多层螺旋CT对局灶性机化性肺炎与周围型肺癌的鉴别诊断

Multi-slice Spiral CT in Differential Diagnosis Between Focal Organizing Pneumonia and Peripheral Lung Cancer

目的探讨局灶性机化性肺炎(FOP)的影像特征,提高多层螺旋CT对FOP与周围型肺癌的鉴别诊断价值。资料与方法收集32例经病理证实的FOP患者,并随机选取43例周围型肺癌作为周围型肺癌组,比较两组大病灶(直径>3 cm)和小病灶(直径≤3 cm)临床特征、CT征象及强化方式的差异。结果 1临床特征:FOP小病灶患者年龄小于肺癌小病灶患者、男女性别比高于肺癌小病灶患者(P<0.05),FOP组与周围型肺癌组大、小病灶患者吸烟史、临床症状及实验室检查差异均无统计学意义(P>0.05)。2 CT征象:FOP组与周围型肺癌组大、小病灶患者病灶分布、血管集束征、毛刺、支气管充气征、结构疏松、胸膜凹陷方面差异有统计学意义(P<0.05);FOP组与周围型肺癌组大病灶在空洞、紧贴胸膜征象方面差异有统计学意义(P<0.05)。3增强扫描:两组平扫CT值及静脉期较动脉期CT净增值差异均无统计学意义(P>0.05)。FOP组动脉期CT净增值及总CT净增值均大于周围型肺癌组,差异有统计学意义(P<0.05)。结论不同大小FOP与周围型肺癌临床特征、CT征象及强化均有一定的差异性及特征性,临床上应综合分析,对于不能确诊的病例,抗感染治疗后短期影像学随访具有一定的价值。

Purpose To investigate the imaging features of focal organizing pneumonia（FOP）, and to improve the value of multi-slice spiral CT in the differential diagnosis between FOP and peripheral lung cancer. Materials and Methods Thirty-two patients with pathologically confirmed FOP were enrolled, with 43 cases of randomly selected peripheral lung cancer as control group, the differences of clinical features, CT findings and enhancement pattern of large lesions（diameter3 cm） and small lesions（diameter ≤ 3 cm） between the two groups were compared. Results 1 Clinical features： there was significant difference in mean age and sex ratio of the small lesions between FOP and lung cancer groups（P〈0.05）, while there was no statistically significant difference of the smoking history, clinical symptoms and laboratory indicators of both large and small lesions between the FOP group and lung cancer group（P〈0.05）. 2 CT signs： there were significant differences in the distribution of lesions, vessel tract syndrome, burr, bronchial inflatable syndrome, structure loosing, pleural indentation between FOP group and lung cancer group in both large and small lesion group（P〈0.05）; there were statistically significant differences in voids, close to the pleura sign between FOP and lung cancer group on large lesions（P〈0.05）. 3 Contrast enhanced scan： there was no statistically significant difference in non-contrast CT value and venous phase added CT value to arterial phase between the two groups（P〈0.05）. The arterial phase net added CT value and the total added CT value of FOP were higher than those of the lung cancer group, and the differences were statistically significant（P〈0.05）. Conclusion There are some differences and characters of the clinical features, CT signs and contrast enhanced patterns between FOP and peripheral lung cancer, they should be analyzed comprehensively in clinical practice, for the cases that can＇t be diagnosed, short-term imaging follow-up after anti-inflammatory treatment may be helpful.