肺硬化性血管瘤的MSCT表现及病理对照分析

Pulmonary Sclerosing Hemangioma: MSCT Finding-pathologic Correlation

目的：探讨肺硬化性血管瘤（PSH）的多层螺旋CT（MSCT）表现,并对照病理结果进行分析,以提高对其认识及影像诊断水平。方法：回顾性分析39例经病理确诊的PSH患者的CT征象,3例仅行胸部CT平扫,余36例行CT平扫和增强。结果：男6例,女33例,平均年龄（46.9±14.36）岁,均为单发病灶,左肺19例,右肺20例。周围型30例,中央型9例,胸膜下32例（15例宽基底贴于胸膜）,非胸膜下7例。病灶最大径5～57 mm,呈类圆形或卵圆形,边界清晰,11例边缘见浅分叶。平扫33例密度较均匀,6例欠均匀,平均CT值（34.0±13.4）HU,12例内见钙化。增强扫描多为中等至明显强化（30例）,22例强化较均匀,14例强化不均匀,其中4例见低密度坏死区。动脉期平均CT值（77.0±25.6）HU,静脉期病灶呈渐进性或持续强化,平均CT值（91.0±17.1）HU。贴边血管征30例,周围磨玻璃密度影4例。结论：PSH的MSCT表现中贴边血管征、周围GGO征、显著肺动脉征、空气新月征及尾征,具有相对特征性,有助于提高术前的诊断准确性。

Objective： To investigate the MSCT imaging features of pulmonary sclerosing hemangioma（PSH） and comparison with the pathologic features, so that to improve the understanding and imaging diagnostic abilities of PSH. Methods： MSCT images of 39 cases with pathologically confirmed PSH were retrospectively reviewed.3 patients experienced only chest CT plain scan while the remained underwent both pre-and post-contrast CT scan. Results： This study comprised 6 male and 33 female with an average age of（46.9 ± 14.36） years. MSCT demonstrated all cases had solitary lesion, including 19 cases in the left lung and 20 in the right. 30 cases were peripheral and 9 were central. 32 cases demonstrated as subpleural lesions, 15 of which sticking to pleural with wide base; while 7 were non-subpleural. PSHs manifested as well-defined, round or ovoid nodules or masses, with a largest diameter ranged 5～57 mm. 11 cases presented slight lobulation. On pre-contrast CT, the density was homogeneous in 33 cases while heterogeneous in 6, with mean CT value of（34.0 ± 13.4）HU. Calcification was visible in 12 cases. After administration of contrast media, 30 lesions exhibited moderate or markedly enhancement, including 22 homogeneous and 14 heterogeneous. Hypodense necrotic area was presented in 4 lesions. The CT attenuation value in arterial phase was（77.0 ± 25.6）HU, and（91.0 ± 17.1）HU in venous phase during when gradual and continuous enhancement was found in 18 cases. Welt vessel sign（30 cases） and surrounding ground-glass opacity（4 cases） were also demonstrated. Conclusion： PSH MSCT findings of welt blood vessels sign、surrounded GGO sign, significant pulmonary artery sign, air crescent sign, tail sign has, which can help improve the preoperative diagnostic accuracy.