孤立性肺结节与支气管关系的多排螺旋CT和病理对照研究

The comparative study of multi-row spiral CT in the relationship between solitary pulmonary nodule(SPN) and bronchus with the pathological examination

目的:研究孤立性肺结节(SPN)与支气管的关系、分型及病理基础。探讨其临床诊断价值。方法:65例直径≤3CM的SPN患者(其中恶性结节43例,良性结节22例),均行多排螺旋CT(MSCT)层厚为10mm轴扫及层厚为2.5mm螺旋靶扫描(骨算法)。经工作站多平面重组(MPR)曲面重组(CPR)最大密度投影(MIP)最小密度投影(MIN-IP)。表面遮盖显示(SSD)方法,显示SPN与支气管的关系及其类型。将结果与手术病理组织对照。结果:①MSCT行层厚为2.5mm的螺旋靶扫描(骨算法)结合各种工作站后处理方法,能极好的显示SPN与相关支气管的关系及形态特征;②65例SPN中与支气管有关系的39例(60.0%),其中恶性结节30例(69.8%),良性结节9例(40.9%)。其差异有显著性意义(P<0.05);③SPN-支气管关系分为4型:Ⅰ型支气管于SPN边缘被截断。Ⅱ型支气管到达SPN时变尖、变细或锥状中断。Ⅲ型支气管穿过SPN,其管腔通畅。Ⅳ型支气管沿SPN边缘走行而不中断;④SPN与支气管关系大部分表现为单型,亦可表现为多型共存。本文中Ⅰ型21例,Ⅱ型13例,Ⅲ型7例,Ⅳ型6例。恶性结节多见于Ⅰ型,Ⅱ型,Ⅳ型。良性结节多见于Ⅲ型和Ⅰ型。结论:多层螺旋CT薄层靶螺旋扫描(骨算法)能清楚显示SPN与支气管关系及类型,两者关系对SPN良恶性性质的诊断和鉴别有重要价值。

Objective：To explore the pathological basic and the clinical diagnostic value of the relationship in solitary pulmonary nodule and bronchus.Methods： MSCT routine scans of 10mm collimation and continuous vohune targeted scans of 2.5mm collimation with bone algorithin were performed and reconstructed imaging of MPR, CPR,MIP, MIN-IP and SSD in workstation in 65 patients of SPN with ≤ 3mm in diameter（ including 43 malignant and 22 begnign nodules）. The shape and patterns of the SPN with related bronchus were analyzed and compared with macroscopic and microscopic specimens. Results： ① The relationship between SPN and bronchus and the SPN structure feature can clearly display by MSCT continuous volume targeted scans of 2.5mm collimation with bone algorithm with all sorts of reconstructed imaging method;②39 patients（60.0%）in relationship between SPN and bronchus were demonstrated by MSCT, and 30 （69.8 % ）malignant nodules and 9（ 40.9% ）, there are statistically significant difference（ P 〈 0.05 ）; ③The SPN-bronchus relationship was identified as four types with MSCT. Type Ⅰ ： the patient bronchus interruperd by the SPN. Type Ⅱ bronchus penetrated into SPN with tapered narrow and interruption. Type Ⅲ bronchus contained within the SPN. TypeⅥ bronchus compressed by the SPN but not interruption. Bronchus lumen be intact or narrowed;④ The relationship between SPN and bronchus existed as signal type in the most patient. And displayed with muhple pattern. In the experiment, SPN-bronchus relationship reflected as follow： type Ⅰ , 21; type Ⅱ , 13; typeⅢ, 7; typeⅣ, 6, with respected to the nature of SPN, malignant nodules most commonly showed type Ⅰ , secondly typeⅡ and typeⅣ ; benign nodules most often dispiayed type Ⅲ, secondly type Ⅰ . Condusion： MSCT continuous volume targeted with bone algorithm, can clearly showed the relationship and grouping type between the SPN and bronchus. The relationship is valuable in the diagnosis of the nature of SPN.