螺旋CT三维重建在中央型肺癌诊断中的应用价值

目的:探讨螺旋CT3D成像在中央型肺癌诊断中的应用价值。材料与方法:螺旋CT对45例中央型肺癌行多层面重建(MPR)、表面阴影显示法(SSD)重建及最大强度投影(MIP)重建。进行3D图像分析与手术、病理结果对照。结果:45例中央型肺癌,MPR与SSD示15例支气管呈刀鞘状或鼠尾状,表面凹凸不平;10例腔内堵塞,呈盲端;8例肿块压迫、破坏支气管呈弧形压迹并向对侧移位;7例腔内结节状隆起;5例支气管壁不规则增厚。MIP示肿块呈类圆形、不规则形、结节形,边缘凹凸不平、大小不等分叶及棘状突起。19例与纵隔呈钝角,广基底相连,其中6例肿块侵入纵隔血管间隙;14例与纵隔呈锐角相交;12例与纵隔分离。16例增强扫描,有9例肺动脉管壁受侵包绕。结论:螺旋CT3D成像是诊断中央型肺癌不可缺少的方法,是创伤性纤维支气管镜检查的补充方法。对中央型肺癌术前定位、分期及制定手术计划具有指导作用。

Applying Value of Spiral CT (SCT) Three-Dimentional (3D) Reconstruction in the Diagnosis of Central Pulmonary Carcinoma

Objective To study the applying value of SCT3D reconstruction imaging to the diagnosis of central lungcancer.Methods Images of 45 cases of central lung cancer were reconstructed (Multipliate,Plane Reconstruction MPR;Superfacial Shaded Display SSD;Maximum Intensity Projection MIP).Analyzed the images and combined with the surgical and pathological results.Results Among 45 cases,on MPR and SSD,bronchial luminal appeared like sheath or mouse-tail with rugged surface(15 cases);the luminal was occlusive to be blind end(10 cases);the luminal was destroyed and compressed by the mass and moved to the opposite side(8 cases);intraluminal nodular projection was seen in 7 cases;bronchial wall irregularly thickened in 5 cases,On MIP,the mass was round-like,irregular,nodular with rugged margin,lobulated and with spicalate process.Relations to the mediastinum was dull angle with wide basis(19 cases,among which invasion into the mediastinal vascnlar space was seen in 6 cases),acute angle(14 cases),apart from mediastinum(12 cases).16 cases under went enhanced CT scan,pulmonary artery wall was invaded and embedded in 9 cases.Conclusion SCT 3D imaging was a necessary method in the diagnosis of central pulmonary carcinoma,it was a complementary method to the traumatic fiberoptic bronchoscopy.It played an instructed role in the location,staging and making surgical planing before the opertion of central pulmonary carcinoma.