多层螺旋CT对肺类癌的诊断及鉴别诊断

Diagnosis and differential diagnosis of pulmonary carcinoid with multi-slice computed tomography

目的：探讨多层螺旋CT（MSCT）对肺类癌的诊断和鉴别诊断的价值。方法：回顾性分析经病理证实的9例类癌患者的临床和MSCT资料。结果：9例中8例表现为边界清楚单发类圆形或不规则形肿块影,1例表现为右肺中叶不规则高密度影,边缘模糊,类似于大叶性肺炎。3例病灶密度均匀,4例可见浅分叶,1例可见深分叶,3例有细短毛刺,3例有胸膜凹陷征,4例可见钙化灶,3例有胸腔积液。8例肿块表现为＂冰山征＂（支气管腔外部分大于腔内部分）。增强扫描后5例中度以上（20~40 HU）强化,3例轻度（1~20 HU）强化,1例病灶内窄带状强化。本组病例均未见空洞、囊变、坏死。结论：肺类癌的MSCT的影像特点为肺内单发边缘清楚类圆形肿块,多为明显均匀强化,以及＂冰山征＂和/或特征性钙化。若见因支气管狭窄或闭塞导致的类似于大叶性肺炎的表现,应高度注意本病可能。

Objective：To assess the value of multi-slice computed tomography（MSCT） in the diagnosis and differential diagnosis of pulmonary carcinoid.Methods：A retrospective analysis of MSCT examinations was performed in 9 patients with pulmonary carcinoid confirmed by pathology.Resuts：Of all the 9 cases,8 had solitary oval-shaped nodules with distinct boundaries or irregular margins,1 had a dense consolidation with ill-defined margin in the right middle lobe resembling a pneumonia,3 had homogeneous high density lesions,4 had mild lobulated lesions,1 had deep lobulated lesions,3 had fine speculated lesions,3 had lesions with visceral pleura retraction,4 had focal calcifications,and 3 had pleural effusions,8 had iceberg lesions with a dominant extra-luminal component and a very small endobronchial portion.Of all the 9 cases who also underwent contrast enhanced CT,5 had marked enhancement（CT value in creased 20~40HU）,3 had mild enhancement（CT value increased 1~20HU）,and 1 had strip-like enhancement.There was no CT evidence of cavity formation,cystic change,and necrosis in any of the lesions.Conclusion：Most of pulmonary carcinoids have some specific imaging features.Multi-slice computed tomography can suggest the diagnosis,particularly when solitary oval-shaped nodules with marked enhancement,iceberg signs and focal calcifications;a dense consolidation with ill-defined margin resembling a pneumonia secondary to bronchial stenosis should be considered a carcinoid.