MSCT血管成像对肺隔离症的诊断价值

目的探讨多层螺旋CT三维血管成像在肺隔离症诊断中的应用价值。方法收集经手术及病理证实的9例肺隔离症患者的资料进行回顾性分析。所有检查采用GE公司的64排螺旋CT扫描机,先行CT平扫,再行双期增强扫描,将图像传输至工作站,进行MPR、MIP、SSD及VR重建。结果 9例肺隔离症均位于下叶后基底段,其中7例位于左下肺,2例位于右下肺。异常供血动脉8例来自于胸主动脉,1例来自于腹腔干。CT平扫主要表现为肺内囊肿、结节或肿块,局部可伴肺气肿征。增强扫描病变区血管影增多、增粗,呈条状或结节状血管强化影。CT血管成像显示病变由异常体动脉供血。采用MPR和MIP可显示供血动脉整体形态及肺实质的病灶。SSD及VR能显示供血动脉的起源与行程及引流静脉。结论多层螺旋CT增强及三维重建可以清晰显示肺部病变及异常供血和引流血管情况,是诊断肺隔离症最理想非创性检查方法。     

三维动态增强磁共振血管造影诊断肺隔离症的价值

目的：评估三维动态增强磁共振血管造影（3D DCE MRA）对显示肺隔离症异常血管的价值。方法：5例肺隔离症患者作了胸部正侧芯片，CT和MRI检查后，均行胸部和上腹部3D DCE MRA检查，并进行最大信号强度投影（MIP）和多平面重建（MPR）。结果：5例肺隔离症均为肺叶内型，位于左肺下叶。胸片表现隔离的肺组织均位于左下叶，呈圆形或椭圆形，密度较均匀的团块影。CT示降主动脉后方软组织密度肿块，2例肿块周围伴有肺气肿。增强CT显示2例供血动脉。平扫MRI示隔离肺组织在T1WI和T2WI较正常肺组织信号高的软组织块影，并显示3例供血动脉，但未能显示其作貌，行程，分支及引流静脉。另2例异常供血动脉未能显示，而3D工DCE MRA均显示了其异常供血动脉和引流静脉，并清楚显示了其分支和行程，与术中所见完全一致。结论：3D DCE MRA较能较好地显示肺隔离症的异常供血动脉和引流静脉，有利于确诊此病和制订手术治疗方案。     

多层螺旋CT三维血管成像对肺隔离症诊断的价值

目的:探讨多层螺旋CT三维血管成像在肺隔离症诊断中的应用价值.方法:收集经手术及病理证实的9例肺隔离症患者的资料进行回顾性分析.所有检查采用GE lightspeed 16层CT扫描机,先行CT平扫,再行双期增强扫描,将图像传输至工作站,进行MPR、MIP、SSD及VR重建.结果:9例肺隔离症均位于下叶后基底段,其中8例位于左下肺,1例位于右下肺.异常供血动脉7例来自于胸降主动脉,2例来自于腹主动脉上段.CT平扫主要表现为肺内囊肿、结节或肿块,局部可伴肺气肿征.增强扫描病变区血管影增多、增粗,呈条状或结节状血管强化影.CT血管成像显示病变由异常体动脉供血.采用MPR和MIP可显示供血动脉整体形态及肺实质的病灶.SSD及VR能显示供血动脉的起源与行程及引流静脉.结论:多层螺旋CT增强及三维重建是诊断肺隔离症最理想非创性检查方法.     

多层螺旋CT血管造影诊断肺隔离症的价值

目的评价螺旋CT血管造影诊断肺隔离症的价值。方法对6例经手术和病理证实、影像资料完整的肺隔离症病例进行回顾性分析。全部病例使用多层螺旋CT胸部平扫、增强扫描及病灶多平面重建(MPR)、曲面重建(CPR)、最大密度投影(MIP)。结果6例中,病变位于左下肺后基底段4例,右下肺后基底段2例。呈囊性病灶1例,实性病灶3例,囊实性病灶1例,多结节融合肿块影1例。增强CT扫描及多种重建后处理图像可显示病灶强化特点、异常供血动脉、引流静脉及其与病变结构的关系。结论螺旋CT三维重建血管成像能很好地显示肺隔离症的病变特征。     

