良、恶性孤立性肺结节支气管征的相关性研究

Correlative study between the nature of solitary pulmonary nodule(SPN) and bronchus sign

目的:分析孤立性肺结节的支气管征的表现形式,研究孤立性肺结节的良恶性与其支气管形态学改变的相关性,探讨其临床应用价值。方法:54例直径≤3cm的SPN患者(其中恶性结节32例,良性结节22例)行全肺层厚为10mm螺旋扫描,并对病灶进行薄层扫描。所有患者平扫的原始数据以2.5mm进行标准算法薄层重建,将数据传入GE-AW4.0工作站进行图像后处理,分别以多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、最小密度投影(MIP)及表面遮盖显示(SSD)等方法显示SPN与支气管的关系。将结果与手术病理组织对照。结果:①全肺层厚为10mm螺旋扫描,并对病灶进行薄层扫描。全肺扫描行层厚为2.5mm的标准算法薄层重建,结合各种工作站后处理方法,能极好的显示SPN与相关支气管的关系及形态特征;②54例SPN中与支气管有关系的43例(79.6%),其中恶性结节29例(90.6%),良性结节14例(63.6%)。其差异有显著性意义(P<0.05);③SPN-支气管关系分为5型:Ⅰ型支气管于SPN边缘被截断;Ⅱ型支气管进入SPN内并变尖、变细或锥状中断;Ⅲ支气管穿过SPN,其管腔通畅;Ⅳ型支气管沿SPN边缘走行而不中断,支气管壁增厚、牵拉;Ⅴ型,支气管沿SPN边缘走行而不中断,支气管壁无改变;④SPN与支气管关系大部分表现为单型,亦可表现为多型共存。恶性结节中均以Ⅰ型、Ⅱ型和Ⅲ型最常见,良性结节以Ⅰ型和Ⅲ型最常见。Ⅱ型主要见于恶性结节,不见于良性结节,其差异有显著性意义(P<0.05)。Ⅲ型表现在良性结节中明显高于恶性结节,其差异有显著性意义(P<0.05)。结论:多层螺旋CT螺旋扫描及薄层扫描合并薄层重建能清楚显示SPN与支气管关系及类型,两者关系对SPN良恶性性质的诊断和鉴别有重要价值。

Objective：To analyze the manifestation of the shapes and patterns of SPN with related bronchi.To investigate the relationship between solitary pulmonary nodule（SPN）,bronchus and the clinical diagnostic value of the relationship.Methods：MSCT routine scans of 10mm collimation and continuous volume targeted scans of 2.5 mm collimation with standard algorithm were performed and reconstructed imaging of MPR,CPR,MIP,MIN-IP and SSD in work station in 54 patients of SPN including 32 malignant and 22 benign nodules. The shape and patterns of the SPN with related bronchus were analyzed and compared with macroscopic and microscopic specimens. Results： ①The relationship between SPN and bronchus and the SPN structure feature can clearly display by MSCT continuous volume targeted scans of 2.5 mm collimation with standard algorithm with all sorts of reconstructed imaging method; ② 43 patients（79.6%） in relationship between SPN and bronchus were demonstrated by MSCT, and 29 （90.6%） malignant nodules and 22（63.6% ）, there are statistically significant difference （ P 〈 0.05） ; ③The SPN-bronchus relationship was identified as five types with MSCT. Type Ⅰ ： the patient bmnchus inter rupted by the SPN. Type Ⅱ ： bronchus penetrated into SPN with tapered narrow and interruption. Type Ⅲ ： bronchus contained within the SPN. Type Ⅳ ：bronchus compressed by the SPN withoutr interruption,but the wall of bronchus thickened, Type Ⅴ ： bronchus compressed by the SPN without interruption, and not the wall of bronchus thickening; ④ The relationship between SPN and bronchus existed as signal type in the most patients. And displayed with multiple pattern. Malignant nodules most commonly showed type Ⅰ , secondly type Ⅱ and type Ⅲ ; benign nodules most often dispiayed type Ⅰ and type Ⅲ. Secondly type Ⅱ was only showed in malignant nodules, typeⅢ was almost showed in benign nodules, there are statistically significant difference （ P 〈 0.05）. Conclusion： MSCT continuous volume targeted with standard algorithm can dearly showed the relafionship and grouping type between the SPiN and bronchus. The relationship is valuable in the diagnosis of the nature of SPN.