不同病理类型肺癌患者孤立性肺结节64排螺旋CT动态增强扫描特点分析

Characteristic analysis of dynamic enhanced 64 row-spiral CT for solitary lung cancer nodules with different pathological patterns

目的分析不同病理类型肺癌患者的孤立性肺结节64排螺旋CT动态增强扫描特点。方法选择肺癌患者79例,均伴有孤立性肺结节,病理类型为鳞癌17例、小细胞癌6例、腺癌56例。采用64排螺旋CT对患者行平扫及动态增强扫描,比较不同病理类型孤立性肺结节的CT值变化、达峰时间、强化方式、强化净增值、强化率,动态增强峰值出现后延迟扫描180、300、600 s的相对廓清值及廓清率。结果不同病理类型孤立性肺结节CT值随延迟扫描时间延长先升高后降低,峰值出现在60~180 s,小细胞癌结节强化达峰时间早于鳞癌和腺癌结节。腺癌结节的强化方式以均匀强化为主（占75.0%）,鳞癌结节以不均匀强化为主（占64.7%）,小细胞癌结节无明显的强化方式,腺癌和鳞癌结节的强化方式构成比比较有统计学差异（P〈0.05）。腺癌与鳞癌结节强化净增值均高于小细胞癌结节（P均〈0.05）,腺癌与鳞癌结节强化净增值比较差异无统计学意义（P〉0.05）。腺癌、鳞癌和小细胞癌结节的强化率比较差异无统计学意义（P〉0.05）。腺癌、鳞癌和小细胞癌结节延迟扫描300 s的相对廓清值及廓清率比较无统计学差异（P〉0.05）,小细胞癌结节延迟扫描180 s相对廓清值、廓清率均高于腺癌、鳞癌结节,腺癌结节延迟扫描600 s的相对廓清值、廓清率均低于鳞癌、小细胞癌结节（P均〈0.05）。结论小细胞癌孤立性肺结节强化达峰时间早,强化净增值低,延迟扫描180 s相对廓清值、廓清率较高;腺癌孤立性肺结节的强化方式以均匀强化为主,延迟扫描600 s相对廓清值、廓清率较低;鳞癌孤立性肺结节的强化方式以不均匀强化为主。

Objective To analyze the characteristics of dynamic enhanced 64 row-spiral computerized tomography（ CT） for solitary lung cancer nodules with different pathological patterns. Methods Seventy-nine patients with histologically confirmed solitary lung cancer nodules were enrolled. According to the pathological type classification,there were 17 cases of patients with squamous-cell carcinoma,6 cases of patients with small cell lung cancer and 56 cases of patients with adenocarcinoma. All patients received plain scan and dynamic-enhanced scan by using 64 row-spiral CT. We recorded the numerical changes,tmax,intensive way,intensive net added value,reinforcement ratio and expurgation rate in delayed scanning of 180 seconds,300 seconds and 600 seconds after dynamic-enhanced peak value. Results The CT values of all kinds of solitary lung cancer nodules first increased and then decreased with the prolonged time,and the peak appeared in60-180 s. The time to peak of the small cell lung cancer nodules appeared earlier than the other two types. About 75% adenocarcinoma nodules were evenly reinforced,about 64. 7% squamous-cell carcinomas nodules were unevenly reinforced,the small cell lung cancer nodules had no obvious way of strengthening. Significant difference was found in the constituent ratio of schedule of reinforcement between adenocarcinoma and squamous cell carcinoma（ P〈0. 05）. The reinforced net added value of adenocarcinoma and squamous-cell carcinoma was higher than that of the small cell lung cancer nodules（ P〈0. 05）. The reinforced net added value of nodules in the adenocarcinoma and squamous cell carcinoma had no statistically significant difference（ P〉0. 05）. The nodule reinforcement rate of all type had no statistically significant difference in delayed scanning of 300 seconds（ P〈0. 05）. The relatively clear value and expurgation rate in delayed scanning of 180 seconds of the small cell lung cancer was higher than the other two types,and the relatively clear value and expurgation rate in delayed scanning of 600 seconds of the adenocarcinoma was lower than the other two types（ all P〈0. 05）. Conclusions The small cell lung cancer has a low tmax,low intensified net added value,and the relatively clear value and expurgation rate after 180 s is higher. The reinforcement of adenocarcinoma is uniform and it has a low relatively clear value and expurgation rate after 600 s. The reinforcement of squamous-cell carcinoma is non-uniform.