中央型肺癌与肺动脉、上腔静脉及支气管关系的多层螺旋CT表现

The relationship between the central lung cancer and pulmonary artery、superior vena cava、bronchi:a multislice helical CT observation

目的利用多层螺旋CT(MSCT)后处理技术,显示中央型肺癌与肺动脉、上腔静脉、支气管的关系。方法分析2008年1月～2009年12月35例经查痰及纤维支气管镜检查病理证实的35例中央型肺癌。经CT平扫加增强扫描后运用多平面重建技术(MPR)、最大密度投影(MIP)、容积再现(VR)技术及CT仿真内窥镜等后处理方法观察肿瘤与肺动脉、上腔静脉及支气管的关系。结果 (1)支气管表现分型:Ⅰ型(1/35)管腔内新生物;Ⅱ型(31/35)沿支气管壁浸润性生长,使支气管壁不同程度的不均匀性增厚,局部管腔狭窄或鼠尾样狭窄;Ⅲ型肿瘤环绕支气管生长,支气管壁光滑无狭窄(3/35)。(2)肺动脉、上腔静脉Ⅲ受侵分型:Ⅰ型直接侵犯肺动脉主干的管壁形成局部充盈缺损并不同程度的压迫肺动脉(25/35);Ⅱ型肿瘤包绕肺动脉生长,肺动脉管壁光滑无充盈缺损(3/35)。Ⅲ型直接侵犯上腔静脉形成瘤栓(5/35)。结论 MSCT后处理技术可较好地显示中央型肺癌与肺动脉、上腔静脉及支气管关系。结合临床病史,认真把握MSCT特点对良恶性病变的鉴别诊断,特别是中央型肺癌的诊断及肿块区肺血管的侵犯情况有极其重要的临床价值。

Objective To investigate the relationship between the central lung cancer and pulmonary artery、superior vena cava、bronchi by multi-slice CT（MSCT）.Methods Thirty-five patients with central lung cancer confirmed pathologically were reconstructed by MSCT multiplanar reformation（MPR）,maximum intensity projection （MIP）,volume rendering（VR）and CT virtual endoscopy （CTVE） techniques to demonstrate the relationship between the centre lung cancer and pulmonary artery、superior vena cava、bronchi.Results （1） Tumor-bronchi relationship： type Ⅰ（1/35）： neoplasm inside the lumens.Type Ⅱ（31/35）： the malignancy originated in a bronchi,bronchi wall thickened irregularly.Type Ⅲ（3/35）： the tumor encircle bronchi,while the bronchi wall were smooth.（2） Tumor-PA（pulmonary artery） and superior vena cava relationship： Type Ⅲ（25例,71.43%）invasion PA,Type Ⅱ（3例,8.57%）the tumor encircle PA .Type 3 （5例,14.29%）invasion superior vena cava immediate.Conclusions MSCT can demonstrate the relations between the central lung cancer and bronchi,pulmonary artery or superior vena cava.It is useful for the differential diagnosis evaluation of the lung cancer with clinic disease.16-slice CTA has great value in demonstration of supplying artery of tumour and evaluating invasion of pul-monary vessels in lung cancer.