【作者】 聂永康；

【导师】 蔡祖龙；

【作者基本信息】 军医进修学院 ， 影像医学， 2001， 博士

【摘要】 第一部分：肺癌肿瘤发生部位的分析 目的：评价肺癌患者中中央型肺癌所占的比例、组织学类型以及临床分期， 为肺癌筛选方案的制订提供依据。材料与方法：对1999年1月～2001年1 月815例病例资料完整者进行回顾性分析，根据肿瘤发生部位将肺癌分为 中央型、周围型、弥漫型或原因不明型三种，757例病人为病理组织学诊 断，58例为临床诊断。结果：815例肺癌中，有吸烟史者568例(69.7%)， 其中男性547例(96.3%)，>45岁者492例(86.6%)。568例吸烟者肺癌 中，中央型肺癌328例，占58%，其中鳞癌198例(60%)，小细胞癌85 例(26%)：周围型肺癌202例，占36%，其中腺癌118例(（58%)，鳞癌54 例(27%)。中央型肺癌临床分期为1期 16例(4%)Ⅱ期 67例(15%)，ⅢA 期98例(24%)，ⅢB～Ⅳ期234例(57%)。结论：吸烟者肺癌患者中，中 央型肺癌占58%，大多数在诊断时已为晚期，在肺癌筛选试验设计中应注 重中央型肺癌的早期检出。 第二部分：低剂量多层面螺旋CT不同参数对段及亚段支气管显 示的影响 目的：描写薄层MSCT正常亚段支气管解剖及其变异，比较不同层厚、不 同管球电流对段及亚段支气管显示的影响，建立MSCT显示段与亚段支气 管的最什扫描程序。材料与方法：(1)对50例健康志愿者亚段支气管CT 影像进竹分析，检查采用LightSpeed Plus多层面螺旋CT扫描机，螺旋扫 描模式，扫描参数为：120 Kv,50mA,螺距6，床速15mm/转，0.8/转，2.5mm 层厚，2.5mm间隔重建，山两位放射医师在监视器上以电影显示方式对图 像进行观察。(2)将90例健康志愿者随机分为3组，每组30人，分别采 I 解放军总医院 军医进修学院 博十学位论文用三种扫描程序检查，A组，螺距 3，床速 15mm／转，重建层厚 10mm，间隔 10mm；B组，螺距 6，床速 30mm／转，重建层厚 smm，间限 smm；C组，螺距 6，床速 15mm／转，重建层厚 2．smm，间隔 2．smm。对三组段与亚段支气管显示率采用 SPSS软件包进行X‘检验统计学分析。3）将健康体检者20人采用不同管球电流（50mA，20mA）分别进行两次检查，其余参数同（l），山三位放射医师对图像质量进行评价。结果：50例健康者亚段支气管共2150支，CT显示2038支，显示率95％。A组、B组、C组段支气管显示率分别为 740、98o、100o，亚段支气管显示率分别为 28o、65o、95o。B组段支气管显示率明显高于A组（P＜0．of）。C组亚段支气管显示率明显高于A组及B组（P＜0．O！）。管球电流5 om0mA与20mA相比，图像质量无显著性差异。结论：采用螺距6，40mAS管球电流，2．smn层厚重建图像可以清晰显示段及亚段支气管。该方法可用于对咯血病人及肺癌高危人群筛选检合。第三部分：低剂量螺旋CT早期肺癌筛选初步研究日的：评价低剂量螺旋CT肺癌高危人群筛选检查对早期肺癌的检出率。材料与方法：对无症状300例体检者胸片及CT进行前瞻性研究，纳入标准为年龄45岁以上，吸烟IO年包以上，或既往有慢性阻塞性肺疾病病史，以前无癌症史，身体状况适合手术治疗者，低剂量CT扫描采用 Philip SR7000及 GE Lightspeed Plus多层面 CT扫描机，螺旋扫描力式，120kV， 50mA，重建层厚smm／25mm，间隔smm／2．smm，图像山两位放射医师在工作站显示器上以电影显示方式观察，存储至PACS系统，对胸部CT检出病变进行 3～6个月短期随诊。结果；低剂量 CT共检出 56例 （ 9％）非钙化结节（其中恶性4例），胸片检出9例（3％）（其中恶性3例），均为1期病变。低剂量 CT检出D支气管或段支气管病变 9例门％），其中早期中央型肺 二 解放军总＊ 皖 丫 ［X进修学院 博卜于仿论文 癌 3例（l％），病理证实 1例小细胞肺癌，2例鳞癌，胸片均未检出。结论： 初步筛选研究结果表明低剂量多层面螺旋CT明显提高了对肺内非钙化小 结节及支气管细微病变的检出，可检出早期可治愈肺癌。 第四部分：中央型肺癌早期CT诊断与鉴别诊断：与支气管镜及 病理组织学表现对照 目的：研究中央型肋癌早期CT表现及其病理学基础，并评价CT在鉴别诊 断中的作用。材料与方法：对17例病理证实的早期中央型肺癌及10例类 似中央地月癌的良件 病变进行分析，CT采用SR7000及／或Li吵tspeed Plus更多还原