螺旋CT三维重建在肺隔离症诊断中的应用

目的 评价螺旋CT三维重建在肺隔离症诊断中的作用。方法 对10例肺隔离症进行回顾性分析。2例行肺血管造影、2例手术、6例CT血管成像显示病变由异常体动脉供血。所有检查采用Philips Tomoscan SR 7000或GE LighhtSpeed Plus多层面CT扫描机，将图像传输至工作站进行三维重建。图像经2位(或2位以上)放射科医师阅片分析。结果 10例肺隔离症病灶1例位于右下叶，9例位于左下叶，异常体动脉供血8例来自胸主动脉，2例来自腹腔干。CT平扫表现为斑片状阴影4例，肺门肿块并邻近肺血管影增多迂曲3例，肺气肿区内条状高密度影2例，多囊融合肿块影1例。10例增强扫描有9例显示异常体动脉供血，其平均直径9．7mm，7例显示引流静脉。采用最大密度投影及曲面重建可显示异常体动脉、引流静脉及其与病变结构的关系，表面阴影成像及容积重现可显示异常血管。结论 螺旋CT增强扫描三维重建可显示异常供血动脉及引流静脉，是诊断肺隔离症的首选检查方法。     

MSCT在肺隔离症诊断中的应用

目的:探讨MSCT对肺隔离症(pulmonary sequestration,PS)的诊断价值。方法:收集经病理证实的PS患者15例,分析患者胸部CT图像。结果:左肺下叶12例,右肺下叶3例;囊实性肿块10例,囊性肿块3例,表现为实性结节影1例,局部肺野增粗、紊乱血管结构1例;出现感染9例,代偿性肺气肿6例,同侧胸腔积液4例;15例均可找到异常体循环供血血管,其中胸主动脉分支供血12例,肠系膜上动脉分支供血2例,腹腔干分支供血1例,引流静脉均为同侧下肺静脉。结论:MSCT可显示病变本身及周围组织关系,多种后处理技术清晰显示异常供血动脉及引流静脉情况,是PS首选检查方法。     

24例镰刀综合征心血管造影征象分析

笔者分析了２４例镰刀综合征心肺血管病变的造影征象及其病理生理意义，并与手术（１４例）和尸解（４例）资料对照。２４例心血管造影示全部或部分右肺静脉异常引流，分别为１７例和７例。异常引流静脉近端局限性狭窄９例，其中２例异常和正常引流静脉间有侧支吻合，右下肺异常体动脉侧支供血１８例。并存各种心脏病变者１８例，马蹄肺６例，右下肺肺隔离症３例，下腔静脉闭锁和狭窄分别为２和１例。右下肺异常体动脉侧支和心脏病变是患者严重症状和肺动脉高压的主要因素。除肺隔离症外，经导管栓塞异常体动脉侧支可使用者明显受益。异常引流静脉狭窄具有限制血液分流的作用。     

MSCT血管成像在肺隔离症诊断中的价值评估

目的：探讨MSCT血管成像在肺隔离症诊断中的应用价值。方法：经临床手术及病理证实的肺隔离症患者23例,均行X线平片、MSCT平扫及CTA检查,结合图像后处理技术（MPR、MIP、VR）,分析本病在MSCT检查中的特征性影像学表现。结果：肺隔离症位于左肺下叶16例,右肺下叶7例。表现为肺野内实性肿块者11例;囊性病灶者8例,其中1例为单囊;表现为团片状病灶者3例;表现为单纯主动脉分支与下肺静脉吻合1例。23例隔离肺的供血动脉均发自体动脉,其中19例发自胸主动脉,4例发自腹主动脉。结论：MSCTA各种后处理技术的有机结合可准确、直观地显示隔离肺组织的供血动脉,MSCTA可以作为目前诊断肺隔离症的首选检查方法。     

多层螺旋CT在肺隔离症诊断中的应用

目的 探讨多层螺旋CT在肺隔离症诊断中的应用.方法 收集经手术及病理证实的32例肺隔离症患者的资料进行回顾性分析,所有检查采用GE Brightspeed 16层螺旋CT扫描机,先行CT平扫,再行双期增强扫描,将图像传输至工作站,进行MPR、MIP、SSD及VR重建.结果 32例肺隔离症均位于下叶后基底段,其中27例位于左下肺,5例位于右下肺.异常供血动脉16例来自胸主动脉,7例来自腹主动脉,3例系膈肌动脉供血,4例为肋间动脉供血,2例为脾动脉供血.CT平扫主要表现为肺内囊肿、结节或肿块,增强扫描病变区血管影增多增粗,呈条状或结节状血管强化影.结论 多层螺旋CT增强及三维重建是诊断肺隔离症最理想的无创性检查方法.     

