肺瘢痕癌的CT诊断与鉴别

CT diagnosis of scar carcinoma of the lung

目的:探讨肺瘢痕癌的CT表现,以提高对该病的CT诊断水平。方法:回顾性分析29例经病理证实的肺瘢痕癌的临床及CT资料,并与52例良性肺瘢痕组织进行对照分析。比较瘢痕癌首次CT表现、瘢痕癌术前CT表现与良性瘢痕组织CT表现,采用t检验和Pearsonχ2检验进行统计学分析。结果:29例肺瘢痕癌中,26例为腺癌。肺瘢痕癌CT表现:瘢痕癌首次检查与术前检查、瘢痕癌术前检查与良性瘢痕组织的大小、分叶、毛刺及血管集束征的差异均有统计学意义(P<0.05)。瘢痕癌首次CT表现和良性瘢痕组织的大小、分叶、毛刺及血管集束征差异无统计学意义(P>0.05)。胸膜凹陷在瘢痕癌首次检查与术前检查、瘢痕癌首次检查和良性瘢痕组织间差异有统计学意义(P<0.05),在瘢痕癌术前检查与良性瘢痕组织间差异无统计学意义(P>0.05)。病灶内是否有空泡、周围是否伴有磨玻璃影在良性瘢痕组织与瘢痕癌的首次检查、术前检查间差异均有统计学意义(P<0.05),而在瘢痕癌首次和术前检查间差异无统计学意义(P>0.05);④不规则或多角形、长条索边缘及钙化灶的差异在3组间差异均无统计学意义(P>0.05)。结论:肺瘢痕癌的CT表现具有一定特异性,通过仔细观察瘢痕组织的大小、分叶、毛刺、血管集束征、胸膜凹陷、病灶内空泡、周边磨玻璃影有助于鉴别肺瘢痕癌与肺良性瘢痕组。随访观察瘢痕组织的动态变化有助于瘢痕癌的早期诊断。

Objective：To investigate the CT features of scar carcinoma of the lung （SCL） ,in order to optimize diagnostic accuracy of of SCL by CT. Methods：Retrospective analysis of CT imaging and clinical data were performed in 29 patients with pathologically proven SCL. Results：Most SCL were adenocarcinoma （26/29）. There were statistically significant differences in size, lobulation, spicule and vessel convergence sign between first CT exams of SCL with pre-operative CT exams of SCL,and pre operative CT exams of SCL with CT exams of non-carcinomatous scars （P〈0.05）. There were statistically significant differences in pleural indentation between first CT exams of SCL with pre-operative CT exams of SCL, and first CT exams of SCL with CT exams of nowcarcinomatous scars （P〈0.05）. There were no statistically significant differ- ences in pleural indentation between pre operative CT exams of SCL with CT exams of non-carcinomatous scars （P〈0.05）. In vacuole sign and ground glass opacities periphery,there were statistically significant differences between first CT exams of SCL with CT exams of non-carcinomatous scars,and pre-operative CT exams of SCL with CT exams of non carci- nomatous scars （P〈0.05）, and no statistically significant differences between pre-operative CT exams of SCL with first CT exams of SCL （P〉0.05）. There were statistically significant differences in irregular or polygonal shape of lesion,long strip of border and calcification among first CT exams of SCL,pre-operative CT exams of SCL and CT exams of non-carcinomatous scars （P〉0.05）. Conclusions：Scar carcinoma of the lung has some specific imaging features. Follow-up CT examination is helpful for early diagnosis and differential diagnosis of scar carcinoma of lung.