OBJECTIVE To assess the accuracy of multi-slice spiral CT (MSCT) with imaging reconstruction in judging central pulmonary vascular involvement from central lung cancer, and to explore its ability to predict the resectability of lung cancer.METHODS MSCTs were conducted on 48 patients who were diagnosed preoperatively with central lung cancer. Images of pulmonary arteries and veins that might affect Iobectomy or pneumonectomy were reconstructed by means of imaging processing techniques. Then the relationship of the tumor to the vessels was assessed prospectively on both axial CT images and axial CT images plus reconstructed images(CT-RI) in comparison to subsequent pathologic and surgical findings.RESULTS MSCTs were obtained on all 48 patients whom 42 underwent thoracotomy, Iobectomy or pneumonectomy. Compared with the axial CT images,CT-RI was more accurate in judging the relationship of the central pulmonary vessels to the tumor based on subsequent pathologic 78 vessels studiedand surgical findings (186 vessels studied) (0.01 ＜P＜0.05). The sensitivity and positive predictive value of unresectability of the vessels were all remarkably higher with CT-RI (P＜0.01).CONCLUSION MSCT with imaging reconstruction can improve the recognition of neoplastic invasion of central pulmonary vessels. It can be used to predict preoperatively the resectability of central lung cancer and to plan surgery.