双源CT重建技术在肺隔离症中的应用价值

目的探讨双源CT在肺隔离症诊断中的应用价值。方法收集经手术及病理证实的12例肺隔离症患者的资料进行回顾性分析,所有检查采用西门子双源CT扫描机,行CT平扫及双期增强扫描,行多平面重建（MPR）、最大密度投影（MIP）及容积漫游技术（VRT）重建。结果1例病灶为肺叶外型。11例为肺叶内型,其中5例位于右下肺,6例位于左下肺。异常供血动脉8例来自胸主动脉,4例来自腹主动脉。CT平扫主要表现为肺内囊肿、囊实性肿块和实性肿块,增强扫描病变区血管影增多增粗,呈条状或结节状血管强化影与体循环相连。结论双源CT增强及重建技术诊断肺隔离症具有较高的应用价值。     

Pulmonary sequestration in the adult. Diagnostic contribution of angiography

PURPOSE: The diagnosis of pulmonary sequestration is based on demonstration of mal-developed lung tissue, feeding on abnormal systemic level. We investigate the role of angiography in the diagnosis of pulmonary sequestration in adult patients. MATERIAL AND METHODS: 1987 to 1998 we examined 9 patients with suspected pulmonary sequestration who were subsequently submitted to surgery. The patients were 3 women and men; 6 of them were symptomatic and 3 asymptomatic. Six patients were examined with CT of chest and upper abdomen, thoracoabdominal aortography and selective arteriography of the abnormal vessel; one patient also submitted to left angiopneumography. One patient underwent bronchography and another one MRI. RESULTS: An unquestionable diagnosis was made in 8 cases, namely 6 of intralobar and 2 of extralobar sequestration, and confirmed surgically. The only questionable case was diagnosed at histology as extralobar pulmonary sequestration atypically fed by thin branches from the left diaphragmatic artery. CONCLUSIONS: Angiography demonstrated the abnormal arterial feeding typical of pulmonary sequestration in all cases but one. The evidence of venous drainage was the key sign to diagnose extra-versus intralobar sequestration. Therefore we conclude that angiography remains an essential tool in the diagnosis of pulmonary sequestration, notwithstanding the great potentials of Helical CT of MR angiography.     

肺隔离症的多层螺旋CT诊断

目的：探讨肺隔离症的多层螺旋CT（MSCT）征象,以提高对该疾病的认识及临床诊断。方法回顾性分析经手术及病理证实的肺隔离症患者13例,包括临床表现,多层螺旋CT扫描资料,并复习文献;所有患者均行胸部平扫及双期增强容积扫描。结果13例肺隔离症患者中,12例为叶内型,1例为叶外型。12例叶内型均位于肺下叶内后基底段,9例位于左下肺,3例位于右下肺;1例叶外型位于左膈与下叶之间。13例中1例为增多增粗的异常血管结构,4例为实质性肿块,5例为囊实性肿块,3例为囊性肿块。6例病灶周围可见局限性肺气肿,4例病灶周围见渗出性阴影。13例隔离肺的供血动脉均发自体动脉。结论肺隔离症CT征象典型,容积扫描能对其作出准确诊断,并能为外科手术治疗提供重要参考,多层螺旋CT可以作为诊断肺隔离症的首选方法。     

多层螺旋CT及三维重组技术对肺隔离症的诊断价值

目的:探讨螺旋CT三维血管成像(3D SCTA)对显示肺隔离症异常血管的价值.方法:回顾性分析15例经手术和病理证实的肺隔离症患者的胸部CT平扫、增强及病灶区最大密度投影(MIP)和多平面重组(MPR)的影像资料.结果:12例为肺叶内型,3例为肺叶外型;10例位于左下肺,5例位于右下肺;增强CT显示13例有异常供血动脉自胸主动脉进入两下肺病灶;MIP或MPR显示了经手术证实的16条异常供血动脉中的15条,并清楚显示了其分支和行程,与术中所见基本一致.结论:螺旋CT血管成像(SCTA)及其重组技术能很好地显示肺隔离症的异常血管,对肺隔离症的诊断具有重要的临床应用价值,可以取代血管造影.     

螺旋CT在叶内型肺隔离症诊断中的价值

目的 探讨螺旋CT在叶内型肺隔离症诊断中对异常供血动脉显示的作用和方法。方法 将14例肺隔离症患者的螺旋CT扫描方案分为2组，第1组8例，单层螺旋扫描；层厚3mm，床进4.5mm/s，重建间隔1.5mm者5例，多层螺旋扫描；实际层厚2.5mm，有效层厚3.2mm者3例。对比剂流率2.5ml/s；启动智能扫描探测到腹主动脉上段强化最佳时开始扫描，扫描资料交工作站行三维图像后处理。第2组6例为单层螺旋扫描，其中5例扫描层厚5mm，床进5mm/s；1例扫描层厚10mm，床进10mm/s。结果 病灶位于右下肺2例，左下肺12例，表现肿块者11例，边缘清楚的结节者3例。14例均见异常供血动脉，发自腹主动脉11例，胸主动脉2例，脾动脉1例；其中多层螺旋CT三维图像后处理显示异常供血动脉最佳。上述异常供血动脉均经外科手术证实。引流静脉均未显示。结论 在肺隔离症定性诊断中，多层螺旋CT横断面结合三维图像后处理利于显示异常供血动脉，有可能替代传统的血管造影。     

