静脉变异的CT影像特征，提高诊断及鉴别诊断的能力，避免误诊漏诊。方法 选取我院住院患者经彩色多普勒超声心动图及CT共同诊断的18例主动脉弓左侧静脉变异的CT图像。结果 心上型完全型肺静脉异位引流2例，左上肺部分型肺静脉异位引流2例，永存左上腔静脉11例，主动脉弓下左头臂静脉2例，食管后左头臂静脉1例。结论 主动脉弓左侧异常血管断面是心上型完全型肺静脉异位引流、左上肺部分型肺静脉异位引流、永存左上腔静脉、主动脉弓下左头臂静脉、食管后左头臂静脉的共同CT征象，不同的是血管走行，通过此征象可以提高CT对主动脉弓旁先天静脉畸形的诊断水平，避免误诊漏诊。     

右肺上叶肺静脉分型的多层螺旋CT评价及临床应用探讨

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。     

舌段支气管的CT解剖

作者对40例病人行薄层CT 扫描以证实左上叶舌支和其段、亚段支气管的正常表现以及寻找区分左上叶舌段和前段解剖标志的可能性。左上叶支气管分为上支和下支(舌支LD)这种分叉类型约占解剖标本的75%,余下的25%其左上叶前段支气管(B_3)向下移行成三叉状。舌支或舌千支气管分为上舌段(B_4)和下舌段(B_5)支气管。上舌支再分为前亚段(B_4b)和后亚段(B_4a)支气管。下舌段再分为上亚段(B_5a)和下亚段(B_5b)。引流左上叶前段的静脉称为前肺静脉(V_3)。它的下支(V_3b)走行在左上叶舌段和前段之间,因其水平的走行,故可为分隔左上叶舌段与前段的明显标志。40例病人中,男性25例,女性15例,年龄22—81岁。30例病人或在舌段或在左肺其它部位有病变。从气管隆凸到基底干远端作层厚1.5或3.0mm、间隔3.0mm 的薄层扫描。影象由两位放射医     

下肺门窗

在侧位胸片上,肺动脉和上肺静脉组成肺门上后部的绝大部份。而在下肺门,两侧下叶支气管前方无大血管。故侧位胸片上,肺门的前下方是一个透x光区。此区间近似三角形,作者称之为“下肺门窗。作者回顾性研究了50例正常人和25例异常者的下肺门窗平片和相应平面的CT 所见。扫描和平片间隔时间不到一个月,如发现中叶和舌叶支气管起始端以下1cm 层面内肺门区有>1cm 的非血管软组织影即视为异常;用有一切口的黑片罩住胸片,     

对比剂智能跟踪与预试验肺动脉MSCT成像的对比研究

目的:探讨对比剂智能跟踪技术(BT)和预实验时间-密度曲线(PTDC)技术在CT肺动脉成像中的应用价值。方法:疑诊为肺动脉栓塞而行CT肺动脉成像(CTPA)的患者中,筛选出CTPA结果阴性的患者38例,其中采用BT法者20例、PTDC法者18例。BT法的兴趣区选在取主动脉弓上1cm水平的头臂静脉内,阈值设为100HU,触发后延迟3.2s开始增强扫描;PTDC法的兴趣区选在支气管隆突水平肺动脉主干内。采用双盲法对两种技术所得CTPA影像质量进行评分,并测量双上肺动脉与肺静脉、下肺动脉与肺静脉的密度差,进行统计学分析。结果:BT组图像质量评分优于PTDC组,但差异无显著性意义;右上肺前叶和右肺下叶的肺动、静脉密度差在两组间的差异没有统计学意义;左上肺前叶和左下肺下叶肺动、静脉密度差在两组间的差异有统计学意义(P值分别为0.008和0.019)。结论:选择头臂静脉BT法CTPA检查较PTDC扫描减少了对比剂剂量和患者受照剂量,而且图像质量好于PTDC法。     

双源CT对先天性心脏病纵隔静脉异常的诊断

目的 探讨双源CT(DSCT)心血管成像对先天性心脏病(先心病)纵隔静脉异常的诊断价值.资料与方法 搜集存在纵隔静脉异常的先心病患者62例,男39例,女23例,年龄17天～29岁.使用Siemens双源CT扫描机扫描,运用多种图像后处理方法,重点观察上腔静脉、头臂静脉、奇静脉、半奇静脉、肺静脉及冠状静脉等有无异常.结果 62例中共存在纵隔静脉异常63处(其中1例同时合并永存左上腔静脉和半奇静脉异常),DSCT均正确诊断,可分为6类:永存左上腔静脉29处,24处经冠状静脉窦汇入右心房,4处直接汇入左心房,1处双上腔静脉分别汇入单心房;左头臂静脉异常15处,包括:主动脉弓下左头臂静脉12处、无名动脉后左头臂静脉1处、食管后左头臂静脉1处、左头臂静脉分为上下2支1处;肺静脉畸形引流15处,包括完全型11处和部分型4处;肺静脉曲张1处,为室问隔缺损并肺动脉高压患儿;无顶冠状静脉窦2处,均为法洛四联症患者;下腔静脉中断并半奇静脉扩张、异常引流入永存左上腔静脉1处.结论 DSCT在先心病纵隔静脉异常的诊断及术前评估中具有重要的应用价值.     

