煤工尘肺小结节HRCT及病理相关性探究.docVIP

煤工尘肺小结节HRCT及病理相关性探究 　 作者:陈步东，马大庆，关砚生，张岩松 【摘要】 目的 研究煤工及煤工尘肺(CWP)患者小结节影的HRCT表现及病理基础。评价HRCT对CWP结节及尘斑的显示，进而探讨HRCT诊断CWP的可行性。方法 45例煤工尘肺和煤尘接触者（生前X线胸片诊断无尘肺37例，0+期3例，Ⅰ期5例）的尸检离体肺脏行尘肺病理诊断，其中32例采用Heitzman法固定、充气干燥制成充气固定肺标本，进行冠状位MSCT／SSCT及HRCT扫描。选取13例肺标本的18片厚切片进行厚度为80～150μm的大切片制作。大切片后剩余的薄片进行5μm组织学切片。图像分析：(1) 结节数量，分0～4级；（2）结节分布范围，分0～3级；（3）结节类型，分圆形结节、模糊结节和星芒状结节。并记录小结节的分布特点及其与肺小叶固有结构的关系。结果 (1) 尸检病理诊断：CWP26例(Ⅰ期7例、Ⅱ期17例、Ⅲ期2例)，无CWP 19例。45例接尘工人尸检肺脏的尘肺病理诊断分期与其生前胸片诊断分期差异有显著性（χ2=4.9，P＜0.05）。（2）32例离体肺标本的HRCT图像均显示有结节存在，病理证实其中29例有结节存在。HRCT对结节的显示与病理所见差异无显著性（χ2=0.5，0.25＜P＜0.5）。结论 （1）X线胸片诊断煤工尘肺和病理诊断间差异有显著性，胸片对早期尘肺的诊断率较低。（2）HRCT对煤工尘肺的诊断与病理诊断差异无显著性，优于胸部X线片。 【关键词】 肺；尸体肺；结节；体层摄影术；X线计算机；高空间分辨率算法；病理 Correlative study between the HRCT and pathology for the nodules of coal worker pneumoconiosis 【Abstract】 Objective The purpose of the study was to assess the appearances of high-resolution computed tomography (HRCT) and pathologic features of nodules of coal worker or coal worker pneumoconiosis (CWP) and to evaluate the display of small nodules of CWP and dust speckle on HRCT，then to discuss the feasibility of HRCT diagnosing pneumoconiosis at the early stage.Methods Forty five entire lung specimens were available from autopsy of the patients with CWP and occupational exposure to coal dusts．They comprised 37 cases without CWP，3 cases with 0+ stage and 5 cases with Ⅰ stage.Thirty two lung specimens were inflated and fixed by Heitzmans method，and undergone coronal single slice computed tomography (SSCT)／multi-slice computed tomography (MSCT) and HRCT scans．Gross specimens section (50～100μm slice thickness) and histologic section(5μm～8μm slice thickness) were performed on eighteen piece of 10mm-thickness slices of lung specimen in thirteen cases.Images analysis：(1) The amount of nodules，divided 0～4 grade；(2) Distribution of nodules，divided 0～3 grade.Results (1) Pathologic diagnosis of lung specimens： CWP were diagnosed in 26 cases including 7 cases with Ⅰ stage CWP，17 cases with Ⅱ stage CWP and 2case