多层CT作肺血管分期造影对肺癌侵犯中央肺动脉的评估

The staging of pulmonary angiography with the multi-slice spiral CT: to evaluate its significance in cancerous invasion of central pulmonary artery in lung cancer

目的 探索多层螺旋CT作肺血管分期造影的可能性和评价肺癌侵犯中央肺动脉的临床价值。方法 用多层螺旋CT对 73例肺门区肺癌患者进行研究。分两段对比剂注射 ,结合三个扫描程序作肺血管分期造影 ,根据肺动脉被侵犯的不同部位和程度分为三度。按盲法评价图像并与手术和病理对照。结果 肺动脉分期造影成功的共 68例 ( 93 .15 % ,68/ 73 )。肺动脉Ⅰ度侵犯者 4例 ( 5 .88% ,4/ 68) ,Ⅱ度侵犯者 9例( 13 .2 3 % ,9/ 68) ,Ⅲ度侵犯者 5 5例 ( 80 .88% ,5 5 / 68)。Ⅰ度者全部作肺叶切除 ;Ⅱ度与Ⅲ度者的肺叶切除率有显著性差异 ( χ2 =64 .0 3 ,P <0 .0 0 5 ) ;Ⅲa度与Ⅲb度者的肺叶切除率也有显著性差异 ( χ2 =68.69,P <0 .0 0 5 ) ;Ⅲc度全部放弃手术。结论 多层螺旋CT作肺血管分期造影能更好地显示肺癌侵犯中央肺动脉的部位和程度 。

Objective To explore the possibility of the staging of pulmonary angiography with multi slice spiral CT (MSCT) and to evaluate its value in making surgical plan for patients with lung cancer. Methods MSCT with two segment injection and three protocol scan was performed in 73 patients with central type lung cancer. According to the site and degree, the involvement of pulmonary artery was divided into three grades and blindly compared with the surgery and pathology. Results MSCT in 68 cases (93.15%, 68/73) was successfully performed. The involvement of central pulmonary artery was grade Ⅰ in 4 cases (5.88%, 4/68), grade Ⅱ in 9 (13.23%, 9/68), and grade Ⅲ in 55 (80.88%, 55/68). All patients with grade Ⅰ underwent lobectomy. There was remarkable difference of lobectomy ratio between grade Ⅱ and Ⅲ (χ 2=64.03, P<0.005) and also between Ⅲa and Ⅲb (χ 2=68.69, P<0.005). All patients with grade Ⅲc were ruled out from surgery.Conclusion The staging of pulmonary angiography by MSCT is useful to demonstrate the site and degree of involvement of central pulmonary artery and provides more precise evidence of images for making surgical plan.