刘加良 陈文宇 吕晓东 方志仙 沈陆斐 孙延豹 杨芝萍 刘倬达

[摘要] 目的 探討应用64排肺部螺旋CT后处理重建技术诊断肺原位腺癌的临床价值。 方法 选择2016年1～12月间经我院胸外科手术确诊为肺原位腺癌的78例患者术前胸部CT后处理重建影像资料进行研究，并分析肺原位腺癌经CT后处理重建后的影像学特征。 结果 影像表现为不均磨玻璃结节样病灶72例，不均实性结节6例。病灶分布：右上尖段2例、右上后段14例、右上前段9例、右中外侧段9例、右中内侧段2例、右下背段3例、右下前基底段3例、右下外基底段3例、右下后基底段3例、左上尖后段10例、左上前段8例、左上舌段4例、左下背段3例、左下前基底段1例、左下外基底段3例、左下后基底段1例。64排螺旋CT后处理重建比普通胸部CT平扫在对肺小结节的细微结构观察上具有显著性的差异。尤其是在边缘毛刺征、周围花瓣征、空泡征、胸膜凹馅征和周围不规则等方面，差异有高度统计学意义（P<0.01）。 结论 64排螺旋CT后处理重建技术能更清晰地了解肺小结节的细微影像改变，并为肺小结节良恶性的判断及手术决策提供重要的影像学依据。

[关键词] 胸部CT；后处理重建技术；肺结节；肺原位腺癌

[中图分类号] R445.3 [文献标识码] B [文章编号] 1673-9701（2018）30-0112-04

[Abstract] Objective To investigate the clinical value of 64-slice pulmonary spiral CT post-processing reconstruction technique in the diagnosis of lung adenocarcinoma in situ. Methods Preoperative chest CT post-processing reconstruction data of 78 patients with pulmonary adenocarcinoma in situ from January to December 2016 were studied. The imaging features of post-processing reconstruction of pulmonary adenocarcinoma in situ were analyzed. Results The images showed uneven ground glass nodular lesions in 72 cases and uneven solid nodules in 6 cases. Distribution of lesions： 2 cases in the right upper tip Segment， 14 cases in the right upper posterior segment， 9 cases in the right upper anterior segment， 9 cases in the right middle outer segment， 2 cases in the right middle inner segment， 3 cases in the right lower back segment， 3 cases in the right lower anterior basal segment， 3 cases of right lower outer basal segment 3 cases of right lower back basal segment， 10 cases of left upper posterior segment， 8 cases of left upper anterior segment， 4 cases of left upper tongue segment， 3 cases of left lower back segment， 1 case of left lower anterior basal segment， 3 cases of left lower outer basal segment， and 1 case of left lower posterior basal segment. The 64-slice spiral CT post-processing reconstruction had a significant difference in the fine structure observation of the small pulmonary nodules compared with the ordinary chest CT plain scan， especially in the edge burr sign， surrounding petal sign， vacuole sign， pleural recession and surrounding irregularities， the difference was highly statistically significant（P<0.01）. Conclusion The 64-slice spiral CT post-processing reconstruction technique can more clearly understand the subtle image changes of small pulmonary nodules， and provide an important imaging basis for the judgment of benign and malignant pulmonary nodules and surgical decision-making.

[Key words] Chest CT；Post-processing reconstruction technique；Pulmonary nodules；Lung adenocarcinoma in situ

近年来，肺癌发病率呈逐渐上升趋势，最新研究数据显示，肺癌已成为全国发病第一位的恶性肿瘤，也是全国死亡第一位的恶性肿瘤[1]。由于肺癌早期症状隐匿，只有进展到一定程度才会出现临床症状，这导致多数肺癌患者就诊时已处于中晚期，因此肺癌预防应该主动从人群中选择高发病风险人群以保证多数人有机会接受适当的防治措施[2-3]。低剂量……