囊泡状周围型肺癌的HRCT表现

HRCT Manifestation of Vesicular-Like Peripheral Lung Cancer

目的:分析以囊泡状结构为主的周围型肺癌的HRCT影像特征,提高对此类影像特征周围型肺癌的认识。材料与方法:回顾分析45例经病理证实的单囊、多囊泡状结构(囊泡壁厚度<3mm)周围型肺癌(其中13例含囊泡状结构的肺内病变经半年至1年随诊,囊腔逐渐变小,囊壁逐渐出现壁结节及实性成份,且实性结节逐渐增大)的HRCT征象,统计各征象的发生率。结果:本组病例共计45例,按按细胞类型分为腺癌27例(60.0%)、腺鳞癌11例(24.4%)、肺泡癌4例(8.9%)、小细胞未分化癌2例(4.4%)、鳞癌1例(2.2%)。按囊泡数量分为单囊泡病灶34例,多囊泡状病灶11例。HRCT特点为:病灶边缘有分叶、毛刺的占91.1%(41/45);有血管聚集征的占77.8%(35/45);囊泡病灶周围有胸膜凹陷症的占46.7%(21/45);囊泡壁毛糙,厚度不均且<3mm的占97.8%(44/45);囊泡有壁结节的占73.3%(33/45);囊泡合并磨玻璃结节(GGO)的占55.6%(25/45)。结论:含囊泡状结构为主的肺内肿瘤,多为肺癌,此样本细胞类型多为腺癌和腺鳞癌,HRCT图像上病灶具有周围型肺癌边缘的基本征象,囊泡可能代表肿瘤生长的某一阶段征象;经动态观察,部分囊壁会出现实性结节或肿块,部分囊泡在肿瘤生长过程中逐渐变小,而成为囊泡伴实性软组织的囊实性肿块。

Purpose： To analyze the characteristics of HRCT images on peripheral lung cancer that are dominated by the single-vesicle or multi-vesicular structures, and to improve the understanding of peripheral lung cancer with these imaging characteristics. Materials and Methods： This study retrospectively analyzed the HRCT signs and counted the incidence of va- rious signs in 45 patients who were confirmed with peripheral lung cancer featuring single-vesicle or multi-vesicular structures （with vesicle wall thickness less than 3 ram; 13 of them had the lung lesions containing vesicle-likes structure, and after half a year to one year follow-up, the cysts became smaller gradually, wall nodules and solid ingredients occurred gradually on cyst walls, and solid nodules grew up gradually. Results： There were 45 cases in this group. In terms of cell type, they were clas- sified into： adenocarcinoma （27 cases, 60. 0% ） , adenosqnamous carcinoma （ 11 cases, 24.4% ） , alveolar cell carcinoma （4 cases, 8. 9% ） , small cell undifferentiated carcinoma （2 cases, 4.4 % ） , squamous cell carcinoma （ 1 case, 2. 2% ）. In terms of the number of vesicles, they were divided into single vesicles lesions （34 cases） and multi-vesicular lesions （ 11 ca- ses）. HRCT features： 91.1% （41/45） had leaflet or burr on the lesion edges; 77.8% （35/45） had vascular aggregation syndrome; 46.7% （21/45） had pleural depression disorder around vesicular lesions; 97. 8% （44/45） had rough vesicle walls, the thickness of which is uneven and less than 3 mm; 73.3% （33/45） had vesicle wall nodules; and 55.6% （25/45） had vesicle-combined ground-glass nodules （GGO）. Conclusion： Lung tumors that mainly comprise vesicular-like structures are mostly lung cancer, in which cell types are mainly adenocarcinoma and adenosquamous carcinoma. On HRCT images, the lesions mostly have the basic signs of the edges of general peripheral lung cancer. The vesicles represent the sign of a certain stage of tumor growth. In dynamic observation of above tumors, partial vesicular walls presents solid nodules or lumps, partial vesicles become smaller gradually in the process of the tumor growth and convert into the cystic lesions of vesicles accompanied with solid soft tissue.