多排螺旋CT显示支气管与外周肺癌关系的价值

目的 研究多排螺旋CT(MSCT)显示支气管与外周肺癌关系中的价值。方法 采用MSCT对53例外周肺癌行层厚为0．5mm的容积靶扫描,通过多层面或曲面重建(MPR or CMPR)以及表面遮盖显示(SSD)的方法,显示支气管与外周肺癌的关系。将结果与手术标本、病理切片对照。结果 (1)全部第3—7级支气管均全程清晰、完整的显示,肿瘤与支气管有关系者：30例腺癌中29例(96．7％),17例鳞癌中13例(76．5％)。(2)肿瘤-支气管关系分为4型：Ⅰ型：支气管被肿瘤截断;Ⅱ型：支气管进入肿瘤锥状中断;Ⅲ型：支气管在肿瘤内保持通畅;VI型：支气管紧贴肿瘤边缘走行,形态正常或受压移位。(3)Ⅰ型发生率为58．5％(31／53),其中鳞癌略多于腺癌;Ⅱ型和Ⅲ型均为15．1％(8／53),仅见于腺癌;Ⅳ型为28．3％(15／53),腺癌略多于鳞癌。(4)与第4级支气管相关的肿瘤,鳞癌多于腺癌;与第6级支气管相关的肿瘤,腺癌多于鳞癌。结论 采用MSCT,超薄层靶扫描后行MPR、CMPR和SSD重建能准确地显示肿瘤-支气管关系,反映一定的病理改变。

The value of multislice spiral computed tomography in demonstrating the relationship between bronchus and peripheral lung cancer

OBJECTIVE: To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchus and peripheral lung cancer. METHODS: We prospectively performed volumetric targeted scans of 0.5 mm collimation with MSCT and reconstructed images of multiplanar reconstruction (MPR), curved multiplanar reformations (CMPR) and surface shaded display (SSD) in 53 peripheral lung cancers. The results were compared with macroscopic and microscopic specimens. RESULTS: (1) The third- to seventh-order branches of the bronchi were clearly shown in all patients by the designed protocol. CT demonstrated the tumor-bronchus relationship in 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistic analysis showed that there was no significant difference between the two groups (chi(2) = 2.8, P > 0.05). (2) The tumor-bronchus relationship was identified as four types with MSCT. Type I: bronchus was obstructed abruptly by the tumor, type II: bronchus penetrated into the tumor with tapered narrowing and interruption, type III: bronchus lumen shown within tumor was patent and intact, type IV: bronchus ran at the periphery of the tumor with intact or narrowed lumen. (3) Type I was shown in 31 of 53 (58.5%) tumors with squamous-cell carcinoma slightly more common than adenocarcinoma. Type II and type III were seen equally in 8 of 53 (15.1%) tumors which occurred only in adenocarcinomas. Type IV was seen in 15 of 53 (28.3%) tumors with adenocarcinoma being slightly more frequent than squamous cell carcinoma. (4) The tumor at the fourth-order bronchus was more common in squamous cell carcinoma, whereas that at the fixth-order bronchus was more likely in adenocarcinoma. CONCLUSION: Volumetric targeted scan of ultra-thin section with MSCT and followed by MPR, CMPR and SSD reconstruction can greatly improve the manifestation of the bronchioles and accurately demonstrate the patterns of tumor-bronchus relationship, thereby reflecting pathologic changes to some extent.