孤立性肺结节的多层螺旋CT表现与病理对照研究

Comparative study of MSCT and pathological findings of solitary pulmonary nodules

目的分析肺内不同病理的孤立性肺结节(SPN)的多层螺旋CT(MSCT)表现,探讨其对SPN定性诊断的价值。方法回顾性分析有明确病理学结果的SPN共45例,其中,良性16例,恶性29例,所有病例均行MSCT扫描与后处理,显示SPN的分布、形态及内部特征,并同病理结果相对照。结果 45例SPN的中,良性结节(良性组)包括炎性假瘤6例,结核球4例,错构瘤3例,隐球菌2例,血管内皮瘤1例;恶性结节(恶性组)包括腺癌21例,鳞癌3例,小细胞癌2例,肺泡细胞癌3例;良性结节组直径平均为2.1cm,恶性结节组直径平均为2.6cm;所有SPN位于肺内侧带5个、中间带12个、外侧带28个,相应部位恶性结节的百分比分别为40%(2/5)、50%(6/12)、75%(21/28),其分布总体差异有统计学意义(P<0.05);而恶性结节在肺部的上、下叶分布差异无统计学意义(P>0.05);结节的分叶、毛刺征、胸膜凹陷征、空泡及支气管气征、血管集束征的发生率,恶性组高于良性组(P<0.05),其中炎性假瘤和腺癌具有类似表现;对于SPN内出现钙化,结核球与错构瘤发生率高;空洞在肺结核和肺癌中出现比例高。结论 MSCT可以充分显示SPN的分布、边缘及内部形态特征,可以达到对良、恶性SPN的定性诊断,对指导临床治疗具有实用价值。

Objective To evaluate the diagnostic value of MSCT in Solitary Pulmonary Nodules （SPN） with different pathologic types .Methods Four-five SPN with pathological findings including 16 benign cases and 29 malignant cases were retrospectively an-alyzed ,and performed with MSCT scanning .Observation of the distribution ,morphology and internal characteristics of SPN by post-processing technique were done ,and the results were compared with pathological findings .Results Among 45 SPN ,the benign nodules included 6 cases of inflammatory pseudotumor ,4 cases of tuberculoma ,3 cases of hamartoma ,2 cases of cryptococcus and 1 case of hemangioendothelioma ,and the malignant nodules included 21 cases of adenocarcinoma ,3 cases of squamous carcinoma ,2 ca-ses of small cell carcinoma and 3 cases of alveolar cell carcinoma .Average diameter of benign nodules was 2 .1 cm ,and 2 .6 cm for the malignant nodules .All SPN ,including 5 cases in the inner zone ,12 in the medial zone and 28 in the lateral zone ,the percentages with malignant signs at the corresponding parts were 40% （2/5） ,50% （6/12） ,75% （21/28） ,there was significant difference be-tween distributions（P〈0 .05） .The distributions of malignant nodules in the upper and lower lung lobe had no significant difference （P〉0 .05）;the incidences of leaf sign ,burr sign ,pleural indentation sign ,cavitas and bronchial air sign ,blood vessels cluster sign of malignant nodules were higher than that of the benign nodules（P〈0 .05） ,and the inflammatory pseudotumor and adenocarcinoma owned similar characteristics ;the incidence of calcification in tuberculoma and hamartoma was high ,while cavitas in tuberculosis and lung cancer were high .Conclusion MSCT can sufficiently display the distribution ,morphology and internal characteristics of SPN , and can help make qualitative diagnosis of benign and malignant SPN ,providing great practical value in clinical treatment .