良性肺结节CT增强扫描征象分析

Benign pulmonary nodules:CT enhancement patterns with pathologic correlation

目的 :用CT增强扫描评价良性肺结节。材料与方法 :38例经手术或穿刺病理证实的良性肺结节(直径1 1～4 2cm) ,其中结核球26例、炎性假瘤7例、硬化性血管瘤3例、错构瘤2例。分别于注射100ml碘造影剂注射开始后的35秒、2分及5分钟 ,对病灶进行薄层系列扫描。观察结节的强化特征并进行CT-病理对照分析。结果 :19例结核球无强化 ,病理显示整个结节为无血管的干酪样坏死组织。7例结核球和1例炎性假瘤呈环蛋壳状强化 ,病理证实 ,结节周围肉芽组织或纤维包膜内有血管结构。4例炎性结节及2例错构瘤强化均匀 ,2例炎性假瘤和3例硬化性血管瘤强化不均匀。病理上 ,硬化性血管瘤内小血管灶性增生并呈血管瘤样扩张 ,透明变性的组织。结论 :①大多数结核球不强化 ,少数呈环状或蛋壳状强化。②炎性假瘤可呈均匀或不强化。③硬化性血管瘤强化显著 。

Objective:To evaluate benign lung nodules by using enhanced CT scan.Materials and Methods:38 patients with benign pulmonary nodules(diameter 1.1～4.2cm)proved pathologically include 26 tuberculomas,7 inflammatory pseudotumors,3 sclerosing hemangiomas,2 hamartomas.Serial thin-section CT scan were performed before and 35 second,2 minutes and 5 minutes after injection of iodinated contrast material.Special attention was devoted to internal enhancement patterns of the nodules and CT-pathological correlative study was done.Results:19 of 26 tuberculomas showed nonenhancement which is histologically composed of caseous necrosis without blood vessels.7 of 26 tuberculomas and 1 of 7 inflammatory pseudotumors appeared as ring or eggshell enhancement and showed pathologically a moderate to marked vascularized peripheral fibrotic or granulomatous zone.4 of 7 inflammatory pseudotumors showed homogeneous enhancement.another 2 inflammatory pseudotumors and 3 sclerosing hemangiomas showed inhomogeneous enhancement,histologically,the low-density region of which was degenerative or necrotic tissue and the high-density region was caused by the granulomatous tissue with marked vescularrity.Conclusion:①nonenhancement is a characteristic of tuberculomas and ring or eggshell enhancement is suggestive of tuberculomas.②inflammatory pseudotumors have homogeneous or inhomogeneous enhancement.③sclerosing hemangiomas showed inhomogeneous enhancement.