27例肺隔离症的影像学诊断分析

Imaging diagnosis of pulmonary sequestration:analysis of 27 cases

目的探讨多排螺旋CT和DSA等多种影像方法在肺隔离症(pulmonary sequestration,PS)诊断中的价值,以期提高对本病的认识和诊断正确率。方法回顾性分析经手术病理证实的27例PS影像学资料,包括胸片、CT和DSA。结果 27例PS叶内型22例,叶外型5例,均发生于两下肺,左下肺19例,右下肺8例。胸片多表现为类圆形的密度较均匀的团块影。螺旋CT表现为肺内囊性、实性或囊实性肿块,伴有感染时可出现液平。增强后实性病灶和囊壁强化,囊性部分不强化。CT血管造影(CTA)通过多种后处理重建技术能准确找到异常来源于体循环的供血动脉及引流静脉,对于诊断PS能提供关键的诊断信息。DSA为诊断PS的金标准,能够显示供血动脉的来源及静脉回流方向。结论选择有效的影像诊断方法能够及时准确地诊断PS,尤其是螺旋CT及CTA后处理重建技术能够准确显示异常血管,可以取代DSA成为PS术前诊断的首选。

Objective To explore the value of many imaging methods including multi-slice spiral CT and DSA in the diagnosis of pulmonary sequestration （PS）, so as to improve the understanding and diagnostic accuracy of this disease. Methods The imaging data including chest radiograph, CT and DSA in 27 cases of PS who were confirmed by pathology were retrospectively analyzed. Results There were 22 cases of intralobar type and 5 cases of extralobar type in 27 cases of PS, and all occurred in the two lower lobes of lungs, with 19 cases of left lower lung and 8 cases of right lower lung. Chest X-ray often showed round mass-like opacities with uniformed density. Spiral CT manifested pulmonary cystic, solid or cystic solid mass, and it could show liquid level when accompanied by infection. After enhancement, the solid and capsule wall were enhanced, while the part of cystic was not enhanced. CT angiography（CTA） can accurately iden- tify abnormal arteries from the systemic circulation through a variety of post-treatment reconstruction techniques, pro- viding critical diagnostic information for the diagnosis of PS. DSA was the gold standard in diagnosis of PS, can show the source of blood supply and venous return direction. Conclusion The effective image diagnosis method is selected to timely and accurately diagnose PS, especially spiral CT and CTA post-processing reconstruction technology can accu- rately show abnormal blood vessels, can replace the DSA which is the first choice to preoperative diagnose PS.