多层螺旋CT对孤立性肺结节与血管关系的评价

Evaluation of the relationship between solitary pulmonary nodules and vessels using multislice spiral CT

目的:研究孤立性肺结节(SPN)与血管关系及其分型,并探讨其诊断价值。方法:对75例直径≤3 mm SPN患者均行多层螺旋CT(MSCT)层厚为10mm轴扫及层厚为2.5mm螺旋靶扫描(标准算法)经工作站行多平面重建(MPR)、曲面重建(CPR)、容积再现(VR)方法,显示与SPN相关血管形态及其关系类型,并与病理结果相比较。结果:①SPN与相关血管的关系及形态特征能良好显示,CT显示SPN与血管有关系者恶性结节41例,良性结节15例;②SPN—血管关系分5型:Ⅰ型肺血管于SPN边缘被截断,一支或多支末端杵状增粗。Ⅱ型肺血管于SPN边缘被截断,末端不呈杵状增粗。Ⅲ型显示为血管切迹征。Ⅳ型肺血管延伸进入或穿过SPN。Ⅴ型血管紧贴SPN边缘走行,或受压呈弧形改变;③SPN与血管关系大部分表现为单型,也可表现为混合型。本组资料Ⅰ型19例,Ⅱ型12例,Ⅲ型15例,Ⅳ型5例,Ⅴ型7例。恶性结节多见于Ⅰ型、Ⅲ型。良性结节多见于Ⅴ型、次见于Ⅱ型。结论:采用MSCT薄层螺旋靶扫描,结合MPR、CPR、VR能准确显示SPN—血管关系及其类型,对SPN良恶性性质的诊断和鉴别有重要价值。

Objective：To investigate the relationship between solitary pulmonary nodules （SPN） and vessels and its diagnostic value, Methods： MSCT routine scans of 10 mm collimafion and continuous volume targeted scans of2.5 mm collhnafion with standard algorithm were performed and reconatructeded imaging d MPR, CPR,and VR in workstation in 75 patients d SIN with ≤3 em in diameter. The em- phasis, was paid on the manifestation of the shapes and patterns of SPIN with related vessels comtaued with the results of pathology. Results：① The SPN-veasels relationship was shown very dearly by the designed protocol. CT demonstrated the relationship between SPN and vessels in 41 malignant and 15 benign nodules; ② The SIN-vessel relationship was identified as five types with MSCT. Type I ： Vessels were obstructed abruptly by the SIN, the end d one or more vessels were drmnstick thickening, and type II ： Vessels were dis- placed, and the end was not drumstick thickening. Type m： Vascular Notch sign was demonsuuted, Type IV ： Vessels penetrated into SPN, Type V ：Yes, Is ran at the periphery d SPN with intact lumen or compressed by SPN;③ The SPN-Vessel relationship existed as single type in the most patient, and displayed with multiple pattern. In the datum, the SPN-vessel relationship refected as follow; type I, 19; typeⅡ, 12; type m,15;type IV,5;Type V,7. With respect to the nature in SPN, mallgnant nodule most conunonly showed type Ⅰ , secondly type m; Benign nodule most often showed type V, secondly type Ⅱ . Conclusion：Continuous volume targeted scan with MSCT and followed by MPR, CPR, and VR recmstmction can accurately de,mnstmte the patterns d SIN-vessel relationship. The relationship is valuable in the diagnosis d the nature in SPIN.