中央型肺癌MRI检查及征象分析

MR imaging and manifestation analysis of central bronchial carcinoma

目的：分析晚期中央型肺癌的瘤体特征及邻近结构侵犯情况,为中央型肺癌^125I放射性粒子植入术前影像学评估及靶区定位创造条件.方法：随机选择近5年来接受^125I放射性粒子植入手术治疗的中央型肺癌44例,行胸部MRI检查.基于中央型肺癌^125I放射性粒子植入手术方案选择、肿瘤靶区定位以及规避手术穿刺风险等临床需要,对中央型肺癌瘤体信号、瘤体并发症、支气管异常、纵隔淋巴结转移、纵隔瘤体蔓延、心脏大血管侵犯,以及胸膜胸壁受累等MRI异常表现进行归纳和分析.结果：瘤体多呈类圆形或不规则形,以T1WI等信号,T2WI等高信号为主,部分出现出血及或液化坏死改变;邻近纵隔和胸壁受累;阻塞性肺不张及血管内瘤栓形成.结论：MRI是评价中央型肺癌纵隔侵犯的最佳影像学方法,它能够准确显示瘤体特征及邻近结构侵犯情况,为^125I粒子植入治疗晚期中央型肺癌的术前影像学评估及肿瘤靶区定位创造条件.

Objective.. To analyse the character of the mass and adjacent involved areas of the central bronchial carcinoma for the imaging evaluation and target orientation in the therapy with interstitial implantation of ^125 Ⅰ seeds for central bronchial carcino- ma before operation. Methods.. Forty-four cases of central bronchial carcinoma were randomly selected, which were treated with the particle ^125 I therapy. All cases were examined by MRI. On the basis of the clinical requirment to determine the implantation plan, orientation of the mass target, as well as the avoidance of the puncture risk, to summarize and analyse the mass signal, mass complications, bronchus abnormal features, metastasis of the hilar and mediastinal lymph nodes, mediastinal invasion, cardiac and vascular invasion, as well as chest wall involved. Results： Most of them showed oval or irregular shape, equal signal on T1WI, equal or high signal on T2WI. Some of them, blood and necrosis in tumor could be found. Adjacent structures could be involved. Obstructive atelectasis and intravascular enbolism could also be found. Conclusion： MRI is the best tool for the evaluation of the involved features in the central bronchial carcinoma, and is the basis for the imaging evaluation and target orientation in the therapy with interstitial implantation of ^125I seeds for central bronchial carcinoma before operation.