Ⅰ期中央型肺癌与支气管播散性肺结核CT树芽征的比较分析

Stage Ⅰ Central Lung Cancer and Bronchial Disseminated Pulmonary Tuberculosis: A Comparative Analysis of Tree-in-bud Sign at CT

目的探讨I期中央型肺癌与支气管播散性肺结核CT树芽征的影像学差异,以降低中央型肺癌的误诊率。资料与方法收集经病理或临床证实并行胸部CT扫描出现树芽征的32例I期中央型肺癌(肺癌组)和47例支气管播散性肺结核(结核组)的影像学资料,比较两组树芽征的分布范围、伴随征象、所在肺叶段及(或)段以上支气管改变,并作统计学分析。结果肺癌组树芽征以单叶分布为主(96.88%),而结核组以多叶分布为主(80.85%),差异有统计学意义(P<0.01)。伴随征象:1树芽征近端支气管黏液栓塞肺癌组发生率高于结核组(100%比6.38%),差异有统计学意义(P<0.01);2实变及(或)磨玻璃密度影肺癌组与结核组发生率(34.38%比48.94%)差异无统计学意义(P>0.05);3空洞征肺癌组发生率低于结核组(0比38.30%),差异有统计学意义(P<0.01);4直径>5 mm结节影肺癌组发生率低于结核组(0比76.60%),差异有统计学意义(P<0.01)。肺癌组中树芽征共累及33个肺叶,均伴有所在肺叶段及(或)段以上支气管异常(100%);结核组中树芽征共累及144个肺叶,其中56个肺叶伴有段及(或)段以上支气管异常(38.89%)。结论I期中央型肺癌与支气管播散性肺结核CT树芽征的影像学表现存在差异,当树芽征呈单叶分布,伴近端支气管黏液栓塞、所在肺叶段及(或)段以上支气管异常时应考虑肺癌的可能。

Purpose To investigate the difference of imaging features of tree-in-bud（TIB） sign at CT between stage I central lung cancer and bronchial disseminated pulmonary tuberculosis in order to reduce the misdiagnosis rate of central lung cancer. Materials and Methods 32 patients of stage I central type lung cancer confirmed pathologically or clinically（lung cancer group） and 47 patients of bronchial disseminated pulmonary tuberculosis confirmed pathologically or clinically（tuberculosis group） underwent chest CT scanning and were found with TIB sign. The imaging data of all the cases were analyzed retrospectively in terms of distribution range, accompanying CT findings of TIB sign, and abnormalities of segmental and（or） larger bronchus proximal to it. Results TIB sign was mainly focal（unilobar） in lung cancer group（96.88%）, while it was mainly diffuse（more than one pulmonary lobe） in tuberculosis group（80.85%）. The difference was significant（P〈0.01）. Accompanying CT findings： 1 Obstructive bronchial mucoid impaction distal to the TIB was more common in lung cancer group than in tuberculosis group（100% vs6.38%, P〈0.01）. 2 Consolidation and/or ground-glass opacities were found both in lung cancer group（34.38%） and in tuberculosis group（48.94%）. The difference was not significant（P〉0.05）. 3 Cavity was less common in lung cancer group than in tuberculosis group（0 vs 38.30%, P〈0.01）. 4 Nodules with diameter larger than 5 mm were much fewer in lung cancer group than in tuberculosis group（0 vs 76.60%, P〈0.01）. TIB sign was found in 33 lobes in lung cancer group, and the abnormity was found in all these lobes（100%）; while in tuberculosis group, TIB sign was found in 144 lobes and the abnormity was found in 56 lobes（38.89%）. Conclusion TIB sign shows differences between stage I central lung cancer and bronchial disseminated pulmonary tuberculosis. The TIB signs such as focal distribution, accompanied by bronchial mucoid impaction and abnormality of segmental or（and） larger bronchus may predict the high possibility of central lung cancer.