中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2014年
4期
357-360
,共4页
刘景旺%李健%刘运秋%郭庆乐
劉景旺%李健%劉運鞦%郭慶樂
류경왕%리건%류운추%곽경악
肺泡癌%CT%肺穿刺%活检
肺泡癌%CT%肺穿刺%活檢
폐포암%CT%폐천자%활검
Alveolar carcinoma%CT%Percutaneous lung%Biopsy
目的 探讨CT导引穿刺活检对CT拟诊为肺炎型细支气管肺泡癌(BAC)的诊断价值及肺炎性BAC的CT特点.方法 对25例CT拟诊为肺炎型BAC患者行CT导引穿刺活检,采用GE公司64排light speed VCT行常规扫描及增强CT扫描,所有图像由两名医师共同分析完成,依据增强扫描可疑肿瘤部位选择穿刺部位及垂直进针路径,确定理想活检部位后应用20 ml注射器进行负压针吸活检,多方向、多点抽吸,吸出物涂片迅速固定,应用活检枪切割活检,标本用福尔马林溶液固定送检.拔针压迫10min后包扎,再次行CT扫描观察有无出血及气胸等并发症发生.结果 25例患者均成功取到组织,病理证实为肺炎型BAC 14例,肺炎6例,真菌感染2例,干酪性肺炎3例.14例肺炎型BAC患者CT表现为实变肺组织内支气管充气征10例(71.4％),实变肺组织内蜂房状气腔或空洞征5例(35.7％),实变区周围呈磨玻璃密度影及多发结节影5例(35.7％);增强CT扫描实变区可见混杂的低密度区内血管造影征11例(78.6％),平均达峰时间为90s,时间密度曲线呈速升缓降型9例(64.2％).结论 CT引导肺穿刺活检结合典型影像学表现可以大大提高肺炎型BAC的早期诊断率,肺段、叶性实变区内蜂窝状气腔及空洞、血管造影征、枯树枝征、周围多发腺泡结节及磨玻璃密度区,增强扫描实变区可见血管造影征,时间-密度曲线呈速升缓降型是肺炎型BAC的主要特点.
目的 探討CT導引穿刺活檢對CT擬診為肺炎型細支氣管肺泡癌(BAC)的診斷價值及肺炎性BAC的CT特點.方法 對25例CT擬診為肺炎型BAC患者行CT導引穿刺活檢,採用GE公司64排light speed VCT行常規掃描及增彊CT掃描,所有圖像由兩名醫師共同分析完成,依據增彊掃描可疑腫瘤部位選擇穿刺部位及垂直進針路徑,確定理想活檢部位後應用20 ml註射器進行負壓針吸活檢,多方嚮、多點抽吸,吸齣物塗片迅速固定,應用活檢鎗切割活檢,標本用福爾馬林溶液固定送檢.拔針壓迫10min後包扎,再次行CT掃描觀察有無齣血及氣胸等併髮癥髮生.結果 25例患者均成功取到組織,病理證實為肺炎型BAC 14例,肺炎6例,真菌感染2例,榦酪性肺炎3例.14例肺炎型BAC患者CT錶現為實變肺組織內支氣管充氣徵10例(71.4％),實變肺組織內蜂房狀氣腔或空洞徵5例(35.7％),實變區週圍呈磨玻璃密度影及多髮結節影5例(35.7％);增彊CT掃描實變區可見混雜的低密度區內血管造影徵11例(78.6％),平均達峰時間為90s,時間密度麯線呈速升緩降型9例(64.2％).結論 CT引導肺穿刺活檢結閤典型影像學錶現可以大大提高肺炎型BAC的早期診斷率,肺段、葉性實變區內蜂窩狀氣腔及空洞、血管造影徵、枯樹枝徵、週圍多髮腺泡結節及磨玻璃密度區,增彊掃描實變區可見血管造影徵,時間-密度麯線呈速升緩降型是肺炎型BAC的主要特點.
목적 탐토CT도인천자활검대CT의진위폐염형세지기관폐포암(BAC)적진단개치급폐염성BAC적CT특점.방법 대25례CT의진위폐염형BAC환자행CT도인천자활검,채용GE공사64배light speed VCT행상규소묘급증강CT소묘,소유도상유량명의사공동분석완성,의거증강소묘가의종류부위선택천자부위급수직진침로경,학정이상활검부위후응용20 ml주사기진행부압침흡활검,다방향、다점추흡,흡출물도편신속고정,응용활검창절할활검,표본용복이마림용액고정송검.발침압박10min후포찰,재차행CT소묘관찰유무출혈급기흉등병발증발생.결과 25례환자균성공취도조직,병리증실위폐염형BAC 14례,폐염6례,진균감염2례,간락성폐염3례.14례폐염형BAC환자CT표현위실변폐조직내지기관충기정10례(71.4％),실변폐조직내봉방상기강혹공동정5례(35.7％),실변구주위정마파리밀도영급다발결절영5례(35.7％);증강CT소묘실변구가견혼잡적저밀도구내혈관조영정11례(78.6％),평균체봉시간위90s,시간밀도곡선정속승완강형9례(64.2％).결론 CT인도폐천자활검결합전형영상학표현가이대대제고폐염형BAC적조기진단솔,폐단、협성실변구내봉와상기강급공동、혈관조영정、고수지정、주위다발선포결절급마파리밀도구,증강소묘실변구가견혈관조영정,시간-밀도곡선정속승완강형시폐염형BAC적주요특점.
Objective To investigate the CT imaging features of pneumonic type Bronchio-loalveolar carcinoma(BAC) and the value of CT-guided percutaneous puncture biopsy in pneumonic type BAC.Methods Twenty-five cases of suspected pneumonic type BAC were biopsied with CT-guided percutaneous puncture.GE 64-slices plain and post contrast CT scans were performed in all patients.Two radiologists finished imaging determination.Site of puncture was selected in suspicious areas of the tumor.The negative pressure aspiration needle were used to be biopsy in the ideal location after vertically into the needle and again performed CT scanning were performed to observe the complications such as hemorrhage,pneumothorax.Specimens were fixed by formalin.Results Twenty-five samples were successfully got from 25 patients.Pathology data showed that 14 cases were pneumonia with BAC,6 cases with pneumonia,2 cases with offungus infection,and 3 cases with caseous pneumonia.Of 14 cases (71.4％) with pneumonia type BAC,CT images of 10 cases showed air bronchogram of lung tissue,5 cases(35.7％) with alveolar gas cavity or cavity of lung tissue,5 cases(35.7％) with ground glass opacity and multiple nodules.Enhanced CT scanning the area of consolidation showed that 11 cases(78.6％) were with mixed low density area angiography and the mean peak time was 90 s,9 cases (64.2％) were with the time density curve of speed up and slow down type.Conclusion The method of CT guided lung biopsy combined with typical imaging findings can enhance early diagnosis rate of pneumonia type BAC.Meanwhile CT feature of pneumonia type BAC shows honeycomb air cavity,void,angiographic sign,dead branches syndrome,multiple peripheral acinar nodules and ground glass density.Enhanced scan area of consolidation shows visible angiogran sign,slow drop type of time density curve of a fast rise.
