中央型肺癌诊治中的影像学特征及诊断价值
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摘要
目的探讨中央型肺癌诊疗过程中的影像学特征及诊断准确性。方法回顾性分析120例中央型肺癌患者的病理学与影像学资料,所有患者均进行了X线检查,49例患者行MRI检查,46例患者行CT检查。分别比较肿瘤的影像学特征与病理诊断之间的关系,判断良恶性肿瘤的影像学诊断正确率。结果 X线检查与CT检查在对中央型肺癌支气管生长、支气管壁不规则增厚、管腔变窄、肿块边界不清等方面表现相似,但在支气管炎并感染、肺上叶片絮状影、渗出性病灶、增厚的支气管黏膜扩散、支气管受累征象、纵膈等血管和脂肪组织丰富处等特殊部位其显像CT更为清晰,而X线在支气管炎并感染方面表现良好,对于血管的侵袭及纵隔淋巴结肿大、支气管狭窄的显像方面MRI表现更为优秀。以病理学判断诊断为金标准,X线诊断的正确率为86.67%、CT诊断的正确率为93.47%、MRI诊断正确率为93.88%,3种影像学检查对于中央型肺癌的诊断正确率方面差异无统计学意义(P>0.05)。结论 X线由于方便、快捷的优势可作为中央型肺癌诊断的首选诊断,CT对于细微病灶、肿瘤的范围具有一定优势,MRI对于血管的侵袭及纵隔淋巴结肿大、支气管狭窄显像优势明显。3种检查方法可作为中央型肺癌诊断的互补检查,提高诊断的准确性。
Objective To investigate the imaging features and diagnostic accuracy of central lung cancer during diagnosis and treatment. Methods Retrospective analysis of 120 cases of central lung cancer patients with pathology and imaging data,all patients were X-ray examination,49 patients underwent MRI examination,46 patients underwent CT examination. Respectively,compared the relationship between the tumor imaging features and pathological diagnosis,and determine the correct rate of imaging of benign and malignant tumors. Results X-ray examination and CT examination showed bronchial growth,irregular thickening of bronchial wall,luminal narrowing,lumen border,and so on. However,in bronchitis and infection,exudative lesions,thickened bronchial mucosal spread,signs of bronchial involvement,mediastinal and other vascular and adipose tissue-rich and other special parts of its imaging CT was more clear,and X-ray in bronchitis and infection performed well,for vascular invasion and mediastinal lymph nodes,bronchial stenosis imaging of MRI performance was more outstanding. The diagnostic accuracy of X-ray diagnosis was 86. 67%,the correct rate of CT diagnosis was 93. 47%; the correct rate of MRI diagnosis was 93. 88%,the 3 imaging examinations for the benign and malignant of central lung cancer There was no significant difference in diagnostic accuracy( P >0. 05). Conclusion X-ray can be used as the first choice for the diagnosis of central type lung cancer because of its convenience and quickness. CT has certain advantages for the subtle lesions and the range of tumor. MRI has obvious advantages in vascular invasion and mediastinal lymphadenopathy,bronchial stenosis,The 3 kinds of examination methods can be used as complementary diagnosis of central lung cancer diagnosis,and improve the accuracy of diagnosis.
Objective To investigate the imaging features and diagnostic accuracy of central lung cancer during diagnosis and treatment. Methods Retrospective analysis of 120 cases of central lung cancer patients with pathology and imaging data,all patients were X-ray examination,49 patients underwent MRI examination,46 patients underwent CT examination. Respectively,compared the relationship between the tumor imaging features and pathological diagnosis,and determine the correct rate of imaging of benign and malignant tumors. Results X-ray examination and CT examination showed bronchial growth,irregular thickening of bronchial wall,luminal narrowing,lumen border,and so on. However,in bronchitis and infection,exudative lesions,thickened bronchial mucosal spread,signs of bronchial involvement,mediastinal and other vascular and adipose tissue-rich and other special parts of its imaging CT was more clear,and X-ray in bronchitis and infection performed well,for vascular invasion and mediastinal lymph nodes,bronchial stenosis imaging of MRI performance was more outstanding. The diagnostic accuracy of X-ray diagnosis was 86. 67%,the correct rate of CT diagnosis was 93. 47%; the correct rate of MRI diagnosis was 93. 88%,the 3 imaging examinations for the benign and malignant of central lung cancer There was no significant difference in diagnostic accuracy( P >0. 05). Conclusion X-ray can be used as the first choice for the diagnosis of central type lung cancer because of its convenience and quickness. CT has certain advantages for the subtle lesions and the range of tumor. MRI has obvious advantages in vascular invasion and mediastinal lymphadenopathy,bronchial stenosis,The 3 kinds of examination methods can be used as complementary diagnosis of central lung cancer diagnosis,and improve the accuracy of diagnosis.
