MSCT鉴别诊断肺门区炎性块影与中央型肺癌

Differential diagnosis of inflammatory mass of hilus pulmonis and central lung cancer with MSCT

目的回顾性分析肺门区炎性块影(HPIM)的多层螺旋CT(MSCT)征象,探讨其与中央型肺癌(CLC)的区别。方法对经手术病理或抗感染治疗证实的HPIM14例患者的MSCT回顾性重建,显示病灶与支气管树、中央血管及支气管动脉的关系,并与同期20例CLC做同等重建对比分析。结果HPIM组炎性假瘤支气管内见良性占位(4/6),彗星尾征(4/6),支气管黏液嵌塞(3/6),桃尖征(3/6);球形肺炎8例均未见支气管异常改变,短直边征(6/8),边缘模糊(5/8);中央血管及支气管动脉均显示正常或相对正常。CLC组支气管壁内外见肿瘤侵犯(19/20),长直边征(11/20),远肺门侧炎性渗出(12/20);增强薄层重建可区分肿瘤边界(15/20),中央血管见不同程度的受侵改变(19/20),支气管动脉异常(18/20),纵隔淋巴结肿大(15/20)。结论MSCT多征象综合分析并结合支气管及血管重建能较好地鉴别HPIM和CLC。

Objective To analyze the differential diagnosis of inflammatory mass of hilus pulmonis （HPIM） and central lung cancer （CLC） with MSCT. Methods MSCT images of 14 cases of HPIM and 20 cases of CLC confirmed pathologically or antimicrobially were enrolled. The source images of each case were reformatted to disclose the relationship of mass with bronchial tree, central pulmonary vessels （CPVs） and bronchial arteries （BAs）. Results HPIMs patients were composed of 6 cases of inflammatory pseudotumor （IPs） and 8 cases of spherical pneumonia （SPs）. IPs patients were detected occupying lesions in bronchuses （4/6）, mucoid impaction in bronchuses （3/6）, ＂comet tail＂ sign （4/6） and ＂peach-tip＂ sign （3/6）. SPs patients were revealed normal bronchuses （8/8）, ＂short straight margin＂ sign （6/8） and indefinite edge （5/8）. CPVs and BAs were found within normal ranges in HPIMs. By contrast, of 20 CLCs, 19 cases of exterior and interior of the bronchial walls and central vesseles were detected by neoplasm invasion, only 1 case of tumor within the bronchus. ＂ Long straight margin＂ sign and inflammatory exudation at the distant of the hilum were found in most of CLCs. Fifteen of 20 cases could be discriminated the tumor borderes in the post-contrast thin-reformatted images. Seventeen of 20 cases were disclosed with abnormal BAs, and 15 with lymphadenectasis in mediastina. Conclusion Integrated interpretaion of multiple signs of MSCT with the reformatted images of bronchus and blood vessels can be employed to differentiate HPIMs from CLCs.