肺硬化性肺泡细胞瘤CT特征回顾性分析

Analysis of the CT features of pulmonary sclerosing pneumocytoma

目的分析肺硬化性肺泡细胞瘤(PSP)的CT和病理表现,提高对此病的认识和术前诊断能力。方法回顾性分析经手术及病理证实的12例PSP的临床及CT资料,其中女性8例,男性4例,年龄14~63岁,平均39.25岁,所有病例均行CT平扫,其中9例行增强扫描。结果 11例为孤立病灶,1例为多发病灶,病灶长径1.17~8.03cm,平均(3.53±0.78)cm。左肺3例(25%,上叶1例,下叶2例),右肺9例(75%,上叶2例,中叶1例,下叶6例);双下肺8例(67%),中上肺4例(33%);肺门中心型4例(33%),周围型8例(67%);病灶形状呈卵圆形及类圆形8例(67%),不规则型1例(8%),浅分叶3例(25%);边缘光滑10例(83%),边缘毛刺2例(17%);增强后7例可见边缘血管贴边征(58%),空气新月征6例(50%),晕征6例(50%),尾征6例(50%);3例(25%)病灶内有散在点样或斑点样钙化,余病变密度均匀,平扫CT值28~47HU,平均35HU;9例增强扫描,1例轻度强化,5例明显均匀强化,3例不均匀强化。增强后CT值60~110HU,平均77.2HU,最大强化净值为75HU。结论青中年女性、3cm左右单发圆形或卵圆形软组织密度样肺结节或肿块,边缘光滑,增强扫描后明显均匀强化,同时伴有血管贴边征、空气新月征及晕征、尾征时,要考虑到PSP的诊断。

Objective To retrospectively analyze the CT features and pathological manifestations of pulmonary sclerosing pneumocytoma （ PSP） so as to improve the understanding as well as the preoperative and diagnostic ability of this disorder. Meth-ods The clinical and CT data of 12 patients with PSP confirmed by surgery and pathology were collected and analyzed retrospec-tively, of whom 8 cases were female and 4 cases were male, aged from 14 to 63 years old, with an average of 39. 25 years old. All cases were subjected to plain CT scan and 9 cases to the enhancement scanning. Results Of those 12 patients, 11 were isolated lesions and 1 case was multiple lesions. The long-axis diameter ranged from 1. 17 to 8. 03 cm, with an average of 3. 53 cm in di-ameter. There were 3 cases （25%） in left lung 3 （1 case in the upper lobe and 2 cases in lower lobe） and there were 9 cases （75%） in right lung （2 cases upper and 1 case in middle lobe and 6 cases in lower lobe）. 8 cases （67%） located in the lower lobe of both lung and 4 cases （33%） located in the upper lung. 4 cases （33%） were hilar center type and 8 cases （67%） were peripheral type. Lesion appeared as the ovoid and roundlike shape in 8 cases （67%）, as the irregular type in 1 case （8%）, as the shallow lobe in 3 cases （25%）. 10 cases （83%） presented with smooth edge and 2 cases （17%） with burr edge. After the Enhancement, 7 cases （ 58%） presented with the vascular welt in the edge, 6 cases （ 50%） with air crescent sign, 6 cases （50%） with halo sign, and 6 cases （50%） with tail sign. In 3 cases （25%）, the inside lesions presented with scattered puncti-form or mottled calcification. The remaining lesions exhibited the uniform density. The plain CT value ranged from 28 to 47 HU, with an average CT value of 35 HU. 9 cases underwent the enhanced scan, of which 1 case exhibited the mild enhancement and 5 cases exhibited obvious enhancement and 3 cases exhibited non-uniform enhancement. The enhanced CT value was 60 ~110 HU, with an average CT value of 77. 2 HU. The max enhanced CT value was 75 HU. Conclusion In middle-aged females, if, the lung CT examination showed single round or ovoid nodules or masses, with soft-tissue density and smooth edge, about 3 cm in size and, also, the lesions were obviously increased enhancement after the enhanced scanning and accompanied by vascular welt, air crescent sign and halo sign, tail sign, at the same time, PSP diagnosis should be considered.