引文
[1]马晓玲,周舒畅,夏黎明.动态增强MRI在孤立性肺结节鉴别诊断中的应用[J].磁共振成像,2015,6(2):125-130.
[2]PARK JY,KIM KY,LEE J,et al.Impact of abnomal uptakes in bonescan on the prognosis of patients with lung cancer[J].Lung Cancer,2000,28(1):55-62.
[3]邓敬锋,邵汛帆,史建军.肺癌骨转移放疗止痛效果临床观察[J].河北医药,2012,34(4):533-534.
[4]马玉波,王忠,顾爱春,等.SPECT/CT图像融合鉴别诊断疑似骨转移灶良恶性的价值[J].上海交通大学学报(医学版),2010,30(10):1246-1250.
[5]陈碧玲.核素骨显像诊断肺癌骨转移102例临床分析[J].临床合理用药,2012,5(1A):89-90.
[6]SCHMIDT GP,REISER MF,BAUR-MELNYK A.Wholebody imagingof the musculoskeletal system:the value of MR imaging[J].Skeletal Radiol,2007,36(12):1109-1119.
[7]汤志谋,许海富,李明智.SPECT核素骨显像联合MRI增强成像鉴别诊断骨转移瘤100例临床观察[J].实用癌症杂志,2009,24(5):498-500.
[8]刘晓梅,张芳,高建青.SPECT、MRI在肺癌骨转移诊断中的价值[J].承德医学院学报,2013,30(6):489-490.
[9]任进军,赵宝宏,訾学荣,等.磁共振DCE和DWI联合评价孤立性肺结节的临床意义[J].中国临床医学影像杂志,2015,26(8):574-576,580.
[10]Jayia PK,Mishra PK,Shah RR,et al.Preoperative assessment of lung cancer patients:evaluating guideline compliance(reaudit)[J].Asian Cardiovasc Thorac Ann,2015,23(3):299-301.
[2]PARK JY,KIM KY,LEE J,et al.Impact of abnomal uptakes in bonescan on the prognosis of patients with lung cancer[J].Lung Cancer,2000,28(1):55-62.
[3]邓敬锋,邵汛帆,史建军.肺癌骨转移放疗止痛效果临床观察[J].河北医药,2012,34(4):533-534.
[4]马玉波,王忠,顾爱春,等.SPECT/CT图像融合鉴别诊断疑似骨转移灶良恶性的价值[J].上海交通大学学报(医学版),2010,30(10):1246-1250.
[5]陈碧玲.核素骨显像诊断肺癌骨转移102例临床分析[J].临床合理用药,2012,5(1A):89-90.
[6]SCHMIDT GP,REISER MF,BAUR-MELNYK A.Wholebody imagingof the musculoskeletal system:the value of MR imaging[J].Skeletal Radiol,2007,36(12):1109-1119.
[7]汤志谋,许海富,李明智.SPECT核素骨显像联合MRI增强成像鉴别诊断骨转移瘤100例临床观察[J].实用癌症杂志,2009,24(5):498-500.
[8]刘晓梅,张芳,高建青.SPECT、MRI在肺癌骨转移诊断中的价值[J].承德医学院学报,2013,30(6):489-490.
[9]任进军,赵宝宏,訾学荣,等.磁共振DCE和DWI联合评价孤立性肺结节的临床意义[J].中国临床医学影像杂志,2015,26(8):574-576,580.
[10]Jayia PK,Mishra PK,Shah RR,et al.Preoperative assessment of lung cancer patients:evaluating guideline compliance(reaudit)[J].Asian Cardiovasc Thorac Ann,2015,23(3):299-301.