肺尖癌的影像学诊断

Imaging diagnosis of carcinoma of apex pulmonis

目的探讨胸部X线片和CT扫描对肺尖癌的影像学诊断,以及指导临床治疗的意义。方法对11例经病理和临床证实为肺尖癌患者的胸片和CT资料进行对比分析。结果11例(团块型10例,胸膜增厚型1例)癌灶,胸片发现10例,确诊6例,提示占位1例,误诊为肺结核3例,漏诊1例。CT扫描确诊9例,提示肺尖占位2例。癌灶对相应背肋或/及胸椎受侵破坏:胸片发现5例,CT发现7例。癌灶向胸腔入口蔓延的软组织肿块和纵隔淋巴结转移:胸片和CT分别发现3例。结论胸片(多相)检查是发现和诊断肺尖癌的首选和最基本方法,CT是胸片检查的有效补充。CT扫描在肺尖癌的发现、诊断以及评估癌灶对周围组织侵犯程度等方面均优于胸片。一些被发现而无法定性的癌灶,采用经皮肺内肿块穿刺活检比纤支镜检更具有确诊价值。

Objective To explore X-ray and CT scanning in diagnosis of carcinoma of apex pulmonis. Methods X-ray and CT findings of eleven patients with carcinoma of apex pulmonis were analyzed. Results Of eleven cases, ten cases were found and six were confirmed in X-ray plan. Three cases were misdiagnosed as pulmonary tuberculosis and one was missed. Nine cases were confirmed in CT scanning. X-ray plan showed ribs of back or/ and thoracic vertebrae invaded in five cases, and CT scanning showed that in seven cases. Soft tissue mass and metastasis of mediastinal lymph node were found by X-ray or CT scanning in three cases, respectively. Conclusion X-ray plan is the first choice and primary method. CT scanning is superior to X-ray in diagnosis of carcinoma of apex pulmonis. The puncture and biopsy of mass in lung can provide more valuable informations for confirmed diagnosis.