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中央型肺癌粒子植入术前MRI分型及临床应用分析

邢刚   

  1. 天津市泰达医院
  • 收稿日期:2010-12-06 修回日期:2011-01-19 出版日期:2011-07-15 发布日期:2011-07-15
  • 通讯作者: 邢刚

Preoperative Evaluation of MRI in the Central Bronchial Carcinoma With 125I Seeds Implantation

Gang XING   

  • Received:2010-12-06 Revised:2011-01-19 Published:2011-07-15 Online:2011-07-15
  • Contact: Gang XING

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摘要： 目的 建立中央型肺癌125I粒子植入治疗术前MRI病变分型模式，探讨该模式临床应用价值。 方法 44例中央型肺癌125I放射性粒子植入治疗的患者均进行胸部MRI检查。基于肿瘤靶区定位、手术方案选择、规避穿刺风险等临床需要，结合对中央型肺癌瘤体信号、瘤体并发症、支气管异常、纵隔淋巴结转移、纵隔瘤体蔓延、心脏大血管侵犯，以及胸膜胸壁受累等MRI异常表现，借鉴TNM分期经验，对中央型肺癌进行术前MRI病变分型，关注分型对临床应用的价值。结果 类圆形瘤体31例，不规则形13例，29例为T1WI等信号，T2WI高或等信号，15例出现出血或液化坏死改变；胸壁侵犯12例；肺不张34例，不张边缘12例平直，22例内陷，17例横S征；叶支气管受累18例，主支气管15例，气管13例，呈瘤体与气道呈相贴、压迫、浸润、腔内占位、截断等多种表现；肺门及纵隔淋巴结异常115例，按照短径大小及部位分类统计；心血管侵犯25例，主要表现为相贴、压迫、浸润，以及瘤栓形成。结论 中央型肺癌粒子植入术前MRI病变分型模式的建立，对术前准确勾画肿瘤靶区，选择合适穿刺部位，决定手术方案，以及界定手术风险具有重要临床价值。是粒子治疗中TNM分期的重要补充。

关键词: 中央型肺癌, MR, 放射性核素, 125I粒子

Abstract: Objective To establish MRI evaluation mode of the tumor (preoperative grouping)in the therapy with interstitial implantation of 125I seeds for central bronchial carcinoma before operation, and to estimate its clinical value. Methods 44 cases central bronchial carcinoma were randomly selected since 2005, which are treated with the particl e 125I therapy. All cases were performed by MRI. On the basis of the clinical requirment of selection of the implantation plan, orientation of the mass target, and the avoidance of the puncture risk, to summarize and analyse the mass signal, mass complications, bronchus abnormal features, metabasis of the hilar and mediastinal lymph nodes, mediastinal invasion, cardiac and vascular invasion, as well as chest wall involved. Results Most of them show oval or irregular shape, equal signal on T1WI, equal or high signal on T2WI. some of them, blood and necrosis in tumor can be found. Adjacent structures can be involved. Conclusion Preoperative grouping of the therapy with interstitial implantation of 125I seeds for central bronchial carcinoma is very valuable for the orientation of the mass target, localization of the puncuture, confirmation of the modus operandi, as well as making sure of the risk in the operation.

Key words: central bronchial carcinoma, MR, Radioactive Nuclide, 125I seeds