周围型肺癌与炎性结节多排螺旋CT影像征象对比分析
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摘要
目的探讨周围型肺癌与炎性结节多排螺旋CT(MSCT)影像征像差异。方法回顾性分析经MSCT检查,经手术病理或随访证实的周围型肺癌与炎性结节病例48例,对照分析病灶MSCT征象。结果周围型肺癌26例,其中腺癌21例,鳞癌4例,类癌1例;炎性结节22例,其中炎症或局灶性机化性肺炎16例,结核4例,隐球菌感染2例。周围型肺癌MSCT征象,分叶征、空泡征、密度不均匀、细支气管充气征、细小毛刺征、胸膜凹陷征和棘状突起出现率均高于炎性结节,其中分叶征、空泡征出现的概率差异有统计学意义(P<0.05),隐球菌感染2例均出现晕征。结论分叶征、空泡征、细支气管充气征、棘状突起和胸膜凹陷征可一定程度上提示周围型肺癌,晕征对隐球菌感染有重要意义,正确认识这些征象可提高诊断的准确性。
Objective To investigate the difference of MSCT signs between peripheral lung cancer and inflammatory nodules. Methods Forty eight cases of peripheral lung cancer and inflammatory nodules confirmed by operation and pathology or follow-up were retrospectively analyzed by multi-slice spiral CT(MSCT). The MSCT signs of the lesions were compared and analyzed. Results There were twenty-six cases of peripheral lung cancer, including adenocarcinoma 21 cases, squamous cell carcinoma 4 cases, carcinoid 1 case; and there were twenty-two cases of inflammatory nodules, including inflammation or focal organic pneumonia 16 cases, tuberculosis 4 cases, cryptococcal infec-tion 2 cases. The lobulation sign, vacuole sign, uneven density, bronchiolo inflatability sign, fine burr sign, pleural in-dentation sign and spinous process of peripheral lung cancer were higher than those of inflammatory nodules in MSCT.The probability of occurrence of lobulation sign and vacuole sign was statistically significant(P<0.05), and the halo sign was found in all cases of cryptococcal infection. Conclusion CT findings including lobulation sign, vacuole sign,bronchiolo inflation sign, spinous process and pleural indentation sign are helpful in differentiating peripheral lung cancer from inflammatory nodules. Halo sign is important for diagnosis of cryptococcal infection. The diagnostic accu-racy can be improved by understanding these signs.
Objective To investigate the difference of MSCT signs between peripheral lung cancer and inflammatory nodules. Methods Forty eight cases of peripheral lung cancer and inflammatory nodules confirmed by operation and pathology or follow-up were retrospectively analyzed by multi-slice spiral CT(MSCT). The MSCT signs of the lesions were compared and analyzed. Results There were twenty-six cases of peripheral lung cancer, including adenocarcinoma 21 cases, squamous cell carcinoma 4 cases, carcinoid 1 case; and there were twenty-two cases of inflammatory nodules, including inflammation or focal organic pneumonia 16 cases, tuberculosis 4 cases, cryptococcal infec-tion 2 cases. The lobulation sign, vacuole sign, uneven density, bronchiolo inflatability sign, fine burr sign, pleural in-dentation sign and spinous process of peripheral lung cancer were higher than those of inflammatory nodules in MSCT.The probability of occurrence of lobulation sign and vacuole sign was statistically significant(P<0.05), and the halo sign was found in all cases of cryptococcal infection. Conclusion CT findings including lobulation sign, vacuole sign,bronchiolo inflation sign, spinous process and pleural indentation sign are helpful in differentiating peripheral lung cancer from inflammatory nodules. Halo sign is important for diagnosis of cryptococcal infection. The diagnostic accu-racy can be improved by understanding these signs.
引文
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[14]Seemann MD,Staebler A,Beinert T,et al.Usefulness of morphological characteristics for the differentiation of benign from malignant solitary pulmonary lesions using HRCT[J].Eur Radiol,1999,9(3):409-417.
