多层螺旋CT在周围型肺癌和局灶性机化性肺炎鉴别诊断中的价值

Value of multi-slice spiral CT in the differential diagnosis of peripheral lung cancer and focal organizing pneumonia

目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)在周围型肺癌(peripheral lung cancer,PLC)和局灶性机化性肺炎(focal organizing pneumonia,FOP)诊断中价值。方法:搜集PLC患者78例(PLC组)和FOP患者35例(FOP组)的CT检查资料和临床资料,对比分析两组CT平扫和增强影像特点。结果:PLC组外带分布率低于FOP组(44.87%vs.80.00%),内带分布率高于FOP组(24.36%vs.0),差异均有统计学意义(P<0.05);PLC组大病灶空洞(25.71%vs.73.68%)、紧贴胸膜(22.86%vs.84.21%)与FOP组相比差异有统计学意义(P<0.05);两组在血管集束征(大病灶80.00%vs.36.84%,小病灶72.09%vs.31.25%)、毛刺、支气管充气征(大病灶31.43%vs.78.95%,小病灶30.23%vs.75.00%)、结构疏松(大病灶5.71%vs.47.37%,小病灶4.65%vs.43.75%)、胸膜凹陷(大病灶0 vs.52.63%,小病灶20.93%vs.81.25%)方面差异有统计学意义(P<0.05),其余各个征象组间比较差异均无统计学意义(P>0.05);两组均进行动脉期、静脉期增强扫描,PLC组动脉期净增CT值[大病灶(18.61±9.55)Hu v s.(2 9.6 0±1 2.3 5)Hu;小病灶(1 9.3 4±9.0 6)Hu v s.(2 8.7 2±1 1.0 9)Hu]和总增加CT值[大病灶(32.76±10.91)Hu vs.(44.53±12.29)Hu;小病灶(29.45±10.70)Hu vs.(41.10±11.89)Hu]均低于FOP组,差异有统计学意义(P<0.01)。结论:PLC和FOP的CT征象有一定特征性和差异性,MSCT可清晰显示出上述特征性和差异性,在两种病灶的鉴别诊断中具有重要作用。

Objective： To explore the diagnosis value of multi-slice spiral CT （MSCT） on peripheral lung cancer （PLC） and focal organizing pneumonia （FOP）. Methods： CT examination and clinical data of 78 patients with PLC （PLC group） and 35 patients with FOP （FOP group） were collected, and the features of CT scan and enhanced imaging were analysed contrastively. Results： The outer zone distribution rate of the PLC group was lower than that of the FOP group （44.87% vs. 80.00%）, while the inner zone distribution rate was higher than that of the FOP group （24.36% vs. 0）, the differences were both statistically significant （P〈0.05）; there were statistically significant differences in large lesions cavity （25.71% vs. 73.68%）, close to the pleura （22.86% vs. 84.21%） between the two groups （P〈0.05）; and there were statistically significant differences in vessel tract syndrome （large lesions 80.00% vs. 36.84%, small lesions 72.09% vs. 31.25%）, burr, bronchial inflatable syndrome （large lesions 31.43% vs. 78.95%, small lesions 30.23% vs. 75.00%）, structure loosing （large lesions 5.71% vs. 47.37%, small lesions 4.65% vs. 43.75%）, pleural indentation （large lesions 0 vs. 52.63%, small lesions 20.93% vs. 81.25%） of the two groups （P〈0.05）, there were not statistical significant differences in the rest signs between groups （P〉0.05）; the patients of the two groups underwent enhanced scan in arterial and venous phase, the arterial phase net added CT value [large lesions （18.61±9.55） Hu vs. （29.60±12.35） Hu; small lesions （19.34±9.06） Hu vs. （28.72±11.09） Hu] and the total added CT value [large lesions （32.76±10.91） Hu vs. （44.53±12.29） Hu; small lesions （29.45±10.70） Hu vs. （41.10±11.89） Hu] of the PLC group were lower than those of the FOP group （P〈0.01）, the differences were statistically significant. Conclusion： CT signs and strengthening characteristics of the PLC and the FOP have certain characteristic features and differences, the characteristic and differences can be clearly shown in MSCT, so it plays an important role in the differential diagnosis of the two types of lesions.