局灶性机化性肺炎的多层螺旋CT诊断及与周围型肺癌鉴别

Multi-Slice Spiral CT Diagnosis of Focal Organized Pneumonia and Its Differentiation with Peripheral Pulmonary Carcinoma

目的探讨局灶性机化性肺炎（FOP）MSCT诊断及与周围型肺癌的鉴别。方法搜集42例经手术病理证实的FOP患者的64层CT检查资料,其中27例在平扫的基础上行两期增强扫描;同时随机搜集同时期入院的42例周围型肺癌患者作为对照组。对研究组、对照组的资料进行影像学征象分析,并比较两者CT征象有无统计学差异。结果 42例FOP患者中,右肺病灶居多（24/42）,以类圆形为主（20/42）,边界清楚占多数（26/42）;各病灶中具有棘状突出征26例、弓形凹陷征9例、浅分叶征6例、支气管充气征23例、血管支气管束异常17例、长毛刺32例、短毛刺14例、邻近胸膜增厚30例、空洞11例、液化18例、反晕征1例、晕征16例;对照组中棘状突出征14例、弓形凹陷征2例、浅分叶征5例、深分叶征34例、支气管充气征6例、血管支气管束异常12例、长毛刺10例、短毛刺32例、邻近胸膜增厚16例、空洞6例、液化5例、晕征25例、钙化8例、淋巴结肿大16例,两组棘状突出征、弓形凹陷征、支气管充气征、长毛刺、短毛刺、邻近胸膜增厚、液化出现频数存在统计学差异（χ2分别为6.87、5.12、16.26、23.04、9.42、10.12,P〈0.05）;增强扫描,FOP病灶CT值增加范围约33-90 HU,均值（58.72±13.9）HU,对照组病灶CT值增加范围约15~62 HU,均值（35.89±14.47）HU,两组CT增加值分布区间及均值存在统计学差异（t=-5.33,P〈0.05）。结论 FOP具有一定的影像学特点,HRCT及增强扫描有利于这些特征的显示,并有助于与周围型肺癌鉴别,某些不典型病灶的确诊仍依赖于病理学检查。

Objective To investigate the value of multi-slice spiral CT（ MSCT） in diagnosing focal organized pneumonia（ FOP）,and to discuss the differentiation of FOP with peripheral pulmonary carcinoma. Methods A total of 42 cases with pathologically-proved FOP were collected（ study group）. Other randomly selected 42 patients with peripheral pulmonary carcinoma,who were encountered at authors＇ hospital at the same period as the patients of FOP,were used as the control group. MSCT scanning was performed in all patients of both groups,and additional bi-phase enhanced CT scanning was carried out in 27 patients of the study group. The clinical data and CT findings were retrospectively analyzed,and the results were compared between the two groups. Results In 24 cases of the study group,the lung lesions were located in the right lung. The lesions presented as round mass（ n = 20） with clear border（ n = 26）. The imaging findings included spinous prominent sign（ n = 26）,bow indentation sign（ n = 9）,shallow lobulation sign（ n = 6）,air bronchogram sign（ n= 23）,abnormal bronchovascular bundle（ n = 17）,long burr（ n = 32）,short burr（ n = 14）,thickened pleura（ n =30）,cavity（ n = 11）,liquefaction（ n = 18）,reverse halo sign（ n = 1）,halo sign（ n = 16）. In the control group,the imaging findings included spinous prominent sign（ n = 14）,bow indentation sign（ n = 2）,shallow lobulation sign（ n =5）,deep lobulation sign（ n = 34）,air bronchogram sign（ n = 6）,abnormal bronchovascular bundle（ n = 12）,long burr（ n = 10）,short burr（ n = 32）,thickened pleura（ n = 16）,cavity（ n = 6）,liquefaction（ n = 5）,halo sign（ n = 25）,calcification（ n = 8） and lymphadenopathy（ n = 16）. Statistically significant differences in spinous prominent sign,bow indentation sign,air bronchogram sign,bronchovascular bundle abnormal,long burr,short burr,thickened pleura and liq-uefaction existed between the two groups（ χ2= 6. 87,5. 12,16. 26,23. 04,15. 57,9. 42 and 10. 12 respectively,P〈0. 05）. Contrast-enhanced CT scanning showed that CT value of FOP lesions ranged from 33 HU to 90 HU with a mean value of（ 58. 72 ± 13. 9） HU,in the control group the CT value of lesions ranged from 15 Hu to 62 HU with a mean value of（ 58. 72 ± 13. 9） HU. The differences in the increase of CT value and the mean CT value were statistically significant between the two groups（ t =- 5. 33,P〈0. 05）. Conclusion Focal organized pneumonia carries certain imaging characteristics,and HRCT as well as contrast-enhanced scanning is favorable to the visualization of these features,such as reversed halo sign and obvious enhancement,which are very helpful in differentiating FOP from the peripheral pulmonary carcinoma.For the diagnosis of atypical lesions,the confirmation of the disease still depends on the pathologic evidence.