螺旋CT血管造影判断肺癌与中央肺动静脉的关系

Use of spiral CT angiography to judge central pulmonary vascular involvement from lung cancer

目的 评价螺旋CT血管造影 (spiralCTangiography ,SCTA)判断肺门区肺癌侵犯中央肺血管的准确性及其临床价值。方法 对 33例病变在肺门区、术前诊断为肺癌的患者进行SCTA检查。分别以手术所见的 30 9支血管和病理观察的 6 9支血管为标准 ,对比 3mm间隔增强横断面CT和SCTA图像判断肿瘤与肺静脉关系的准确性。结果 (1)SCTA的几种重建法所得图像判断血管与肿瘤的关系各有优缺点。 (2 )以手术所见和病理观察为标准 ,SCTA判断血管与肿瘤关系的正确率高于横断面CT ,分别为 88 40 %、73 91%和 92 5 6 %、83 82 % (χ2 =4.90 ,χ2 =18.2 3,P <0 0 5和P <0 0 0 0 1)。

Objective To evaluate the accuracy of spiral CT angiography (SCTA) in judging central pulmonary vascular involvement from lung cancer located in the hilum and correlate the resultant images with pathologic and surgical findings. Methods SCTA was done in 33 patients who were preoperatively diagnosed as having lung carcinoma located in the hilum. Contrast medium was injected at a rate of 3 ml/sec with a power injector. The delay time was from 20 to 25 seconds. The pitch was 1 with 3 mm collimation. Images of central pulmonary arteries and veins were reconstructed with shaded surface display (SSD), maximum intensity projection (MIP), curved planar reformation (CPR), and multi planar reformation (MPR). Then the relation between tumor and vessels was assessed prospectively on both 3 mm interval axial CT and SCTA images with comparison to subsequent pathologic or surgical findings. Results (1) In showing the integrity of central pulmonary arteries and veins, images reconstructed by different ways of SCTA had different strong and weak points. (2) The grading standard in this study, with which the relation between vessels and tumor was judged, reflected the basic and common characters of central pulmonary vascular involvement by tumor located in the hilum. Compared with axial CT images, SCTA was more accurate in judging the relation between central pulmonary vessels and tumor,and the correlation of SCTA imaging features with pathologic patterns and surgical findings was better than that of axial CT images, P <0.05 and P <0.0001, respectively. Conclusion It was feasible to show the relation between central pulmonary vessel and lung cancer located in the hilum with SCTA. And the accuracy of judging the vascular involvement with SCTA was higher than that with axial CT.