肺叶切除后肺静脉血栓引起的单侧肺水肿

作者报告2例肺叶切除后肺静脉血栓形成引起的单侧肺水肿。例1,女,71岁。因鳞癌行右中下叶肺切除,术后立即胸片,见右上叶充气良好。术后5天发热,胸片示右肺余部有间质性与含气间隙病变,抗菌治疗10天无改善,胸片示右肺病变进展,选择性右肺动脉造影示肺静脉血栓形成。手术证实,且右上叶肺坏疽。切除该叶,完全治愈。例2,女,64岁。因腺癌做左上叶肺切除。术后进行性气短与发热。胸片示左肺含气间隙病变,且逐渐进展。血管造影示有血栓的肺静脉。手术见左下叶肺静脉血栓。行左下叶肺切除,病人治愈。作者指出,肺静脉梗阻是肺静脉高压与肺水肿的已知原因。肺切除后肺静脉血栓的原因不明,当肺血管的压力升高引起血管内液漏出至血管外间隙时,则可产生肺水肿。胸片上细菌肺炎早期有含气间隙病变     

肺门分层摄影:对常规55°后倾斜位解剖的再认识

胸平片观察肺门解剖比较困难。许多作者介绍55°后倾斜位是最佳检查方法。一般认为这一投照位置能充分显示支气管,容易辨认血管结构。血管周围和支气管交角处的软组织阴影都提示淋巴结肿大。作者通过150例后倾斜分层和50例肺动脉造影的对照分析,认为这一认识必须修正,强调由于上肺静脉的参与,使肺门结构在常规55°后倾斜位中较为复杂。作者证实,上肺静脉的解剖与文献所载一致:两肺上叶都有一静脉干存在。在左肺它由尖后支和前支汇合;在右肺它由尖支和后支汇合。正位上,上叶静脉干从上外向下内走向左房,侧位上略向下后行。在右肺常见单独的前支汇入右上叶静脉干。     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段:上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段;左肺8段:上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点:(1)横断面双肺由肺尖至肺底选取11个层面:胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面;(2)双肺由内向外分别选取6个层面,左肺:左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面;右肺:右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外;(3)冠状面双肺由前向后选取7个层面:胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

SPECT/CT肺灌注显像中肺段精确定位方法的研究

目的 研究SPECT/CT肺灌注显像中肺段横断面、矢状面及冠状面的精确定位方法.方法 分析12名健康成人的肺灌注断层图像、CT图像及二者的融合图像,按CT解剖命名标准对肺灌注横断面、矢状面及冠状面图像上肺段进行划分.即右肺10段：上叶尖段、后段、前段,中叶外侧段、内侧段,下叶背段、内基底段、前基底段、外基底段、后基底段 左肺8段：上叶尖后段、前段、上舌段、下舌段,下叶背段、前内基底段、外基底段、后基底段,并总结3个层面肺段分布的特点.结果 确定了左右肺在横断面、矢状面及冠状面上的典型层面及各个肺段的主要分布特点：（1）横断面双肺由肺尖至肺底选取11个层面：胸锁关节层面及以上,主动脉弓上缘层面,主动脉弓层面,奇静脉弓层面或气管杈层面,右肺上叶支气管层面或左肺动脉层面,左肺上叶支气管层面或右肺动脉层面,中叶或舌叶支气管层面,底干支气管层面,下肺静脉层面,上下底段静脉层面,底段静脉层面 （2）双肺由内向外分别选取6个层面,左肺：左肺门层面,左主支气管杈层面,左肺动脉叶间部层面,心尖层面,心尖左侧第一层面,心尖左侧第二层面 右肺：右肺门层面,中间支气管杈层面,叶间动脉层面,叶间动脉分杈层面或右心房右侧第一层面,右心房右侧第二层面,右心房右侧第三层面向外 （3）冠状面双肺由前向后选取7个层面：胸锁关节层面,升主动脉层面,肺动脉杈层面,气管杈层面,中间支气管层面,底段总静脉层面,胸主动脉层面.结论 按该研究方法划分肺段,可为肺灌注断层图像中肺段的精确定位提供参考依据.     