Surgical treatment of lung sequestration

BACKGROUND/AIM: Pulmonary sequestration is a congenital malformation which consists of afunctional part of the lung, separated of the normal airway, and vascularisated with anomal systemic artery instead of pulmonary artery. There are two kinds of sequestration. Intralobar is surrounded with normal lung and its pleura, and extralobar which has extrapulmonary position and pleura of its own. This anomaly is very rare and appears in 1.1-1.8% of all congenital lung malformations. The illness is revealed either in early childhood whith other life-threatening anomalies or in adulthood and middle age when secondary infection arises. The aim of this paper was to show our own experience in surgical treatment of pulmonary sequestration and to emphasize sequestration as a real differential-diagnostic possibility with patients with recidive bronchopneumonias. METHODS: We retrospectively analyzed medical records for the period from 1967-2007 and found 15 patients with pulmonary sequestration at the average age of 30 years. We pointed out the well known problems with identification of this anomaly, preoperative diagnostic procedures and surgical possibilities of treatment. RESULTS: There were 13 patients with intralobar and two patients with extralobar sequestration. By the use of preoperative angiography, seven patients were found to have intralobar pulmonary sequestration. All intralobar sequestrations were clinically manifested, the most often with recidive bronchopneumonia. Six patients had no preoperative diagnosis of lung sequestration. The most common locality of intralobar sequestration was the left lower lobe (eight patients). We performed nine lobectomies, three sequestrectomies, two segmentectomies and one pneumonectomy. Both extralobar sequestrations were diagnosed intraoperatively. CONCLUSION: Pulmonary sequestration is a rare malformation. Diagnosis is established by angiography. Treatment is exclusively surgical. In the last three years we have had one patient per year. This experience obliges to consider pulmonary sequestration as a real differn tial diagnostic possibility in patients with localised repeated bronchopneumonias.     

64层螺旋CT双期血管成像在肺隔离症术前评估中的应用

目的：探讨64层螺旋CT双期血管成像在肺隔离症术前评估中的应用价值。方法：12例肺隔离症患者均行双期CT血管成像（cTA）,将原始扫描数据行容积再现（VR）、最大密度投影（MIP）、薄层最大密度投影（TSMIP）重建,观察血管情况及肿块与供血动脉的关系。结果：12例肺隔离症患者11例为叶内型,1例为叶外型。左肺下叶后基底段9例,右肺下叶后基底段3例。囊性肿块6例,囊实质性肿块4例,实质性肿块2例。12例患者共发现12支供血动脉,分别发自胸主动脉（9支）、腹主动脉上段（2支）、腹腔干（1支）,静脉引流均为肺静脉。CTA可清楚显示肺隔离症肿块形态、血管及周围组织的关系。结论：双期CTA扫描结合不同后处理成像方式为肺隔离症术前评估提供了重要的资料,可在临床推广应用。     

Congenital anomalies of the lungs in adults: MR diagnosis

Over an 18-month period, 11 adults with congenital pulmonary anomalies within the sequestration spectrum, identified either surgically or radiographically by CT and/or angiography, were evaluated with MR. These included seven patients with bronchogenic cysts, two with intralobar pulmonary sequestrations, one with scimitar syndrome, and one with bronchial atresia. In each case, MR showed at least some findings indicative of the correct diagnosis. MR proved especially effective in the detection of abnormal fluid collections (nine cases) and the identification of anomalous vessels (three cases). Fluid collections were easily identified in all cases, including four cases with high-density collections on CT (two with bronchogenic cysts and two with intralobar pulmonary sequestration), especially when single-level, multiecho T2-weighted sequences were obtained. Calculated T2 values ranged from 78 to 439 msec (average, 223 +/- 123 msec). Although T2 values were statistically significant for differentiating fluid from muscle (p = .0012) and fat (p = .0046), they were not sufficiently specific to allow precise fluid characterization. Significant limitations were also apparent, such as an inability to detect alterations in the parenchymal architecture of the lungs (three cases) or intrapulmonary vascularity (one case). Despite this, we conclude that MR may be of considerable value in the assessment of congenital pulmonary anomalies and in select cases obviate more invasive diagnostic procedures.     

Intralobar pulmonary sequestration: Value of aortography and pulmonary arteriography

Twelve patients with plain roentgenographic findings of intralobar pulmonary sequenstration were evaluated with aortography and, in most instances, pulmonary arteriography. Correlative criteria from aortography and pulmonary arteriography permit a precise diagnosis to be made. Pulmonary infections must be differentiated from intralobar pulmonary sequestration because treatment for the latter should be surgical.