AJCC/ATS胸内淋巴结影像分区中某些重要界线的确定——断层解剖与CT、MRI对照研究

Some boundary lines of intrathoracic lymph nodal classification based on ATS and AJCC nodal staging system for lung cancer:a contrast study between sectional snd imaging anatomy

目的 :确定ATS/AJCC胸内淋巴结CT、MRI分区中一些重要界线。方法 :在 5具尸体上观察胸内淋巴结分布 ,用胸部横断层标本 (4套 )与CT(5 0例 )、MRI(2 0例 )图像对照观察。确定了 2条辅助线和 2个影像解剖标志来区分 4、5、6及 10区淋巴结。结果 :在主动脉弓上缘至肺动脉干区段 ,经升主动脉断面圆心的冠状线分开 5区与 6区 ,升、降主动脉断面圆心间连线分开 5区与 4L(ATS、AJCC)或 10L区(ATS)。左肺动脉分开 5区与 4L或 (AJCC) 10L区 (ATS)。奇静脉弓分开 4R区与 10R区 (ATS)或 4R上、下组 (AJCC)。结论 :文中设计的组间界线使ATS和AJCC分区系统易于使用 ,有利于肺癌准确的影像学分期。

Objective: According to the intrathoracic lymph nodal classification system of ATS and AJCC, some boundary lines were definited on CT and MR imaging. Methods: Intrathoracic lymph nodes were observed on five cadaveric specimens and classified based on ATS and AJCC system. Station 4,5,6 and 10 were separated by two assisted lines and wto imaging based anatomic landmarks on CT scan and MR imaging and were contrasted to those on cross sectinal specimens.Results: From superior aspect of aortic arch to main pulmonary artery, station 5 was separated from station 6 by the coronal line through the center of ascending aorta on axial images. Another line drawn from the center of ascending aorta to the center of descending aorta distinguisthed station 5 from station 4L (ATS, AJCC), or 10L(ATS) on axial images from superior aspect of aortic arch to left pulmonary artery. As a natural anatomic landmark, left pulmonary artery separated station 5 from 10L(ATS), or 4L(AJCC). Respectively, the superior aspect of azygos arch separated station 4R from 10R(ATS), or superior from inferior subsets of 4R(AJCC). Conclusion: It is expected that the boundary lines definited on axial images should be useful to the staging of lung cancer by CT and MR imaging.