肺内良恶性结节微血管结构的差别及其对CT强化程度的影响

目的　研究周围型肺癌及良性结节CT增强与微血管结构 (包括微血管密度和毛细血管基底膜 )的关系 ,探讨肺内孤立结节 (SPN)CT强化的基础。方法　应用MarconiMX 80 0 0或SiemensPlusS螺旋CT机对 3cm以下的 3 8例肺癌、5例错构瘤、10例活动性炎性结节进行动态增强 ,绘制时间 密度曲线。以ABC法进行免疫组织化学染色 ,标记微血管和微血管基底膜 ,计算微血管密度 (MVD)。结果　肺癌的CT强化值明显高于错构瘤 [( 4 9.0 5± 16.0 8)HUvs ( 8.98± 4.5 6)HU ,t =7.48,P <0 .0 5 ) ] ,与活动性炎性结节无显著性差异 [( 4 9.0 5± 16.0 8)HUvs ( 4 9.5 9± 2 1.3 0 )HU ,t =0 .76,P >0 .0 5 ) ] ;活动性炎性结节与错构瘤之间也有显著性差异 (t=8.3 5 ,P <0 .0 5 )。活动性炎性结节时间密度曲线的上升快且略高于肺癌 ,两者达到峰值后交叉形成一平台 ;错构瘤仅有轻微上升 ,曲线平直。周围型肺癌MVD为 48.45± 10 .0 9,活动性炎性结节49.60± 19.94,两者无显著性差异 (t=-0 .2 6,P =0 .799) ,但均明显高于错构瘤 ( 8.70± 7.3 0 ) (t =11.64 ,P<0 .0 0 1;t=6.0 9,P <0 .0 0 1)。结节CT强化值与MVD呈正相关 (r =0 .80 5 1,P <0 .0 0 1)。以强化值 3 0HU为界将 5 3例结节分成两组 ,两组基底膜完整性无显著性差异 ( χ2     

MRI增强薄层环状强化模式对结核瘤的诊断价值

目的:探讨MRI增强簿层环状强化诊断结核瘤的病理基础、形态特征及其鉴别诊断价值。方法:对15例经病理证实的结核瘤患者行MRI平扫和Gd DTPA增强检查,观察其强化程度和强化模式,并与病理结果进行对照研究。结果:15例中9例表现为周边簿层环状强化,内部实质无强化;4例无强化;2例轻微强化。病理对照显示环状强化部分系含血供稍多的包膜,而内部干酪样物质无强化。而35例直径小于3cm的肺癌中均无簿层环状强化。结论:部分结核瘤增强MRI表现为簿层环状强化具有一定特征性,可帮助区分结核瘤和周围型肺癌。     

孤立性肺结节质子磁共振波谱的初步研究

目的:研究孤立性肺结节氢质子波谱(1H-MRS)的特征及其代谢物变化规律,探讨MRS在孤立性肺结节鉴别诊断中的应用价值.方法:应用Siemens Vision 1.5T超导磁共振机对69例孤立性肺结节行常规MRI检查和MRS测量,观察记录所有孤立性肺结节MR波谱特征及各代谢物参数值.10例手术标本行MRS检查,并将其结果与术前结节的MRS结果对照分析.结果:恶性结节组患者胆碱含量(Cho)、胆碱与肌酸比值(Cho/Cr)及乳酸含量(Lac)明显高于炎性结节、结核球及错构瘤组(P<0.01,P<0.05, P<0.01).10例手术标本MRS检测结果与术前MRS检测结果行配对t检验,两者之间无显著性差异.结论:Cho升高、Cho/Cr值的增加和出现异常Lac峰是恶性结节的波谱特征,其对良恶性肺结节的鉴别诊断有重要的辅助诊断价值.     

Difference in microvascular structure between benign and malignant pulmonary nodules and its relationship with CT enhancement

Objective: To investigate the enhancement basis and the mechanisms of solitary pulmonary nodules (SPNs) by comparing the differences in microvascular structure between benign and malignant lesions. Methods: Dynamic contrast-enhanced CT scan was performed on 53 patients with SPNs (diameter<3 cm. 38 peripheral lung cancers, 5 hamartomas, 10 inflammatory lesions) using a Siemens Plus S or a Marconi MX8000 multi-slices spiral CT scanner. The time-attenuation curves were interpreted. The microvascular density (MVD) and the continuity of the microvessels' basemental membrane in the dissected specimens were observed with the ABC (avidin-biotin-complex) immuno-histochemical method in all patients. ResultS:The CT enhancement values of lung cancer (49. 05±16. 08 HU) and inflammatory lesions (49. 59±21. 30 HU) were significantly higher than those of hamartoma (8. 98±4. 56 HU) (t = 7. 48. P<0. 05; t = 8. 35, P<0. 05). But the enhancement of lung cancer was similar to that of inflammatory lesions (t = 0. 76. P>0. 05). The time-attenuation curve of inflammatory lesions tended to increase faster and reached a higher peak compared to the lung cancer, and both of them maintained a high plateau after crossing. The hamartoma showed a slight increase in the time-attenuation curve and demonstrated a low-plateau curve. The MVD of SPNs was positively correlated with CT enhancement (r=0. 8051). The microvascular counts of peripheral lung cancer (48. 45±10. 09) and inflammatory lesions (19. 60±19. 94) were significantly higher than those of hamartoma (8.70±7.30) (t = 11.64, P<0.001;t = 6. 09. P< 0. 001). but no significant difference was found between lung cancer and inflammatory lesions (t= -0. 26, P = (). 799). There was no difference in the continuity of basement membrane between nodules with an enhancement less than 30 HU and those with an enhancement higher than 30HU (x2 = 3. 13, P>0. 05 ). Conclusion: The microvascular counts mainly contribute to the enhancement value of SPNs. The basement membrane is not related to nodule enhancement, but it might influence the pattern of the time-attenuation curve.     

多层螺旋CT动态增强评价恶性孤立肺结节血流模式的初步探讨

目的 初步探讨多层螺旋CT(MSCT)动态增强评价恶性孤立性肺结节血流模式的技术方法。方法 57例恶性孤立性肺结节(直径≤4cm)患者，经屏气训练后，在增强前、后采用Marconi Mx8000多层螺旋CT进行扫描，以4m1／s的速度从肘静脉注入非离子型造影剂90m1，动态扫描选择肺结节最大层面进行。其中29例于第15～45s、75～105s时，每间隔1s扫描一次(程序1)；28例于第11～41s、71—101s时，每间隔1s扫描一次(程序2)；两组患者均于2～9min时每间隔30s扫描一次。病灶直径为3～4cm时，扫描层厚5mm；病灶直径≤3cm时，扫描层厚2．5mm，以常规算法重建图像。记录孤立肺结节增强前后各时相的CT值并计算强化值、灌注量、结节--主动脉强化值比、平均通过时间。结果 两组患者所得强化值、灌注量、结节—主动脉强化值比、平均通过时间均无统计学差异(P＝O.516，P＝O.609，P＝O.356，P＝O.693)。程序1只测得部分患者(22／29)的结节平均通过时间；程序2得到了全部患者(28／28)的结节平均通过时间。结论 多层螺旋CT(MSCT)动态增强是定量评价恶性孤立性肺结节血流模式的无创性技术，具有研究肺癌血管生成的潜在价值。