摘要
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.
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.
出处
《中华劳动卫生职业病杂志》
CAS
CSCD
北大核心
2014年第9期668-673,共6页
Chinese Journal of Industrial Hygiene and Occupational Diseases
关键词
尘肺
结节病
肺
体层摄影术
X线计算机
病理学
Pneumoconiosis
Sarcoidosis, Pulmonary
Tomography, X-ray computed
Pathology
