尸检肺脏小结节的高分辨率CT表现及其病理学基础

HRCT and pathology for nodules in cadaveric lung with coal workers' pneumoconiosis

目的评价煤工和煤工尘肺(CWP)尸检肺脏小结节影的高分辨率(HRCT)表现及其病理学基础。方法32例CWP和煤尘接触者(生前X线胸片诊断0^+期3例、Ⅰ期4例、无尘肺25例)的尸检离体肺脏采用Heitzman法固定、充气干燥制成充气固定肺标本,进行冠状位MSCT/SSCT及HRCT扫描,然后行尘肺病理诊断。32例选取13例肺标本的17片厚切片进行厚度为80～150μm的大切片制作,大切片后剩余的薄片进行5μm组织学切片。分析HRCT图像,记录结节类型并记录小结节的分布特点及其与肺小叶固有结构的关系。结果(1)尸检病理诊断:无CWP 14例,CWP 18例(Ⅰ期5例、Ⅱ期11例、Ⅲ期2例)。(2)32例离体肺标本的HRCT图像均显示有结节存在,病理检查证实29例有结节存在。(3)CWP结节的HRCT有边缘清楚的圆形结节、模糊结节及星芒状结节。HRCT所见14个边缘清楚的圆形结节,病理检查12个为典型结节;HRCT所见26个模糊状结节,病理检查14个为非典型结节、11个为尘斑及1个为典型结节;HRCT所见9个星芒状结节6个为尘斑,3个为非典型结节。(4)HRCT可显示结节位于小叶肺动脉、增厚的小叶间隔和胸膜的邻近部位及胸膜下。结论HRCT可显示煤工和CWP患者肺脏的典型结节和非典型结节及部分尘斑,还可显示结节与肺小叶结构及其与胸膜的关系。

Objective To evaluate imaging of high-resolution computed tomography （HRCT） for nodules of cadaveric lungs of coal workers＇ or coal workers with coal workers＇ pneumoconiosis （CWP） and to determine types of small nodules of CWP and dust speckle based on CT-pathologic correlation. Methods Thirty-two entire lung specimens were available from autopsy of the patients with CWP and coal workers occupationally exposed to coal dusts.They comprised 25 workers without CWP, 3 patients with 0^＋ stage and 4 patients with Ⅰ stage. Thirty-two lung specimens were inflated and fixed by Heitzman＇ s method, and underwent coronal single slice computed tomography （SSCT）/multi-slice computed tomography （MSCT） and HRCT scans.Gross specimens section （50-100 μm of slice thickness） and histological section （5-8 μm of slice thickness） were performed on seventeen pieces of lOmm-thickness slices of lung specimen in thirteen cases. The nodules were divided into round, ill defined and stellate-shaped, and their distributions and relationships with pulmonary lobule were analyzed. Results The findings were as follows （1） 14 cases without CWP and 18 cases with CWP （including 5 cases with Ⅰ stage, 11 cases with Ⅱ stage and 2 cases with Ⅲ stage） were diagnosed by pathology. （2） Nodules were displayed on HRCT in 32 cases, among which 29 cases were verified by pathology. There was no significant difference between HRCT and pathology （Χ^2=0.5,0.25〈P〈0.5）. （3） Nodules of CWP on HRCT included well-defined round nodules, ill defined nodules and stellate-shape nodules. Twelve of fourteen round nodules on HRCT were pathologically typical ones. Twenty-six ill defined nodules on HRCT included 14 atypical ones, 11 dust macules and 1 typical one by pathology. Six dust macules and 3 atypical nodules were found by pathology in nine stellate-shape nodules on HRCT. （4） HRCT accurately displayed nodular distributions, including nodules adjacent to small artery, thickened septa and subpleural regions. Conclusion HRCT could display typical, atypical nodules and some dust macules presenting pathologic changes, as well as relationship between nodules and structure of pulmonary lobule.