多排螺旋CT肺血管成像技术显示周围型肺癌与肺血管的关系

Multi-detector spiral computed tomography pulmonary angiography in demonstrating the relationship between pulmonary vessels and peripheral lung cancer

目的采用多排螺旋CT肺血管成像技术显示周围型肺癌与肺血管的关系,并探讨其诊断价值。方法51例周围型肺癌患者行多排螺旋CT肺血管造影检查,分别采用螺旋CT多层面重建、最大密度投影等技术显示周围型肺癌与肺动脉和肺静脉的关系。将周围型肺癌引发肺动脉和肺静脉的改变分为4型,分析分型与周围型肺癌病理类型间的关系。结果1～6级肺血管均可显示,5级以上肺血管形态可清晰显示。肺鳞癌和腺癌间肺动、静脉受累及率均无统计学意义。腺癌Ⅲ型肺动脉改变所占百分比高于鳞癌(x^2=4.595,P<0.05)。腺癌和鳞癌间Ⅰ～Ⅳ型肺静脉改变所占百分比均无统计学意义,腺癌Ⅰ型+Ⅱ型肺静脉改变所占百分比高于鳞癌(x^2=7.526,P<0.05)。结论多排螺旋CT肺血管造影及后处理技术可确切显示5级以上肺血管与肿瘤间的关系,周围型肺癌与血管关系的分型有助于周围型肺癌的诊断、分期及预后,同时在一定程度上提示病理学改变。

Objective To evaluate the value of multi-detector spiral computed tomography （MDCT） in demonstrating the relationship between pulmonary vessels （pulmonary artery and vein） and peripheral lung cancer, Methods 51 patients with peripheral lung cancer were exam- ined by CT angiography of pulmonary vessels with MDCT. Using the reconstructed images of multiplanar reconstruction, maximum intensity projection and surface shaded display to demon- strate the relationship between pulmonary vessels and peripheral lung cancer. And the tumorvessel relationship was identified as four types with MDCT. The relationship between 4 types and pathologic types of peripheral lung cancer was analyzed. Results The first to sixth order vessels of pulmonary artery and vein were clearly shown in all patients by designed protocol. It showed no significant difference in the ratio of tumor involved pulmonary artery and tumor involved pul- monary vein between adenocarcinomas and squamous-cell carcinomas. Type Ⅲ in tumor involved pulmonary artery with adenocarcinomas was slightly more frequent than that with squamous-cell carcinomas （X2=4.595, p 〈0.05）. There was no significant difference between adenocarcinomas and squamous-cell carcinomas in all 4 types of tumor involved pulmonary vein. But type Ⅰ ＋ Ⅱ of tumor involved pulmonary vein in tumor with adenocarcinomas was slightly more frequent than that with squamous-cell carcinomas （X2=7.526, p 〈0.05）. Conclusion MDCT angiography can greatly improve the manifestation of the pulmonary vessels and accurately demonstrate the relationship between pulmonary vessels （fifth-order above） and peripheral lung cancer. Therefore it can reflect pathology to some extent and be very helpful for the diagnosis and prognosis by the stage divisions of peripheral lung cancer.