多层螺旋CT及其三维重组对中央型肺癌的诊断价值

Diagnostic Value of Multi-sliced Spiral CT and 3D Reconstruction Techniques in Central Lung Cancer

目的:评价多层螺旋CT(MSCT)及其三维重组对中央型肺癌(CLC)的诊断价值。方法:58例CLC患者,经MSCT平扫,增强动、静脉期扫描,二维多平面及曲面重组(MPR及CPR),三维容积重组(VR)、最大密度投影(MIP)及仿真内窥镜重组(CTVE),同时均经支气管镜及其病理检查,44例经术后病理证实。并将各种重组诊断结果与横断面扫描结果进行统计学对比分析。结果:58例CLC MSCT三维重组、支气管镜及手术分三型:腔内结节型5例,环状狭窄型19例,偏心狭窄截断型34例。MPR及CPR、MIP、CTVE诊断结果与横断面扫描相比,差异无显著性;VR差异则有显著性。结论:MSCT三维重组能准确分型诊断CLC,评价气管、支气管树肿瘤侵犯程度与范围,具有较好的临床应用价值。

Objective：To assess the diagnostic value of multi-sliced spiral CT （MSCT） scanning and its 3D reconstruction techniques in central lung cancer （CLC）. Methods：58 cases of CLC,identified by bronchoscopy or operation, were scanned using a 16 detector-row spiral CT scanner. Non-enhanced axial scans and enhanced scans of arterial and venous phases were included. Reconstruction images acquired with 2D MPR （multiplanar reformation）,CPR （curved reformation）,3D VR （volume rendering）, MIP （maximum intensity projection） , and VE （virtual endoscopy） techniques were studied. The CT diagnoses of CLC established with the above-mentioned image reconstruction techniques were correlatively and statistically compared with the relative pathological findings. Results：On the bases of the findings from MSCT 3D reconstruction, bronchoscopy and operation,our 58 CLC cases could be morphologically classified as 3 types：intraluminal polyp type in 5 cases,circumscribed and ring-shaped lumen narrowing type in 34 cases and eccentric narrowing and truncation type in 34 cases. The diagnoses derived from MPR and CPR, MIP as well as CTVE techniques were compared with those made by conventional axial scanning,the difference was not significant,while the difference between those made by VR and axial scans respectively was significant. Conclusion： MSCT with its 3D image reconstruction techniques was capable of morphologically distinguishing the types of CLC,accurately evaluating tumor extent and the range of tumor invasion to the tracheo-bronchial tree. Therefore,clinically it was an optimal diagnostic imaging modality of choice for diagnosing CLC.