多层螺旋CT分析周围型肺癌形态学特征—MPR正交重组切面结合MIP

Analysis of Morphological Features of Peripheral Pulmonary Carcinoma in MSCT-orthogonal Planar Reconstruction Combing MIP

【目的】分析多层螺旋CT后处理图像(MPR正交重组切面结合MIP)对周围型肺癌形态学特征的显示价值。【方法】回顾性纳入75例(男:女=36:39;平均年龄:60.0岁)术前行64排CT检查并经手术病理证实为周围型肺癌的孤立性肺结节。记录结节形态学特征(边缘,分叶征、血管集束征、胸膜凹陷征、毛刺征)分别在横断位,冠、矢状切面及MPR正交重组切面结合MIP(5 mm)图像上的显示率、诊断结果,进行对比分析。【结果】MPR平行肺门支气管血管束方向5 mm MIP明显提高肺结节血管集束征的检出率(N5mm MIP=27(36%)vs.N横断=13(17%),P≤0.007)及胸膜凹陷的检出率(N5mm MIP=57(76%)vs N横断=48(64%),P≤0.003)但对于结节毛刺的检出明显低于其他切面(P≤0.004);MPR垂直肺门支气管血管束方向切面对结节边界、边缘、分叶征、胸膜凹陷及毛刺征与其他几种切面的检出率无明显差异。综合分析不同切面对孤立性肺结节的准确诊断率(71%)明显高于单纯依赖横断面图像(52%,P<0.05)。【结论】MPR平行肺门支气管血管束方向5 mm MIP明显提高血管集束征及胸膜凹陷的检出率,有助于提高多层螺旋CT对周围型肺癌的诊断价值。

[ Objective ] To analyze the morphological features of peripheral pulmonary carcinoma by using the postprocessing technique of MSCT （orthogonal planar reconstruction （OPR） combing MIP）. [Methods] 75 patients （male ： female = 36： 39; mean age： 60 years） with pathologically proved peripheral pulmonary carcinoma were investigated retrospectively and underwent CT examination before surgery. The morphologic features （margin, lobulation, vascular convergence, pleural indentation, and spiculation） and the diagnosis of each nodule which based on traverse, coronal, saggital and OPR combing 5mmMIP CT images were recorded and compared, respectively. [Results] OPR （parallel to the pulmonary bronchovascular bundle） with 5mm MIP could significantly demonstrated more vascular convergence sign （N5mmMIP： Naxial = 27 （36%） ： 13 （17%）, P ≤0 0.007） and pleural indentation （N5mmMIP： Naxial= 57 （76%） ： 48 （64%）, P≤0 0.004） ; However, the spiculation sign was less found （N5mmMIP： Naxial = 24： 38, P≤0.003） in OPR （parallel to the pulmonary bronchovascular bundle） combing 5mmMIP. Besides, for nodule margin, lobulation, spiculation and pleural indentation, there were no significant differences were found among OPR （plumb to the pulmonary bronchovascular bundle）, traverse, coronal and saggital CT images. Further, comprehensively analysis of the nodules in different imaging sections, compared with traverse CT images, could significantly improve our diagnosis （52% ~ 71%, P 〈 0.05）. [ Conclusion ] OPR （parallel to the pulmonary bronchovascular bundle） 5mmMIP could significantly show more vascular convergences and pleural indentations which could significantly improve our diagnosis for peripheral pulmonary nodule.