磨玻璃晕征环绕的周围型肺癌的CT特征及病理对照观察

CT and pathology observation of peripheral lung cancer with halo sign

目的探讨表现为磨玻璃晕征环绕的周围型肺癌的CT影像特征,以提高对其的认识及诊断正确率。方法回顾性分析10例经手术病理证实的周围型肺癌患者,均有环形磨玻璃密度影环绕中心实性结节。另选取临床综合诊断或病理证实的具有晕征的炎性结节病变患者44例作为对照,其中球形肺炎21例,结核球15例,真菌病8例。所有患者均有详细的CT平扫和增强扫描资料,观察晕征及中心实性结节的影像特点,对肺癌及炎性结节各影像表现的发生率行χ2检验。肺癌患者与病理进行对照分析。结果 10例周围型肺癌,磨玻璃影与肿瘤实性结节交界面、肺野交界面均境界清楚(100%)。炎性结节磨玻璃影与实性结节交界面清楚者仅11例(25.00%),交界不清楚者33例(75.00%);炎性结节磨玻璃影与肺野交界面均不清楚(100%)。10例周围型肺癌病灶中心实性结节边缘出现分叶征3例,毛刺征7例,胸膜凹陷征4例,恶性征象的发生率为100%;炎性结节病灶中心实性结节边缘无一出现上述征象。10例肺癌结节与21例球形肺炎均明显强化;结核球仅3例出现包膜强化,真菌病1例少许强化,与肺癌比较差异有统计学意义(P<0.05)。结论磨玻璃晕征环绕的周围型肺癌的CT表现具有特征性,综合分析磨玻璃影及中心实性结节的边缘及内部结构的影像表现,对良恶性结节的鉴别诊断具有重要意义。

Objective To observe CT features of peripheral lung cancer with the ground-glass halo sign for improving diagnosis.Methods Ten patients with peripheral lung cancer surrounding with circular ground-glass opacity proved pathologically were retrospective analyzed.A total of 44 inflammatory nodules with a halo sign confirmed clinically or pathologically were selected as controls,including 21 patients with spherical pneumonia,15 with tuberculoma,and 8 with fungal disease.CT image characteristics of the halo sign and center solid nodules were observed and analyzed statistically with Chi-Square test.Pathologic features of the lung cancer were analyzed as well.Results In 10 patients with peripheral lung cancer,interfaces in ground-glass opacity and tumor nodules solid,the interface with the lung fields were all clear（100%）.In the inflammatory nodules,interface of the ground-glass opacity and solid nodules was clear in only 11 patients（25.00%）,but not clear in 33 patients（75.00%）,and all the borderline in ground-glass opacity and lung field were undefined surrounding inflammatory nodules.In the edge of solid nodules of lung cancer,lobulation was found in 3 patients,spiculation in 7 patients and pleural indentation in 4 pleural indentations.The occurrence of malignant signs were 100%.None of the above malignant signs was found in the edge of solid nodules in all inflammatory nodules.Ten nodules of lung cancer and 21 spherical pneumonia enhanced obviously.Three of the tuberculomas had capsular enhancement and 1 fungal lesion had little enhancement,both were different from lung cancer（P〈0.05）.Conclusion The peripheral lung cancer surrounded by ground-glass halo sign has characteristics on CT image.Comprehensive analysis of the border and internal structure about ground-glass opacity and center solid nodules contributes to the differential diagnosis of benign and malignant nodules.