【Abstract】 Part 1 Analysis of tumor location in lung cancerPurpose: To assess the frequency of central bronchogenic carcinoma in all lungcancer, analyze histopathologic type and clinical stage of central lung cancer andprovide evidence for designing clinical trials of screening early lung cancer.Materials and Methods: we retrospectively reviewed the clinical records of 815inpatients with bronchogenic carcinoma between 1999～2001. According to thelocation of tumor origin, lung cancer was classified into three types, includingcenitral, peripheral and diffuse or unknown cause. Rcsults: Among 815 patientswith bronchogenic carcinoma, there were 568(69.7%) patients with history ofsmoking, male 547(96.3%), 492 patients(86.6%) older than 45 years old. Insmoking patients, there were 328(58%) patients with central lung cancer(squamous cell carcinoma 198(60%), small ce1l lung cancer 85(26%)), 202patiens with peripheral lung cancer(adenocarcinoma 118(58%), squamous cellcarcinoma54(27%)). Clinical stage of central lung cancer included 16 cases withstage Ⅰ, 67 cases with stage Ⅱ, 98 cases with stage ⅢA and 234 cases withstageⅢ/Ⅳ. Conclusion: Centhel bronchogenic carcinoma accounted for 58%of all smoking paients with lung cancer and the majority of these patients wereadvanced stage at diagnosis. We put emphasis on the early detection of centrallung cancer in design of clinical screening trial.Part 2 Visualization of segmental and subsegmental bronchi:effect of different parameters with low dose multi-slicc CTPurpose: To delineate normal subsegmenta bronchi anatomy and varation onthin-section multi-slice CT (MSCT ) and compare the effect of visualization ofbronchi with different thickness and different tube currents so as to establish theoptimal protocol in depicting segrnental and subsegmental bronchi wth low dosemulti-slice CT Method8 and Materials: (l) Thin-section MSCT images of 50volunteers were evaluated on workstation monitor’ CT scans were perfOrmedwith GE Lightspeed Plus multi-slice scanner using spiral mode, l20Kv, 50mA,l5mm/rotation, 0.8s/rotation, 2.5mm collimation and pitch 6:l to produce2.5mm thick image at 2.5mm increments. (2) 90 consecutive symPtom-freevolunteers were divided into 3 groups at random. GrouP A(n=30) was scannedwith protocol l, high quality mode, l5mtn/rotation, l0mm thicAnessreconstruction, 40mAs, group B(n=30) with protocol 2, high speed mode,30mm/rotation, 5mm thickness reconstruction, 40mAs, group C(n=30) withprotocol 3, high speed mode, l5mm/rotation, 2.5mm thickness reconsttuction.Monitor evalwtion was perfOrmed by three radiologists. Rcsults: 2038subsegmental bronchi of 50 volunteers were identified, which accounted for 95%of all subsegmental bronchi. The frequencies of visualization of segmentalbronchi were 74%, 98%, l00% and that of subsegmental bronchi were 28%,65%. 95% in group A, group B and group C, respectively. Group C hassignificantly higher percentage in visualization of subsegmental bronchicompared with group A and group B (P<0.0l ), Group B with significant higherpercentage in visuaIizing segmefltal bronchi than group A (P<0.0l ).Conclusion: Low dose MSCT with pitch 6, 40mAs, 2.5mm thick reconstructionscans can enhance our ability to evaluate the abnorn1ality of the segmental andsubsegmental bronchi wall and lumen, Which has a potential role as a screeningmethod fOr patients with hemoptysis and people at high risk of lung cancer.Part 3 Early lung cancer screening: preliminary study withlow-dose spiral CTPurpose: To evaluate prevalence rate of pulmonary malignant disease detectedby low-dose spiral CT screening in People at high risk of lung cancer. MatcriaIsand methods: Low-dose MSCT scans and chest radiograPhs of 300 symptom-free volunteers from an on-going screening Study were prospectively evaluated.The study has enrolled 240 smokers, aged 45 years or older, with at least l0pack-years of cigarettC smoking and 60 individu更多还原