肺内孤立性炎性结节的CT表现及其鉴别诊断探讨(附30例分析)

CT differential diagnostic study of solitary lung inflammatory nodule (report of 30 cases)

目的探讨孤立性肺炎性结节和肺癌性结节的CT表现,以提高CT对孤立性肺结节(SPN)定性诊断的正确性。方法分析经CT导引下肿块穿刺活检、手术病理及临床治疗证实的SPN 30例。结果肺炎性结节2 0例,肺癌性结节10例。肺炎性结节CT表现为形状不规则5 5 % ,圆形或类圆形4 5 % ,病灶边缘模糊或部分清楚,部分模糊6 0 % ,边界清楚39% ,密度不均匀6 0 % ,内部有钙化者13% ,胸膜粘连者4 0 % ,结节中强化后CT值大于2 0HU者占30 % ,15例经抗炎治疗,12例治疗1～3周病灶吸收,3例治疗1个多月才吸收。肺癌性结节CT征象形态不规则70 % ,斑点状钙化30 % ,分叶多且深80 % ,短细毛刺70 % ,胸膜凹陷征4 0 % ,其内空泡征30 % ,血管截断征或集束征6 0 % ,结节中强化后CT值大于2 0HU者占70 %。结论CT是鉴别肺内孤立性炎性结节和肺癌性结节的一种理想的检查方法,对多数肺结节可以正确诊断。

Objective:To study CT findings of solitary lung inflammatory nodule and lung carcinoma nodule in order to improve the diagnostic accuracy.Methods:CT-guided percutaneous transthoracic needle biopsy and surgical-pathology and proved by clinical of 30 cases. (solitary lung inflammatory nodule 20 cases;solitary lung carcinoma nodule 10 cases).Results:CT findings of solitary lung inflammatory nodule: irregular nodule (55%), spheroidal nodule similar to sphere (45%),nodule with blurred margin or part of margin well-defined (60%),nodule with clearly margin (39%),nodule with inhomogeneous density (60%), calcification inside the nodule (13%),nodule with pleural adhesion (40%). The growth of CT value after enhancement more than 20HU (30%) .Among the 15 cases with the treatment with antibiotics, nodules were resolved in 1～3 weeks (12 cases), nodules were resolved after one month 3 cases,CT-findings of solitary lung carcinoma nodule :irregular nodule(70%),mottling calcification inside the nodule (30%),lobulation (80%),fine speculation (70%),pleural tail (40%),vacuolole sign (30%),vessel convergence (60%) of the nodules ,the growth of CT value after enhancement more than 20HU (70%).Conclusion:CT is one of the best examine methods to differentiating the nature of solitary lung inflammatory nodule and lung carcinoma nodule and can make mostly correct diagnose between the two.