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[16]Edey AJ,Hansell DM.Incidentally detected small pulmonary nodules on CT[J].Clin Radiol,2009,64(9):872-884.
[17]谢汝明,吕岩,周新华,等.肺内孤立结节周围病灶的HRCT特征[J].中国医学影像技术,2010,26(6):1104-1107.
[18]乔鹏岗,李珊珊,周娟,等.螺旋CT多平面重建诊断周围型肺癌的价值[J].中国医学影像学杂志,2009,17(1):22-24.
[19]强永乾,郭佑民,王秋萍,等.基于Web平台孤立性肺结节影像计算机辅助诊断的研究[J].西安交通大学学报(医学版),2011,32(3):367-370.
[2]Swensen SJ,Viggiano RW,Midthun DE,et al.Lung nodule enhancement at CT:multicenter study[J].Radiology,2000,214(1):73-80.
[3]Rosadodechristenson ML,Templeton PA,Moran CA.Bronchogenic carcinoma:radiologic-pathological correlation[J].Radiographics,1994,14(2):429-446.
[4]Qiang JW,Zhou KR,Lu G,et al.The relationship between solitary pulmonary nodules and bronchi:multi-slice CT-pathological correlation[J].Clin Radiol,2004,59(12):1121-1127.
[5]Winer-Muram HT.The solitary pulmonary nodule[J].Radiology,2006,239(1):34-49.
[6]Xu DM,vanKlaveren RJ,deBock GH,et al.Limited value of shape,margin and CT density in the discrimination between benign and malignant screen detected solid pulmonary nodules of the NELSON trial[J].Eur J Radiol,2008,68(2):347-352.
[7]李琼,刘士远,范丽,等.3 cm以下肺恶性局灶性磨玻璃密度病变的MDCT表现[J].实用放射学杂志,2011,27(5):689-693.
[8]Henschke CI,Yankelevitz DF,Mirtcheva R,et al.CT screening for lung cancer:frequency and significance of part-solid and non-solid nodules[J].Am J Roentgenol,2002,178(5):1053-1057.
[9]Trigaux JP,Gevenois PA,Goncette L,et al.Bronchioalveolar carcinoma:computed tomography findings[J].Eur Respir J,1996,9(1):11-16.
[10]张志勇,周康荣,洪应中.胸膜凹陷征的病理基础及其HRCT诊断价值[J].实用放射学杂志,1996,12(11):645-649.
[11]张志勇,周康荣,洪应中,等.良、恶性胸膜凹陷征的HRCT表现[J].实用放射学杂志,1997,13(9):517-519.
[12]周洪彬,郑宇,郑晓涛,等.孤立局灶型机化性肺炎的螺旋CT评价[J].实用医学影像杂志,2011,12(4):211-213.
[13]玉林,徐忠飞,汗国余,等,肺隐球菌CT表现与临床病理特征分析[J].医学影像学杂志,2010,20(2):172-175.
[14]Seemann MD,Staebler A,Beinert T,et al.Usefulness of morphological characteristics for the differentiation of benign from malignant solitary pulmonary lesions using HRCT[J].Eur Radiol,1999,9(3):409-417.
[15]Siegelman SS,Zerhouni EA,Leo FP,et al.CT of the solitary pulmonary nodule[J].Am J Roentgenol,1980,135(1):1-13.
[16]Edey AJ,Hansell DM.Incidentally detected small pulmonary nodules on CT[J].Clin Radiol,2009,64(9):872-884.
[17]谢汝明,吕岩,周新华,等.肺内孤立结节周围病灶的HRCT特征[J].中国医学影像技术,2010,26(6):1104-1107.
[18]乔鹏岗,李珊珊,周娟,等.螺旋CT多平面重建诊断周围型肺癌的价值[J].中国医学影像学杂志,2009,17(1):22-24.
[19]强永乾,郭佑民,王秋萍,等.基于Web平台孤立性肺结节影像计算机辅助诊断的研究[J].西安交通大学学报(医学版),2011,32(3):367-370.