CT诊断孤立性肺结节

CT in diagnosing solitary pulmonary nodulus

目的 回顾分析孤立性肺结节病灶的CT表现 ,提高诊断和鉴别诊断水平。方法 选择孤立性肺结节病灶 4 0例 ,自肺尖向肺底连续CT平扫 ,层厚 10mm ,间隔 0 ,行 1 5mm层厚病灶重建。增强扫描使用非离子型对比剂 10 0ml,经肘静脉推注 ,速率 2～ 3ml/s。结果 病灶位于右肺 2 8例 (70 % ) ,下叶 2 3例(5 7 5 % ) ;结节病灶为圆形 14例 (35 % ) ,类圆形 11例 (2 7 5 % ) ,不规则形 15例 (37 5 % ) ;病灶边缘可见分叶征 14例 ,切迹征 5例 ,长毛刺征 10例 ,短毛刺征 12例 ;病灶密度均匀 15例 ,不均匀 2 5例 ,其中 9例内部可见钙化 ;恶性病灶注入对比剂后 30s开始强化 ,2min达峰值 ,CT值较平扫平均上升 4 1Hu ,而良性病灶注入对比剂后 30s无强化 ,且无明显峰值 ,CT值较平扫上升小于 2 0Hu。结论 掌握病灶的分布、形态、边缘性状、密度及增强前后变化等特征 ,有助于提高结节病灶的定性诊断。

Objective To retrospectively analyze the CT appearance of solitary pulmonary nodulus in order to improve the knowledge of diagnose and differential diagnosis.Methods 40 cases of solitary pulmonary nodulus were chosen.From the apex to the base of lung,scanning was performed in 10mm sickness and 0mm gap,reconstruction was performed in 1.5mm sickness.Meanwhile non-ionic contrast agent was bolus injected at a speed of 2～3ml/s via cubital vein to enhance the scanning.Results 28 cases(70%) located in right lung,23 cases(57.5%) in lower lobe.14 caess(35%) of nodulus appeared round shape,11 cases(25.5%) elliptic,15 cases irregular.The edge presented lobulation(14 cases),incisure(5 cases),long spicule(10 cases) and short spicule(12 cases).15 cases of nodulus were homogeneous in density,and 25 cases were of heterogeneous,out of the latter calcification was seen in 9 cases.Enhancement began at 30 seconds and reached peak at 2 minutes after contrast medium was injected,and the value of CT elevated 41Hu in malignant lesions.While in benign lesions enither enhancement at 30 seconds nor peak was seen,and the value of CT only elevated less than 20Hu.Conclusion The knowledge of the distribution,shape,edge characters,density and changes after enhancement is helpful to the qualitative dagnosis of solitary pulmonary nodulus.