多层螺旋CT血管成像对中央型肺癌侵犯肺门、纵隔血管的评价

Evaluation of invasion of hilar and mediastinal vessels in central lung cancer using MSCT angiography

目的 :探讨多层螺旋CT血管成像诊断中央型肺癌 (CLC)肺门及纵隔血管侵犯的准确度 ,并评价横断面图像及其 4种后处理技术的诊断价值。方法 :对 2 0例临床确诊及 2 1例疑诊的CLC患者行MSCT血管成像 ,并利用多平面重组(MPR)、最大密度投影 (MIP)、表面遮盖显示 (SSD)、容积再现 (VR)技术对肺门、纵隔血管及肿瘤进行图像后处理。根据横断面图像和不同的重组图像分别评价CLC对肺门、纵隔血管侵犯的程度。其中 12例行手术患者 ,以术中观察结果为参照标准。结果 :3 8例CLC中 ,血管未侵及 5例 ,Ⅰ～Ⅲ级分别为 8、12和 13例 ;12例有术中观察结果者 ,横断面CT判断肺门、纵隔血管侵犯的符合率为 83 .3 % ,MSCTA的符合率为 10 0 % ,两组间经 χ2 检验 ,χ2 =7.15 ,P <0 .0 1。结论 :MSCTA能比较准确地显示CLC肺门、纵隔血管侵犯的程度与范围 ;MPR为首选应用的技术 ,SSD对显示肿瘤与受累血管的三维空间关系有补充作用。

Objective:To explore the accuracy of multislice computed tomography angiography (MSCTA) for evaluation of hilar and mediastinal vascular invasion of central lung cancer (CLC),and to assess the value of axial images and four postprocessing techniques in depicting hilar and mediastinal vascular invasion of CLC.Methods:41 cases of CLC,including 20 proven and 20 suspected cases,were performed MSCTA and postprocessed using four techniques,including multiplanar reformation (MPR),maximum intensity projection (MIP),shaded surface display (SSD),and volume rendering technique (VRT).The extent of hilar and mediastinal vascular invasion was assessed on the axial images and postprocessing images,respectively.Operation findings were documented and regarded as gold standard in 12 cases.Results:From 38 cases of CLC,5 cases were absent of hilar and mediastinal invasion;Ⅰ～Ⅲ grade were in 8,12,13 cases,respectively.In 12 cases underwent operation,the accuracy of MSCT axial images was 83.3% for evaluation of hilar and mediastinal vascular invasion of CLC,while that of MSCTA was 100% (χ 2 test,χ 2=7.15,P<0.01). Conclusion:MSCTA has a high accuracy in displaying the extent of hilar and mediastinal vascular invasion of CLC;MPR is the mode of first choice,and SSD can provide complementary informations about the three-dimentional relationship between the tumor and adjacent vessels.