多层CT多向多平面重组引导肺内局灶性病变活检的价值

Value of multi-direction multiplanar reconstruction with multislice CT for guiding biopsy of focal pulmonary lesions

目的:前瞻性研究多层CT多平面重组(MPR)在引导肺内局限性病灶活检中的价值。方法:分别对连续的33例及31例肺内局限性病变患者行常规轴位CT扫描(非MPR)及多向MPR导向活检,比较2组的穿刺难度、操作总时间、成功活检时进针次数、并发症出现率、平均剂量-长度积(DLP)及定性诊断率。结果:2组穿刺难度与定性诊断率无差异。MPR组导向活检平均操作时间33min,非MPR组为44min(P<0.001)。活检成功时MPR组平均进针1.16次,非MPR组为1.61次(P=0.001)。MPR组仅6例(19.35%)出现少量气胸或咯血,而非MPR组15例(45.45%)出现并发症(P<0.05)。MPR组平均DLP为81.84mGy·cm,非MPR组为91.18mGy·cm(P<0.001)。结论:多层CT多向MPR导向直观显示穿刺路径、病变与周围解剖结构的关系,缩短了操作时间、减少了进针次数及术中扫描,降低了并发症发生率与辐射剂量,因此对肺内局灶性病变、尤其是肺深部肿块CT导向活检有一定价值。

Objective： To study the value of multi-direction multiplanar reconstruction（MPR） using muhislice CT for guiding biopsy of focal pulmonary lesions. Methods： Thirty-three cases and 31 cases with focal lung diseases were biopsied guided by axial CT imaging（non-MPR） and multi-direction MPR imaging successfully. The difficulty of biopsy, total time of manipulation, the times of puncture, the incidence of complications, average dose-length product（DLP） and the rate of definitive diagnosis were compared between the two groups. Results： There was no difference of biopsy diffculty and the rate of definitive diagnosis between non-MPR and MPR groups. The time consumption for MPR group was 33 minutes, and 44 minutes for non-MPR group （P〈0.001）. For successful biopsy, 1.16 times of puncture were made for MPR group, whereas 1.61 times for non-MPR group（P=0.001）. Only 6 patients（19.35%） of MPR group had a little pneumothorax or hemoptysis, but the complication incidence of non-MPR group was 45.45%（15133）（P〈0.05）. The average DLP Was 81.84mGy-era for MPR group and 91.18mGy.cm for the non-MPR group （P〈0.001）. Conclusion： With guidance of multi-direction MPR of multislice CT scan, the puncture path and the relationship between lesions and surrounding structures were manifested visually. Hence the manipulation time, the times for puncture and intraoperative scan, incidence of complications and exposure dose were reduced markedly. So multi-direction MPR is a valuable method for needle biopsy of focal pulmonary diseases, especially for deep lesions.