MSCT在判断中央型肺癌对气管、支气管及肺门血管侵犯中的价值

Application of 64-row spiral CT in the evaluation of invasion of trachea,bronchi,and hilar vessels in central type of lung cancer

目的:探讨64排螺旋CT及后处理技术在判断中央型肺癌(CLC)对气管、支气管及肺门血管侵犯中的价值。方法:75例经纤支镜或病理确诊的CLC患者行64排螺旋CT扫描,运用多平面重组、曲面重组、容积再现、最大密度投影、CT仿真内窥镜等后处理技术观察肿瘤与气管、支气管及肺门血管的关系。结果:肿瘤对气管、支气管的侵犯表现为管外压迫型38例(50.7%),CT表现为肿瘤压迫并侵犯支气管,管腔内呈不均匀狭窄;管壁浸润型(28例,37.3%)CT表现为管壁不规则增厚,呈向心性狭窄;管内增生型(9例,12.0%)CT表现为肿块突入管腔,支气管管腔呈偏心性狭窄。肿瘤共侵犯117支肺门血管,其中95支(81.2%)CT可见血管明显狭窄或闭塞;12支(10.3%)CT可见肿瘤环绕血管生长;10支(8.5%)CT可见瘤栓形成。结论:64排螺旋CT及后处理技术能准确显示气管、支气管、肺门血管的解剖结构及其与中央型肺癌肿块的空间关系,对判断中央型肺癌侵犯气管、支气管、肺门血管有重要价值。

Objective：To investigate the value of 64-row spiral computed tomography （MSCT） in the diagnosis of tra- chea,bronchi and hilar vascular invasion by central type of lung cancer （CLC）. Methods：Seventy-five cases of CLC under- went MSCT examination with post-processing techniques including multiplanar reformation （MPR）,curved planar reforma- tion （CPR）,volume rendering （VR）,minimum intensity projection （MinIP）, maximum intensity projection （MIP） and CT virtual endoscopy （CTVE~＇. The relationship of trachea, bronchi, pulmonary hilar vessels with the neoplasm was studied. Re- suits：Invasion of trachea and bronchi by CLC included extraluminal compression type （38 cases, 50.7 %）, which was showed on CT as compression and/ or invasion of bronchi led to uneven stenosis; infiltration of bronchial wall （28 cases, 37.30/oo ） showed as irregular thickening of bronchial wall and concentric luminal stenosis of bronchus;intra-luminal type （9 cases, 12.0 % ） showed as protruding of neoplasm into the lumen which led to eccentric stenosis of trachea/bronchi. Altogether 117 hilar vessels were invaded by CLC,of which, 95 （81.2 G） could be assessed on CT, showing obvious narrowing or oblitera- tion;blood vessels encircled by tumor （n= 12,10.3%）,and tumor thrombosis （n= 10,8.5~）. Conclusion：The anatomic features of trachea, bronchi, and hilar vessels and their spacial relationship with CLC could be accurately assessed on 64-row spiral CT with post-processing techniques, which provides significant information in judging whether there are trachea, bronchi,and hilar vessel invasion by CLC.