MSCT动态增强扫描及三维重建对中央型肺癌并支气管阻塞的诊断价值简

目的探讨多层螺旋CT动态增强扫描及三维重建对中央型肺癌并支气管阻塞的诊断价值。方法合并阻塞性肺不张的中央型肺癌患者53例，行平扫加三期动态增强扫描，分析肿瘤与并发的阻塞性肺不张的动态强化差异。对增强扫描实质期的全肺容积数据进行三维重建，分析肿块的空间影像解剖。结果平扫时肿瘤实性部分边界不清。动态增强扫描时肿瘤呈轻～中度强化，而不张的肺组织呈逐渐、持续强化。动态增强扫描各期能够分辨肿瘤与实变肺组织边界的例数分别为：肺动脉期14例，支气管动脉期48例，实质期29例，三期的差异有显著性（x^2=44．52，P〈0．01），其中支气管动脉期可判断肿瘤范围的比率最高。三维重建显示肿瘤包绕、破坏支气管壁，支气管腔狭窄及截断，断端表现为平直、杯口或锥状。26例左右肺动脉及／或其分支血管壁受侵蚀或包绕，呈向心性或偏心性狭窄甚至闭塞。结论对于中央型肺癌并发支气管阻塞者，利用多层螺旋CT动态增强扫描及三维重建，可很好地显示肿瘤的部位和大小，肿瘤阻塞支气管的情况，以及肿瘤与外周结构的解剖关系，为临床分期及治疗提供丰富的信息。

Diagnostic Value of Dynamic Enhanced MSCT Scan and Three-Dimensional Reconstruction in Central Pulmonary Carcinoma Complicating with Bronchial Obstruction

Objective To investigate the clinical application of dynamic enhanced multi-slice computed tomograghy （MSCT） scan and three-dimensional reconstruction in diagnosing central pulmonary carcinoma complicating with bronchial obstruction. Methods Fifty-three cases with central pulmonary carcinoma complicating with obstructive puhnonary atelectasis were underwent plain scan and three-phase dynamic enhanced MSCT scan, the dynamic enhanced differences between the tumor and the obstructive pulmonary atelectasis were analyzed. Three-dimentional construction was performed to the whole lung in the parenchyma-phase, and then the imaging anatolny of the tumor was analyzed. Results The margin of the tumor was ill-defined in plain scan. The tumor was slightly-moderately enhanced in three-phase dynamic enhanced scan, while puhnonaW atelectasis was gradually, continuely enhanced. The cases that showed difference between the tumor and the pulmonaW atelectasis in enhanced MSCT scan were respectively as follows, 14 m pulmonary-arterial-phase, 48 in bronchial-arterial-phase and 29 in parenchyma-phase. The difference of the 3 phases was significant （X^2=44.52, P〈0.01）. There was the highest accuracy in bronchial-arterial-phase in defining the tunlor margin. Three-dimentionat reconstruction showed the tumor encompassed and destroyed the bronchial wall. The bronchial lumen was stenosis or blocked, and its stump was flat, cup rim like or taper. Conclusion Dynamic enhanced MSCT scan and three-dimensional reconstruction are helpful in the diagnosis of central pulmonary carcinoma complicating with bronchial obstruction, especially in ascertaining the location and size of tumor, the status of bronchial obstruction, and the anatomy relationship between tumor and its neighboring strnctures, accordingly, provides more infonnation for clinical staging and treatnlent.