螺旋CT仿真内窥镜在中央型肺癌外科中的应用

目的　评价多层面螺旋电子计算机体层扫描仿真内窥镜 (CTVE)在中央型肺癌外科临床中的应用价值。方法　对 33例中央型肺癌患者进行了多层面螺旋 CTVE检查 ,将扫描数据重建 ,得到仿真内窥镜图象及重建的二维和三维图象。采用评分法评价横断面电子计算机体层扫描 (CT)和多层面螺旋 CTVE两种检查方法的肿瘤与肺血管关系 ,并比较其准确度、敏感度、特异度、阳性预测值和阴性预测值。　结果　 33例患者多层面螺旋 CTVE可清晰地显示肺动、静脉主干及 90 %以上的一级分支 ,其中血管腔狭窄 4 8处、闭塞 5处。多层面螺旋 CTVE判断血管与肿瘤关系的准确度高于横断面 CT(P<0 .0 5 ) ,预测肺血管不能处理的敏感度和阳性预测值也高于横断面 CT(P<0 .0 1)。结论　多层面螺旋 CTVE判断中央型肺癌肺血管受侵是可行的 ,优于横断面 CT,但不能明确显示或区分肿瘤管壁浸润和外压性狭窄。

The evaluation of spiral computed tomography virtual endoscopy for central lung cancer

Objective To evaluate the clinical application value of multislice spiral computed tomography virtual endoscopy (CTVE) for central lung cancer. Methods Multislice spiral CTVE was done in 33 patients with central lung cancer. Images of pulmonary arteries and veins that might affect lobectomy or pneumonectomy were reconstructed by means of imaging processing techniques. The relation between tumor and vessels were assessed prospectively on both axial computed tomography (CT) and CTVE in comparison with subsequent pathologic and surgical findings. Results CTVE could reveal 100% stem of pulmonary arteries and veins, and 90% segmental branches. Narrowing (48 vessels) or occluding (5 vessels) of the lumen looked like the surgical or pathological findings. Compared with axial CT images, CTVE was more accurate in judging the relation of central pulmonary vessels and tumor in comparison with subsequent pathologic and surgical findings(P<0.05), the sensitivity and positive predictive values of undissectability of the vessels were all remarkably higher(P<0.01). Conclusion CTVE is a noninvasive method of observing vascular lumen with unique advantages. It can be used to predict vascular involvement from central lung cancer and to plan the surgery. But it could not distinguish the vascular wall thickening by tumor infiltration or extravascular compression.