MSCT下胸膜凹陷征对肺外周结节鉴别诊断价值

THE VALUE OF PLEURAL INDENTATION SIGN ON MSCT IN DIFFERENTIAL DIAGNOSIS OF PERIPHERAL PULMONARY NODULES

目的探讨MSCT下胸膜凹陷征(PI)对肺外周结节或包块良、恶性的鉴别诊断价值。方法收集经手术切除或经皮肺穿刺活检病理证实的118例有PI的肺外周结节或包块的CT图像,其中周围型肺癌73例,良性病变45例。观察PI的不同形态,并结合有无相应区域胸膜增厚,将其分为6型。然后结合病理结果,回顾性分析各型PI在不同性质肺外周结节或包块中的分布情况。采用MSCT后处理技术对其中34例图像进行各种方式的3D重建,观察其显示PI的临床应用价值。结果Ⅰ、Ⅴ型PI多为周围型肺癌的CT表现,Ⅱ、Ⅳ型PI多见于结核球、炎性假瘤等良性病变,差别有统计学意义(χ2=5.29～28.86,P<0.05)。MSCT多种3D重建技术能够清晰地显示PI的不同形态。结论MSCT下PI的形态展现及分型在肺外周结节的诊断与鉴别诊断中有重要价值。

Objective To assess the value of pleural indentation sign （PIS） on MSCT in the differential diagnosis between benign and malignant nodules surrounding the lung. Methods CT images of 118 cases with nodules or massess surrounding the lung accompanying PIS, which were confirmed by surgery or needle biopsy, were collected. Of which, peripheral lung cancer, 73 cases, benign diseases 45 cases. The PIS was classified as six types based on its different appearances, and whether or not with pleura thickening of corresponding region. The distribution of various types of PIS in different nodules and massess around the lung was analyzed retrospectively combined with pathologic results. Using MSCT post treatment technic, 3D reconstruction of 34 images was done, and the clinical value of PIS evaluated. Results Type-1 and type-5 PIS were more commonly seen in peripheral lung cancer, while type 2 and type-4 PIS in peripheral lung benign diseases, the differences were significant between them （X^2= 5.29--28.86,P〈0.05）. Various 3D reconstructions could clearly display different shapes of PIS. Conclusion The forms and types of PIS on MSCT are of great value in the diagnosis and differential diagnosis of peripheral lung nodules and massess.