CAJ | 학술논문

目的通过分析尸检煤工尘肺病例肺内结节病理与64排螺旋CT(MSCT)影像表现的关系,探讨肺内结节分布特征的最佳影像学检查方法,为建立煤工尘肺CT诊断依据提供数据.方法收集7例煤工尘肺尸检离体肺标本,均为男性,年龄42～77岁,平均(60.0±13.3)岁,接尘工龄5～30年,平均(15.4±8.0)年.将7例尸检离体肺标本制成充气肺标本后进行病理组织学切片制作,并分别对组织学切片进行固定、64排MSCT冠状位薄层扫描,并对扫描后的原始数据进行3、5、8mm层厚MIP图像后处理.以结节局部解剖关系病理结果为依据,判断不同层厚影像学显示方法的灵敏度,并分别进行病理与不同影像学显示方法的相关性分析.结果 (1)病理分期诊断结果与煤工尘肺患者生前高仟伏胸片分期诊断结果比较的差异有统计学意义(x2=4.667,P＜0.05;kappa值为0.167,P＜0.05).(2)7例尸检离体肺标本病理切片共显示271个结节,表现为支气管血管周围结节(27个,9.9％)、小叶中心性结节(67个,24.6％)、小叶间隔结节(65个,24.3％)、距胸膜5 mm内结节(45个,16.5％)、侧胸壁胸膜斑样结节(45个,16.5％)、叶间胸膜结节(22个,8.1％).(3)病理与不同影像方法对肺内结节局部解剖关系经x2检验显示,5 mmMIP组与病理组似然比最高,为0.981.结论肺内结节的病理分期诊断结果与患者生前高仟伏胸片诊断结果差异较大.64-MSCT-5 mmMIP影像学图像能够很好地反映煤工尘肺肺内结节病理组织学图像和局部真实解剖关系.
목적 통과분석시검매공진폐병례폐내결절병리여64배라선CT(MSCT)영상표현적관계,탐토폐내결절분포특정적최가영상학검사방법,위건립매공진폐CT진단의거제공수거.방법 수집7례매공진폐시검리체폐표본,균위남성,년령42～77세,평균(60.0±13.3)세,접진공령5～30년,평균(15.4±8.0)년.장7례시검리체폐표본제성충기폐표본후진행병리조직학절편제작,병분별대조직학절편진행고정、64배MSCT관상위박층소묘,병대소묘후적원시수거진행3、5、8mm층후MIP도상후처리.이결절국부해부관계병리결과위의거,판단불동층후영상학현시방법적령민도,병분별진행병리여불동영상학현시방법적상관성분석.결과 (1)병리분기진단결과여매공진폐환자생전고천복흉편분기진단결과비교적차이유통계학의의(x2=4.667,P＜0.05;kappa치위0.167,P＜0.05).(2)7례시검리체폐표본병리절편공현시271개결절,표현위지기관혈관주위결절(27개,9.9％)、소협중심성결절(67개,24.6％)、소협간격결절(65개,24.3％)、거흉막5 mm내결절(45개,16.5％)、측흉벽흉막반양결절(45개,16.5％)、협간흉막결절(22개,8.1％).(3)병리여불동영상방법대폐내결절국부해부관계경x2검험현시,5 mmMIP조여병리조사연비최고,위0.981.결론 폐내결절적병리분기진단결과여환자생전고천복흉편진단결과차이교대.64-MSCT-5 mmMIP영상학도상능구흔호지반영매공진폐폐내결절병리조직학도상화국부진실해부관계.
Objective To analyze the relationship between the pathological features and 64-muhislice spiral computed tomography (64-MSCT) findings of pulmonary nodules in autopsies from patients with coal workers' pneumoconiosis (CWP),to investigate the optimal imaging method for the distribution of pulmonary nodules,and to provide data for the establishment of CT diagnostic criteria for CWP.Methods Cadaveric lung specimens were collected from 7 CWP patients.All of them were men,aged 42～77 years (mean,60.00±13.00 years),and their dust exposure time was 5～30 years (mean,15.4±8.01 years).The cadaveric lung specimens were treated by aeration,sectioning,and immobilization and were then examined by coronary 64-MSCT.The primitive images were reconstructed into the maximum intensity projection (MIP) images (slice thickness:3 mm,5 mm,and 8 mm).The sensitivities of imaging methods with different slice thickness were evaluated based on the pathology and anatomy of local pulmonary nodules,and the correlation between pathological results and radiological findings was analyzed.Results There were significant differences between the stages determined by pathological examination and high-kV chest radiography (before death) (x2=4.667,P＜0.05; kappa value =0.167,P＜0.05).A total of 271 nodules were found in all pathological sections,including peribronchovascular nodules (27,9.9％),centrilobular nodules (67,24.6％),interlobular nodules (65,24.3％),nodules within 5 mm from the pleura (45,16.5％),pleural plaque-like nodules on the lateral chest wall (45,16.5％),and nodules on the interlobar pleura (22,8.1％).The likelihood ratio was the highest (0.981) between 5-mm MIP images and pathological results according to the chi-square test.Conclusion The stage of pulmonary nodules determined by pathological examination is significantly different from that determined by high-kV chest radiography.The 5-mm MIP images of 64-MSCT provide a good reflection of the local pathology and anatomy of pulmonary nodules in CWP patients.