多层面螺旋CT图像重建判断中心型肺癌可切除性的研究与病理、手术相关性分析

Reconstruction of Images from the Multislice Spiral CT for Judging the Resectability of Central Lung Cancer

目的:利用多层面螺旋CT(MSCT)图像重建技术,判断中心型肺癌是否侵犯肺中央血管及其可切除性。方法:对48例病变在肺门区的中心型肺癌的患者术前进行MSCT扫描,拟行肺叶或全肺切除有关的肺动静脉进行图像重建,对照手术所见和病理结果,分析肿瘤与肺血管的关系、血管能否分离等方面,对比常规CT图像和CT+重建图像二者之间判断的准确率。结果:48例中42例进行了开胸探查、肺叶或全肺切除术。CT+重建图像判断血管与肿瘤关系的准确率高于单一CT。对照术中所见(186根血管)和病理观察(78根血管),二者的准确率有统计学差异(0.01<P<0.05)。以手术对血管的实际处理结果为标准,CT+图像重建对预测血管不能处理的灵敏度及阳性预测值明显高于后者(P<0.01)。结论:多层面螺旋CT图像重建的方法可以提高对中心型肺癌血管受侵的认识,对外科医生预测其可切除性及制定手术方案有一定的帮助。

Objective： To assess the accuracy of multi-slice spiral CT （MSCT） plus imaging reconstruction in judging central pulmonary vascular involvement from central lung cancer and to explore its ability in foreseeing the resectability of lung cancer. Methods： MSCT was clone in 48 patients with central lung cancer diagnosed preoperatively. Images of pulmonary arteries and veins that might affect lobectomy or pneumonectomy were reconstructed by means of image processing techniques. Then the relation of tumor and vessels was assessed prospectively on both axial CT images and axial CT images plus reconstructed images （CT-RI） in comparison with Results： MSCTs were obtained of all 48 patients, and 42 monectomy. Compared with axial CT images, CT-RI was subsequent pathologic and surgical findings. underwent thoracotomy, lobectomy or pneumore accurate in judging the relationship between the central pulmonary vessels and the tumor, based on subsequent pathologic （78 vessels studied） and surgical findings （186 vessels studied） （0.01〈P〈0.05）. The sensitivity and positive predictive value of unresectability of the vessels were all remarkably higher （P〈0.01）. Conclusions： MSCT plus image reconstruction can improve the recognition of neoplastic invasion of central pulmonary vessels. It can be used to foresee preoperatively the resectability of central lung cancer and to plan the surgical procedure.