肺原发性神经内分泌肿瘤的CT表现

CT findings and differential diagnosis of Neuroendocrine carcinoma of the lung

目的分析肺原发性神经内分泌肿瘤的CT影像表现特征。方法回顾性分析24例经手术或纤维支气管镜穿刺活检病理证实的肺原发性神经内分泌肿瘤的临床及CT影像特点,包括病变的部位、大小、形态特点、CT平扫和双期增强扫描等影像表现。结果典型类癌2例(8%),不典型类癌7例(29%),大细胞神经内分泌肿瘤3例(13%),小细胞癌12例(50%)。右肺14例(上叶6例,中叶3例,下叶5例),左肺10例(上叶2例,下叶8例),中央型14例,周围型10例。CT影像表现为局部软组织结节或肿块21例,大片实变影3例。伴有阻塞性炎症或肺不张12例,肺门淋巴结增大13例,纵隔淋巴结增大8例;胸腔积液2例,心包积液1例,胸膜牵拉或局限性增厚10例。远处转移7例。结论 CT对各种类型的肺原发性神经内分泌肿瘤有一定的诊断价值,但最终确诊仍需要依靠活检病理。

Objective To analyze CT findings and differential diagnosis of Neuroendocrine carcinoma of the lung （NE）. Methods We reviewed clinical manifestation and CT imaging findings of 24 cases of NE confirmed by surgery or biopsy, including the location, size, morphological characteristics and features of the dual-phase CT enhanced scanning. Results Atypical carcinoid was found in 2 cases （8%）, atypical carcinoid in 7 cases （29 %）, large cell neuroendocrine tumors in 3 cases （13%）, small cell carcinoma in 12 cases （50%）. 14 cases （six eases in upper lobe, three cases in middle and lower lobe 5 cases） occurred in the right lobe, 10 cases （2 cases in upper lobe, 8 cases in lower lobe） occurred in the left lobe, 14 cases were the central type, 10 cases were the peripheral type. CT scan showed soft tissue nodule or mass in 21 cases, large opacities in 3 cases, Accompanied by inflammation or obstructive atelectasis were found in 12 cases, large lymph nodes were seen in 21 cases （13 cases were in hilar; 8 cases were in mediastinal） ; Pleural fluid was seen in 2 eases, peri- cardial effusion was seen in 1 case, pleural thickening was seen in 10 cases. Distant metastasis was seen in 7 cases. Conclu- sion CT findings have a certain diagnostic value on the various types of NE, but the final diagnosis still relies on biopsy.