拟诊为肺脓肿的肺癌的CT特征及病理对照

CT and Pathology Observation of the Lung Cancers which Presumed as Lung Abscess

目的探讨表现为酷似肺脓肿的周围型肺癌的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12例经病理证实的影像表现酷似肺脓肿的肺癌患者资料，另随机选取22例肺脓肿作为对照。所有患者均有详细的cT平扫和增强扫描资料，观察病变主体及周围病灶的影像特点，两组计数资料行X2检验。两组病例影像表现与病理进行对照分析。结果12例周围型肺癌，均表现为肺内圆形、不规则形软组织密度结节、团块状影，周围肺野散在片絮、磨玻璃影，病变主体密度不均匀，均可见不规则低密度液化区，7例见空洞，增强扫描病变实质不均匀强化，病变主体境界清楚者9例（75％），周围病变与邻近肺组织交界面周径的1／3～1／2境界清楚者8例（66．7％）。22例肺脓肿病例，病变主体境界清楚者4例（18．2％），与肺癌组比较差异有统计学意义（P=0．002，P〈0．05），周围病变与邻近肺组织交界面周径的1／3—1／2境界清楚者5例（22．7％），与肺癌组比较差异有统计学意义（P=0．025，P〈0．05）。抗炎治疗后病变主体肺癌组均无明显变化（100％），肺脓肿组1例（4．5％）未见明显变化，余21例（95．5％）均缩小，两组比较差异有统计学意义（P〈0．001）；两组病例空洞及液化区变化比较差异有统计学意义（P=0．001及P=0．003，P〈0．05）。周围病变肺癌组中8例（66．7％）与肺交界面周径的1／3～1／2境界清楚病灶未见明显变化，两组其余周围病灶均缩小，病变变化比较差异有统计学意义（P〈0．001）。结论影像表现酷似肺脓肿的肺癌，cT表现具有一定特征性，病变主体境界及周围病灶与相邻肺组织交界面周径的1／3—1／2是否清楚，对肺癌及肺脓肿的鉴别诊断具有重要意义，同时抗炎治疗对于两种疾病的鉴别亦是十分必要的。

Objective To investigate the performance of CT image features of peripheral lung cancer mimicking pulmo- nary abscess, in order to improve the correct diagnostic rate. Methods Retrospective analysis of 12 cases of patients with lung cancer, whose imaging performance resembles abscess, another randomly selected 22 patients with lung abscess as con- trol. All patients had plain CT scan and enhanced scan data. Changes in the body and its surrounding lesion imaging char- acteristics are analyzed in detail, and two counts column X2 test. Imaging performances of two groups of patients were com- pared with pathological analysis. Compared the two group cases imaging manifestations and pathological analysis. Results 12 cases of peripheral lung cancer lesions subject showed uneven density, which can be seen in the irregular low density liquefaction zone, 7 cases showed cavity; enhanced scanning showed substantial inhomogeneous enhancement, focal subject realm clear in 9 cases （75%）, 8 cases of peripheral lesion and adjacent lung tissue interface circumference 1/3 ~ 1/2 realm clear （66.7%）. 22 cases of lung abscess were the control group, 4 cases （18.2%） had a clear boundary of the main body of the lesions, there was a significant difference between this and the lung cancer group （ P = 0.002, P 〈 0.05 ） ; 5 cases of peripheral lesion and adjacent lung tissue interface circumference 1/3 ~ 1/2 realm clear （ 22.7% ） , and lung cancer compared differences there was statistical significance （ P = 0. 025 ,P 〈 0.05 ）. The main lesion of lung cancer after anti - inflammatory treatment group had no significant changes （ 100% ）, lung abscess group 1 cases （4.5%） had no sig- nificant changes, the other 21 cases （95.5%） were reduced, there was significant difference between two groups （P 〈 0.001 ） ; two cases of empty changes and liquefaction area comparison difference has statistical significance （P = 0. 001 andP = 0. 003,P 〈 0.05）. Conclusion Imaging performance resembles lung abscess, which has a certain characteristic CT findings. The main lesion boundary, adjacent lung tissue surrounding the lesion and that, the interface circumference of 1/ 3 to 1/2 , is clearly important for the differential diagnosis of lung cancer and lung abscess, while the reaction of anti - in- flammatory treatment for both diseases identification is also very necessary.