支气管肺癌侵犯纵隔的CT征象分析

目的:探讨CT征象评价支气管肺癌侵犯纵隔结构的诊断价值。方法:经手术病理证实的支气管肺癌97例,对14种(共750个)纵隔结构的CT表现与手术、纤维支气管镜及病理结果进行回顾性对照分析。记录原发肿瘤与纵隔结构的接触程度,判断该纵隔结构是否扭曲及是否有气管、支气管腔内肿瘤等。结果:以肿瘤与纵隔接触角大于0°(CT分级3~6级)为CT阳性征象,CT评估纵隔结构侵犯敏感度为72.5%,阳性预测值为80.6%;以肿瘤与纵隔结构接触角大于90°(CT分级4~6级)为CT阳性征象,CT评估纵隔结构侵犯的敏感性为47.5%,阳性预测值为82.6%;以纵隔结构与肿瘤接触角大于180°(CT分级5~6级)为阳性CT征象,病理结果为全部受累,其中结构扭曲占7/40,管腔内肿瘤侵犯占2/40。结论:CT检查对于发现支气管肺癌纵隔侵犯有重要价值,改进CT扫描技术并制定特定判断标准有助于提高CT对支气管肺癌纵隔侵犯的阳性预测值。

CT signs of mediastinal invasion by primary bronchogenic carcinoma

Aim: To determine the accuracy of computed tomography(CT) signs in assessment of direct mediastinal invasion by primary bronchogenic carcinoma.Methods: Ninety-seven patients with primary bronchogenic carcinoma who underwent CT with thoracic surgical staging and thoracotomy,the pathologic and CT findings in 14 mediastinal structures were compared retrospectively.The degree of contact of the primary tumor with each structure and whether the structure was distorted or contained intraluminal tumor were recorded.A total of 750 mediastinal structures(40 with tumor invasion) were analyzed.Results: When greater than 0 degrees of contact was considered a positive CT finding,the sensitivity of CT(was 72.5%)(29 of 40 structures) and positive predictive values was 80.6%.When greater than 90 degrees of contact was considered a positive CT finding,the sensitivity of CT was 47.5%(19 of 40 structures) and positive predictive values was 82.6%.All structures with > 180 degrees of contact had pathologic involvement,but only 7 of 40 had distorted structures(17.5%) and 2 cases had structures with intraluminal tumor(5%) involved.Conclusion: CT has very important value in detecting mediastinal invasion of primary bronchogenic carcinoma.The positive predictive value may be higher,depending on the technique improving of CT scan and the criteria used.