肺结节CT靶扫描及重建技术对肺腺癌支气管改变的诊断价值分析
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摘要
目的:探讨如何应用CT靶扫描及重建技术显示肺结节支气管改变,以提高对亚临床期肺腺癌的诊断准确率。方法:回顾性分析经手术和病理证实的肺腺癌及癌前病变共97个病灶的CT扫描资料,所有患者均进行常规2.5mm扫描加局部0.625mm靶扫描及冠状位与矢状位靶重建。结果:病理证实的97个病灶中,靶扫描85个病灶(87.6%)有支气管改变,其中不典型腺瘤样增生2个,原位癌13个,微浸润腺癌31个,浸润型腺癌39个;而平扫仅63个(64.9%)能显示支气管改变。肺结节支气管扩张、狭窄、壁增厚、截断、远端变尖、扭曲、受压等改变。结论:0.625层厚、小FOV的CT靶扫描及重建技术对显示肺腺癌支气管改变优于常规CT扫描,尤其是能更早地发现支气管壁增厚情况,有利于早期肺腺癌及癌前病变的诊断及分型诊断。
Purpose: To investigate how to use CT target scan and reconstruction techniques to display bronchial changes in lung nodules, and to improve the diagnosis rate of subclinical lung adenocarcinoma. Methods: A total of97 lesions in 89 patients with lung adenocarcinoma and precancerous lesions confirmed by surgery and pathology results were analyzed. All patients underwent conventional 2.5 mm scan including local 0.625 mm target scan and coronal and sagittal target reconstruction. Results: Of the 97 lesions, 85 lesions(87.6%) could be shown with bronchial changes by target scan, including 1 case of atypical adenomatoid hyperplasia, 8 cases of carcinoma in situ,27 cases of micro-invasive adenocarcinoma, and 38 cases of invasive adenocarcinoma; while only 63 cases(64.9%)could be shown with bronchial changes by conventional CT scan. Conclusion: Thin slice thickness(0.625), small FOV CT target scan and reconstruction techniques are better than conventional CT scan in display of bronchiectasis,stenosis, wall thickening, truncation, distal tipping, distortion, compression and so on, especially in early detection of bronchial wall thickening, which is benefits for the diagnosis and classification of early lung adenocarcinoma and precancerous lesions.
Purpose: To investigate how to use CT target scan and reconstruction techniques to display bronchial changes in lung nodules, and to improve the diagnosis rate of subclinical lung adenocarcinoma. Methods: A total of97 lesions in 89 patients with lung adenocarcinoma and precancerous lesions confirmed by surgery and pathology results were analyzed. All patients underwent conventional 2.5 mm scan including local 0.625 mm target scan and coronal and sagittal target reconstruction. Results: Of the 97 lesions, 85 lesions(87.6%) could be shown with bronchial changes by target scan, including 1 case of atypical adenomatoid hyperplasia, 8 cases of carcinoma in situ,27 cases of micro-invasive adenocarcinoma, and 38 cases of invasive adenocarcinoma; while only 63 cases(64.9%)could be shown with bronchial changes by conventional CT scan. Conclusion: Thin slice thickness(0.625), small FOV CT target scan and reconstruction techniques are better than conventional CT scan in display of bronchiectasis,stenosis, wall thickening, truncation, distal tipping, distortion, compression and so on, especially in early detection of bronchial wall thickening, which is benefits for the diagnosis and classification of early lung adenocarcinoma and precancerous lesions.
引文
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[9]高丰,葛虓俊,李铭,等.经多层螺旋CT探讨肺磨玻璃结节与支气管的关系.中华放射学杂志,2013,47:157-161.
[10]陈天忠,韦乐心,余绍立,等.多层螺旋CT对肺磨玻璃结节与支气管关系的初探.临床放射学杂志,2014,33:711-715.
[11]杨越清,高杰,金梅,等.纯磨玻璃密度肺腺癌内异常空气支气管征预测病理亚型的价值.中华放射学杂志,2017,51:489-492.
[12]Nakata M,Saeki H,Takata I,detectedby low-dose helical1464-1467.et a1.Focal ground-glass opacity CT Chest,2002.121:1464-1467.
[13]金鑫,赵绍宏,高洁,等.纯磨玻璃密度肺腺癌病理分类及影像表现特点分析,中华放射学杂志,2014,48:283-287.
[2]李惠民,肖湘生,刘士远,等.螺旋CT靶扫描对肺部小结节的诊断价值.临床放射学杂志,2001,20:424-427.
[3]望云,范丽,刘士远,等.改变体位联合CT靶扫描对特殊部位肺结节的诊断价值.实用放射学杂志,2016,32:694-698.
[4]李鲁,李惠民,舒锦尔,等.生理通气辅助超高分辨率CT扫描技术探讨.中国医学计算机成像杂志,2015,21:228-231.
[5]方元,肖湘生,于红,等.改变扫描野及矩阵对肺结节CT图像质量影响的体模研究.实用放射学杂志,2016,32:10.
[6]周莹,刘士远,李琼,等.临床IA期周围型肺腺癌病理性脉管浸润与其薄层CT征象的相关性研究.中华放射学杂志,2015,49:259-263.
[7]胡星,刘含秋,张家文,等.孤立性肺结节与血管和支气管关系:多层螺旋CT与病理对照初步研究.中国医学计算机成像杂志,2015,21:105-110.
[8]方金忠,张文奇,王善军,等.螺旋CT靶扫描及后处理重建技术对孤立性肺结节的诊断价值.医学影像学杂志,2014,7:1138-1142.
[9]高丰,葛虓俊,李铭,等.经多层螺旋CT探讨肺磨玻璃结节与支气管的关系.中华放射学杂志,2013,47:157-161.
[10]陈天忠,韦乐心,余绍立,等.多层螺旋CT对肺磨玻璃结节与支气管关系的初探.临床放射学杂志,2014,33:711-715.
[11]杨越清,高杰,金梅,等.纯磨玻璃密度肺腺癌内异常空气支气管征预测病理亚型的价值.中华放射学杂志,2017,51:489-492.
[12]Nakata M,Saeki H,Takata I,detectedby low-dose helical1464-1467.et a1.Focal ground-glass opacity CT Chest,2002.121:1464-1467.
[13]金鑫,赵绍宏,高洁,等.纯磨玻璃密度肺腺癌病理分类及影像表现特点分析,中华放射学杂志,2014,48:283-287.