Segmental bronchovascular anatomy of the lower lobes: CT analysis

A systematic evaluation of the anatomic relationships of the segmental bronchi, arteries, and veins of 107 right and 113 left lower lobes was made from CT scans of patients with normal chest radiographs. The classic taxonomies of Boyden and Jackson and Huber were used for nomenclature. Identification of individual structures was based primarily on careful analysis of contiguous CT slices. The frequency of identification of each of the major segmental bronchi and their corresponding arteries was established, and variations in the number and position of arteries were recorded at four transverse levels on the right side and three levels on the left side. The segmental venous tributaries of the inferior pulmonary vein were also identified. Although there is considerable constancy in the anatomy of the lower lobe segments, variation from the dominant pattern occurred in as many as 20% of cases. Sometimes major segmental bronchi were not identified and presumably varied in their origin. The segmental arteries may be single, duplicate, or even triplicate. Within the segments, the arteries generally lie toward the lung periphery relative to their corresponding bronchi, thus being anterior, lateral, or posterior. The segmental veins generally lie central to their bronchi, thus being posterior, medial, or anterior. Knowledge of prevailing patterns and variant appearances of the lower-lobe vascular structures can be helpful in interpreting CT scans. Such knowledge is a prerequisite for the identification of pulmonary nodules in the vicinity of vascular structures and the recognition of intersegmental lymph nodes and aberrant vessels.     

CT anatomy of the lingular segmental bronchi

Thin-section CT scans were performed in 40 patients to demonstrate the normal appearance of the lingular division (LD) bronchus and its segmental and subsegmental bronchi and to search out the possible anatomical landmark dividing the anterior segment and LD of the left upper lobe. The LD bronchus was identified in all patients. The complete branching pattern of the lingular segmental and subsegmental bronchi could be traced in 19 (47.5%) patients. Since the lower branch of the draining vein of the anterior segment of the left upper lobe (V3b) runs horizontally between the anterior segment and the LD of the left upper lobe, it is a good landmark dividing the anterior segment and LD of the left upper lobe. Familiarity with thin-section CT anatomy of the lingular segmental and subsegmental bronchi and surrounding vascular structures is helpful in identifying the lingular bronchial tree precisely and localizing a lesion in the left upper lobe correctly.     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

肺动脉吊带的影像学诊断

目的 评价肺动脉吊带的影像学诊断价值。方法 7例肺动脉吊带中5例做了心血管造影（ACG）（5例均做了MR检查，4例同时做了CT检查），2例仅做MR检查。结果 7例肺动脉吊带病例中6例显示左肺动脉起始于右肺动脉远端分叉部，并绕过气管后方（4例有气管压迫征象，临床有气急、喘鸣的症状），另有1例为左下肺动脉起始于右肺动脉远端近分叉处，左上肺动脉起始正常。5例经手术证实。结论 ACG、造影增强磁共振血管造影（CE-MRA）、CT血管造影（CTA）为明确肺动脉吊带诊断的最佳方法，3种方法可互为补充。心血管造影选择性强，CE-MRA的三维成像显示肺动脉的走向较有优势；CTA可以同时显示气管和异常起源的左肺动脉之间的关系。     

Analysis of interlobar (between upper and middle lobes) lymph node enlargement on hilar tomography

We examined interlobar (between upper and middle lobes) lymph node enlargement by compensating filter hilar tomography in cases of central vein type right upper lobe vein. The control group consisted of 100 randomly selected specimens, in which hilar lymphadenopathy such as malignant lymphoma or sarcoidosis, and displacement of interlobar fissure due to atelectasis or tuberculosis were excluded. Eighty-four of the control cases were central vein type. As a lung cancer group, 18 cases were analyzed. These cases consisted of central vein type, and interlobar lymph node enlargement was noted on operation, in the course of therapy or on enhanced CT study. The right hilum bordered by the upper lobe bronchus (medial to the orifice of B1) and segmental bronchus (B2 or B3) above, central vein lateral and intermedial arterial trunk on the mediastinal side were evaluated. The shadows that obscured the inner margin of the central vein and lower margin of the upper-lobe and segmental bronchi were analyzed. The inner margin of the central vein was visible in 75 cases (89.3%) in the control group, compared to 1 (5.6%) of 18 cases in the lung cancer group. Decreased radiolucency beneath the upper lobe bronchus and segmental bronchus was found in 10 cases (11.9%) in the control, compared to 16 cases (88.9%) in the lung cancer group. In conclusion, obliteration of the inner margin of the central vein and the opacity that decreased the radiolucency extending to the peripheral side of the upper lobe bronchus are strongly suggestive of interlobar lymph node enlargement. Recognition of interlobar lymph node enlargement is useful for the staging of lung cancer and diagnosis of the disease that accompanies systemic hilar lymphadenopathy.     

异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT表现

目的 总结异常体动脉供应正常左下肺基底段在胸部X线片和螺旋CT上的特征性表现。方法 回顾分析5例异常体动脉供应正常左下肺基底段的胸部X线片和螺旋CT资料。结果 5例异常体动脉供应正常左下肺基底段在胸部X线片上均表现为心后区肿块，左下肺动脉纹理细小，受累左下肺区域无正常肺动脉分支影分布，但有异常增粗纹理。CT上5例均表现为受累肺组织体积轻度缩小，支气管通畅，2例肺实质呈磨玻璃状改变。5例均可见左下肺动脉在背段动脉起始远侧缺如，增粗扭曲的异常体动脉起自降主动脉，其扩张的分支分布于受累肺段。1例血管造影表现与CT相仿。结论 该病在胸部X线片上的表现有一定特征性。增强螺旋CT扫描可明确诊断，以避免创伤性的血管造影和致命的穿刺活检。