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目的探讨螺旋CT血管成像(CTA)及重建技术在肺癌术前评价中的作用。方法对37例肺癌患者术前行螺旋CT增强检查,增强扫描后结合轴位图像对纵隔、肺门血管按多平面重建(MPR)、最大密度投影(MIP)、表面遮盖显示(SSD)技术软件程序重建,根据肿瘤对血管的侵犯程度分为5级,比较轴位与各种重建图像综合显示结果,并与手术结果进行对照。结果轴位图像评价纵隔、肺门血管侵犯的敏感度、特异度及准确度分别为73.9%,66.7%,67.6%,重建图像评价血管侵犯的敏感度、特异度及准确度分别为90.9%,86.7%,89.2%,两者相比有显著性差异(χ2=7.546,P<0.05;χ2=6.657,P<0.05;χ2=6.604,P<0.05)。轴位图像分级与重建图像分级都与手术分级有相关性(相关系数分别为0.700、0.786)。结论CTA可以全面反映肺癌对肺门及纵隔大血管的侵犯程度与范围,各种重建方法结合优于单纯CT轴位,对肺癌的术前评价很有帮助。
Objective To investigate the role of spiral CT angiography (CTA) and reconstruction in preoperative evaluation of lung cancer. Methods Thirty-seven patients with lung cancer underwent preoperative spiral CT (CT) contrast-enhanced examinations. The enhanced axial scan combined with MPR, MIP, SSD software The procedure was reconstructed and classified into 5 levels according to the extent of tumor vascular invasion. The axial results were compared with those of reconstructed images and compared with the surgical results. Results The sensitivity, specificity and accuracy of axial images in assessing mediastinal and hilar vascular invasion were 73.9%, 66.7% and 67.6% respectively. The sensitivity, specificity and accuracy of reconstructed images in assessing vascular invasion were 90.9% 86.7% and 89.2%, respectively (χ2 = 7.546, P <0.05; χ2 = 6.657, P <0.05; χ2 = 6.604, P <0.05). Axial image grading and reconstruction of the image grading were associated with the surgical grading (correlation coefficients were 0.700,0.786, respectively). Conclusion CTA can fully reflect the degree and extent of lung cancer invasion of the hilar and mediastinal vessels. The combination of various reconstruction methods is superior to the simple axial CT and is helpful for the preoperative evaluation of lung cancer.