The relationship between solitary pulmonary nodules and bronchi: multi-slice CT-pathological correlation

AIM: To investigate the relationship between solitary pulmonary nodules (SPN) and bronchi and its value in predicting the nature of the SPN. MATERIALS AND METHODS: We performed volumetric targeted scans of 0.5 mm collimation with multi-slice computed tomography (MSCT), reconstructing multiplanar reconstructions (MPR), curved multiplanar reconstructions (CMPR) and surface-shaded display (SSD) images of bronchi in 78 consecutive patients with SPN (53 malignant and 25 benign) and correlated the findings with those of macroscopic and microscopic specimens. RESULTS: With this CT protocol, the third to seventh-order bronchi were shown continuously and very clearly in all patients. CT findings were consistent with those of specimens. CT demonstrated the relationship between the SPN and bronchi in 46 (86.8%) malignant and 18 (75.0%) benign nodules. Five types of tumour-bronchus relationships were identified with MSCT. Type 1: the bronchus was obstructed abruptly by the SPN; type II: the bronchus penetrated into the SPN with tapered narrowing and interruption; type III: the bronchial lumen shown within the SPN was patent and intact; type IV: the bronchus ran around the periphery of the SPN with intact lumen; type V: the bronchus was displaced, compressed and narrowed by the SPN. Malignant nodules were most commonly of type I (58.5%), secondly of type IV (26.4%) and rarely of type V (1.9%). Benign nodules were most often of type V (36.0%), followed by type III (20.0%), type I (16.0%), and there were no type II. Types I, II and IV were more common in malignant nodules, whereas type V was seen more frequently seen in benign nodules (p < 0.05). There was no statistically significant difference between the two groups regarding type III. CONCLUSION: Ultra-thin section with MSCT and MPR, CMPR and SSD reconstruction can improve the demonstration of the patterns of tumour-bronchus relationships, which can reflect the pathological changes of the nodules to some extent and help differentiate malignant from benign tumours. (C) 2004 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.