间质纤维化背景下肺癌的CT征象及动态演变特征

CT features and dynamic contrast characteristics of lung cancer in the background of interstitial pulmonary fibrosis

目的 :通过回顾性分析发生在蜂窝肺背景下的一组肺癌病例的CT表现,期望提高对肺间质纤维化合并肺癌的重视,提高诊断能力。方法:回顾性收集我院2011年11月—2016年7月5年内蜂窝肺合并肺癌的病例,采用西门子双源CT(Somatom Definition Flash)和西门子128层CT(Somatom Definition AS)进行扫描,仰卧位,扫描层厚5 mm,重建图像层厚1 mm(高分辨算法重建)。采用统一图像观察窗位,测量记录病变的大小、位置、形态学征象及CT复查的动态变化特征。结果:共收集间质纤维化背景下发生肺癌的病例36例,所有病例均经手术病理或穿刺活检病理证实为肺癌,其中腺癌11例(30.6%),鳞癌25例(69.4%)。临床诊断为特发性肺间质纤维化2例,慢性阻塞性肺疾病(COPD)12例,类风湿关节炎6例,系统性红斑狼疮8例,干燥综合征3例,皮肌炎3例,成人Still病2例。根据CT表现将本组肺癌分为4种类型:(1)结节型,26例(72.20%);(2)不规则实变型,4例(11.1%);(3)不规则索条型,2例(5.6%);(4)三角形或楔形实变型,4例(11.1%)。36例患者中20例初次CT检查时诊断为肺癌,诊断正确率55.56%。结论:间质纤维化背景下合并肺癌的CT表现多样,尤其是肺纤维化区内的结节及片状实变影应予以动态观察。

Objective： To analyzed the CT features of a group of lung cancer cases occurred in the honeycomb lung background, to draw attention to interstitial pulmonary fibrosis combined with lung cancer and to improve the diagnosis ability. Methods： Cases of honeycomb lung combined with lung cancer from November 2011 to July 2016 in our hospital were retro-spectively collected. All the cases underwent CT（Somatom Definition Flash and Omatom Definition AS） scanning on supine position, with 5 mm slice thickness and 1 mm reconstruction. Size, location, morphological features and dynamic CT characteristics of the lesions were reviewed using unified image window. Results： There were 36 patients diagnosed of interstitial pulmonary fibrosis with lung cancer by pathology. Twenty-six （72.2.0%） lesions were lobulated with blurred edge. Four cases （11.1%） showed irregular consolidation. Two cases（5.6%） showed irregular fibers. Four cases（11.1%） showed a small triangle or wedge consolidation under the pleural in the first CT examination. Conclusion： Images should be carefully analyzed in the chest CT of the patients with a honeycomb lung, especially the nodules and patches of consolidation, which should be followed up.