多层螺旋CT三维成像对周围型肺癌胸膜凹陷的观察研究

Study of three dimensional image of multi-slice spiral CT for pleural indentation of peripheral lung cancer

目的探讨周围型肺癌胸膜凹陷在多层螺旋CT三维成像(MSCT-3D)的影像学表现及临床价值。方法采用4层螺旋CT对43例周围型肺癌进行胸部薄层扫描和三维图像后处理,获得横轴位、多平面重建(MPR)、三维的容积重建(VR)以及表面重建(SSD)图像,进行肺癌胸膜凹陷3D影像学观察分析;与肺炎症病变、肺结核进行3D影像学比较。结果43例周围型肺癌39例出现胸膜凹陷征(90.6%),按三维立体形态学改变分为:①裂隙征6例;②星样征13例;③脐样征9例;④火山口征11例。MSCT-3D显示肺癌胸膜凹陷优于MPR和横轴位图像(χ2=17.09,P<0.01);肺癌病变大小与胸膜凹陷征之间无明显差异(P>0.05),病灶至胸膜的距离与胸膜凹陷的深度之间呈负相关(r=-0.753,P<0.05);胸膜的"火山口征"是肿瘤侵犯胸膜的影像学征象;肺部炎性肿块的胸膜3D影像表现为凹陷浅无皱褶,多沿叶间裂分布,结核球胸膜3D表现为"苦瓜皮"样改变。结论MSCT-3D对于周围型肺癌胸膜凹陷的显示更接近于活体状态下胸膜凹陷的病理形态,有助于肺内肿块的鉴别诊断。

Objective To investigate the image findings and clinic value of the pleural indentation （PI） of peripheral lung cancer in three dimensional image （MSCT-3D） of Multi-slice spiral CT. Methods With 4-slice spiral CT, 43 cases of peripheral lung cancer were studied by thoracic thin layer region scanning and 3D postprocessing. Procure pictures of horizontal axis, multi-plane reconstruction, volume reconstruction of 3D, and resurfacing were collected. The 3D image of the PI of lung cancer were analysed, comparing with pneumonia and tuberculosis. Results There are pleural indentation in 39 cases （90.6%）. Classified with the change of 3D stereo morphology, there are 6 cases of cranny sign, 13 cases if asteroid sign, 9 cases of bellybutton sign, llcases of crater sign. There is not obviously correlation between the size of lung cancer and pleural indentation （P 〉 0.05）. There is negative correlation between the distance of tumor to pleural and the depth of pleural indentation; the crater sign of pleural is the image sign of tumor encroachment pleural. Conclusion MSCT-3D is comparable to pathology for the disclosing of PI.