Chagnaud C, Bartoli J M, Magnan P E, Bereder J M, Guidicelli R, Fuentes P, Kasbarian M, Reboud E
Service de Chirurgie Thoracique, Hôpital Sainte-Marguerite, Marseille.
Ann Chir. 1990;44(2):125-8.
In order to evaluate the reliability of medical imaging methods in the assessment of mediastinal invasion by lung cancers, a prospective study was conducted in 30 patients undergoing preoperative computed tomography (CT), magnetic resonance imaging (MRI) and pulmonary digital subtraction angiography. MRI improved the sensitivity of detection of surgically confirmed mediastinal lymphadenopathy, but its specificity in relation to histological results was poor and identical to that of CT. In terms of extension to vascular structures, MRI and CT gave comparable results for the pulmonary artery and vein with two false positives for the pulmonary veins and left atrium with the two methods. MRI was found to be superior to CT for the detection of invasion of the aortic arch. Digital subtraction angiography is not as reliable as the other two modalities, particularly for extension to the pulmonary vein for which it was found to be technically inappropriate. By means of sagittal and frontal scans, MRI was therefore found to be more effective than CT for examination of the subcarinal region and aorto-pulmonary window. In contrast, the persistence of false positives with the two methods and the impossibility of distinguishing between inflammatory lymph nodes and neoplastic lymph nodes means that thoracotomy can never be contraindicated on the basis of the results of imaging alone.
为了评估医学成像方法在评估肺癌纵隔侵犯方面的可靠性，对30例接受术前计算机断层扫描（CT）、磁共振成像（MRI）和肺数字减影血管造影的患者进行了一项前瞻性研究。MRI提高了手术证实的纵隔淋巴结病的检测敏感性，但其与组织学结果相关的特异性较差，与CT相同。在血管结构受累方面，MRI和CT对肺动脉和静脉的结果相当，两种方法对肺静脉和左心房均有2例假阳性。发现MRI在检测主动脉弓侵犯方面优于CT。数字减影血管造影不如其他两种方法可靠，特别是在检测肺静脉受累方面，发现其在技术上不合适。通过矢状面和额状面扫描，发现MRI在检查隆突下区域和主动脉-肺动脉窗方面比CT更有效。相比之下，两种方法均存在假阳性，且无法区分炎性淋巴结和肿瘤性淋巴结，这意味着绝不能仅根据影像学结果就禁忌开胸手术。
