摘要
目的 研究孤立性肺结节 (SPN)与支气管的关系及其类型 ,并探讨其诊断价值。方法采用多层螺旋CT(MSCT) ,前瞻性对直径≤ 3 0cm的 75例SPN(其中恶性 5 1例 ,良性 2 4例 )行层厚为0 5mm的容积靶扫描 ,经工作站行多层面重建 (MPR)、曲面重建 (CPR)和表面阴影成像 (SSD)后处理重建 ,重点显示与SPN相关的支气管形态及其关系类型 ,并与手术大体标本、组织学切片对照。结果 (1)所有SPN与支气管的关CPR系均良好显示 ,CT显示SPN与支气管有关系者恶性组 4 4例(86 3% ) ,良性组 16例 (6 6 7% ) ,其差异无显著意义 (P =0 0 6 5 )。 (2 )SPN 支气管关系分 5型 ,Ⅰ型 :支气管被SPN截断 ;Ⅱ型 :支气管进入SPN ,呈锥状中断 ;Ⅲ型 :支气管在SPN内呈长段开放状 ,并可进一步分叉 ;Ⅵ型 :支气管紧贴SPN边缘走行 ,管腔形态正常 ;Ⅴ型 :支气管紧贴SPN边缘走行 ,管腔受压变扁。 (3)就SPN性质而言 ,恶性结节最常见者为Ⅰ型 ,次为Ⅳ型 ,Ⅴ型最少见 ;良性结节最常见者为Ⅴ型 ,次为Ⅰ型 ,未见到Ⅱ型。就SPN 支气管类型而言 ,Ⅰ、Ⅱ和Ⅳ型多见于恶性结节 ;Ⅴ型多为良性结节 ;Ⅲ型良性略多见。结论 采用MSCT ,超薄层靶扫描后行MPR、CPR和SSD重建能明显提高细小支气管的显示率 ,并准确地显示SPN 支气管关系 ,不同关系类型对应某?
Objective To investigate the relationship between solitary pulmonary nodule (SPN) and bronchus and its value in predicting the nature of nodule. Methods Continuous volume targeted scans of 0.5 mm collimation were prospectively performed with multislice spiral CT (MSCT) and reconstructed images of MPR, CPR, and SSD in workstation in 75 patients of SPN with ≤3 cm in diameter were acquired. The emphasis was paid on the manifestation of the shapes and patterns of SPN with related bronchi. The results were correlated with macroscopic and microscopic specimens. Results (1) The SPN-bronchus relationship was shown very clearly in all patients by the designed protocol. CT demonstrated the relations between SPN and bronchus in 44 (86.3%) malignant and 16 (66.7%) benign nodules. There was no statistically significant difference (P=0.065). (2) Five types of SPN-bronchus relationship were identified with MSCT. Type Ⅰ: bronchus was obstructed abruptly by the SPN, type Ⅱ: bronchus penetrated into SPN with tapered narrow and interruption, type Ⅲ: bronchus lumen shown within SPN was patent and intact, type Ⅳ: bronchus ran at the periphery of SPN with intact lumen, and type Ⅴ: bronchus was displaced, compressed, and narrowed by SPN. (3) With respect to the nature of SPN, malignant nodule most commonly showed type Ⅰ, secondly type Ⅳ, and rarely type Ⅴ. Benign nodule most often showed type Ⅴ, secondly type Ⅰ, and no type Ⅱ. With respect to the pattern, type Ⅰ, Ⅱ, and Ⅳ patterns were more commonly seen in malignant nodule, whereas type V pattern was seen frequently in benign nodule. Type Ⅲ pattern was slightly more common in benign cases. Conclusion Spiral targeted scan of ultra-thin section with MSCT and followed by MPR, CPR, and SSD reconstruction can greatly improve the manifestation of the bronchioles and accurately demonstrate the patterns of SPN-bronchus relationship. Varied patterns are corresponding to certain nodule and reflect definite pathologic changes.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2003年第11期992-996,共5页
Chinese Journal of Radiology
