肺大细胞癌的CT诊断价值

CT diagnostic value of large cell lung carcinoma

目的:探讨肺大细胞癌(LCLC)的CT表现。方法:回顾分析经手术病理证实的LCLC15例的CT表现;10例采用常规CT;5例采用多层螺旋CT(MSCT)检查。结果:15例LCLC均为周围型,肿块多位于肺外围周边部,肿块平均4.5cm×5.5cm,肿块呈圆形、类圆形或欠规则形;13例边缘大部分光滑,浅分叶,周边少许小棘状突起,其密度欠均匀;2例边缘光滑,密度均匀;1例肿块内见多发细砂粒样钙化灶;1例形成厚壁空洞;1例形成薄壁空洞,见典型“空气半月征”;9例增强后肿块实质部分欠均匀轻中度强化,2例较均匀强化,1例环形强化,3例MSCT增强后60s肿块边缘及实质内见点状血管样强化;10例纵隔或同侧肺门淋巴结肿大;4例肿块侵犯胸膜,2例见胸膜凹陷征;MPR可以准确显示肿块的空间特征,准确了解肿块周围肺野及胸膜的关系。结论:CT特别是MSCT平扫及增强扫描,结合多平面重组(MPR)对LCLC的诊断具有重要价值。

Objective： To explore CT features of large cell lung carcinoma （LCLC）. Methods： CT findings in 15 cases of LCLC confirmed by surgery and pathology were retrospectively analyzed. Imaging were obtained by whole body CT in 10 eases and multi-slice spiral CT （MSCT） in the others, Results： The lesions were all presented as peripheral. Most of them were located in peripheral areas with a mean size of 4.5cm×5.5cm, which presented as round, oval or irregular in shape. The features of shallow lobulation, smooth margin, spicule-like process and heterogeneous density existed in 13 cases, and smooth margin homogenous density in 2 eases, 1 ease showed internal grit-like calcification, 1 ease showed thick-wall cavities and 1 case showed thin-wall with typical ＂air-crescent sign＂. After contrast moderately heterogeneous enhancement of solid portion existed in 9 cases, homogenous enhancement in 2 cases and ring-shaped enhancement in 1 case. Three cases demonstrated punctiform vascular-like enhancement in the edge and solid portion after 60 seconds enhanced MSCT. Lymph node enlargement in mediastinum or hilum of the same side in 10 cases, pleural involed in 4 cases, ＂pleural indentation sign＂ existed in 2 cases. Multiple planar reconstruction （MPR） could exactly display the mass spatial characteristic and relationship with normal lung field and pleura. Conclusion： Plain and enhanced CT（especially MSCT） with MPR were valuable methods to the diagnosis of LCLC.