吴伟成等

【摘要】目的探讨多层螺旋CT容积再现（Volume rending，VR）及多平面重建（Multiple planner reconstruction，MPR）图像重组技术在肺结节良恶性胸膜凹陷征（pleural indentation，PI）中的鉴别价值。

方法根据手术病理及临床随访资料，将48例伴PI的肺结节分为良性组（18例）和恶性组（30例）。所有结节均进行多层螺旋CT扫描后行图像薄层重建，并行三维图像重组。依据肺表面VR图像中的凹陷中心及周围沟槽表现进行分类并比较。以MPR图像上显示的胸膜相关切迹征（Nodule notch due to pleural indentation，NNPI），比较两组显示率。

结果VR图像显示的PI凹陷中心表现分为：小圆/点状型、斜线型、宽带型、不规则型；周围沟槽分为深长型和短浅型。恶性PI以小圆（点）或斜线型凹陷中心伴深长沟槽多见，而良性PI以宽带状凹陷中心伴短浅沟槽多见，两者存在明显差异（P<005）。MPR所见NNPI中恶性组发生率明显高于良性组（P<001）。

结论 VR及MRP图像重组技术对肺结节良恶性PI鉴别具有指导价值。

【关键词】胸膜；肺结节；体层摄影术；X 线计算机；图像处理；计算机辅助

中图分类号：R563；R814.32文献标识码：ADOI：10.3969/j.issn.10031383.2014.05.023【Abstract】ObjectiveTo investigate the value of volume rending （VR） and multiple planner reconstruction （MPR） techniques multislice spiral CT in differential diagnosis of benign and malignant pleural indentation （PI）.

MethodsBased on pathology and clinic followup data，48 cases of lung nodules with PI were divided into benign group（18 cases） and malignant group（30 cases）.All lung nodules got thinslice target reconstruction after undergoing multislice spiral CT，and 3D reformation were performed in all cases.Then they were classified and analyzed according to the appearance of the center of PI and surrounding furrow in VR images.Nodule notch due to pleural indentation （NNPI） was demonstrated in MPR images，and the detection rates of two groups were compared.

Results The appearance of the center of PI in VR images was classified into four types： small round/punctiform，oblique line，wideband and irregular；while surrounding furrow was classified into two types：long and deep，short and superficial.There were mainly small round or oblique line type of indentation center with long and deep surrounding furrow in malignant PI，while wideband type of center with short and superficial furrow was always found in benign PI，so the difference was statistically significant in two groups（P<005）.The occurrence of NNPI showed in MRP in the malignant group was obviously higher than that in the benign group（P<001）.

ConclusionVR and MPR techniques play important roles in guiding the differential diagnosis of PI.

【Key words】pleura；pulmonary nodules；tomography；Xray computed；image processing；computerassisted

胸膜凹陷征（Pleural indentation，PI）作为周围型肺癌的一个重要形态学征象，一直受到影像科和临床医师的关注，对其形态学表现、瘤内病理基础、形成机制等方面均有深入研究[1～6]。大量文献报道PI最常见于周围型腺癌，但许多肺内周围良性结节亦可见此征象，两者存在重叠性[4]。随着螺旋CT的发展普及，三维图像重组技术在影像诊断中的价值日益得到重视。本文旨在通过分析PI在多层螺旋CT（MDCT）肺容积再现（Volume rending，VR）图像上的不同表现，以及多平面重建（Multiple planner reconstruction，MPR）对胸膜相关切迹征（Nodule notch due to pleural indentation，NNPI）[7]在良、恶性肺结节中显示的不同比例，指导鉴别诊断。……