不同病理类型肺癌脑转移瘤的CT平扫及增强扫描特征

CT plain scan and enhancement features of brain metastases in different pathological types of lung cancer

目的探讨不同病理类型肺癌脑转移瘤的CT平扫及增强扫描特征。方法回顾性分析40例肺癌脑转移瘤患者的临床资料,所有患者均接受了颅脑CT平扫及增强扫描,观察脑转移瘤的分布情况,分析不同病理类型肺癌脑转移瘤的病灶数目、密度特征、瘤周水肿情况及强化特征。结果 40例肺癌脑转移瘤患者中,CT平扫及增强扫描共显示165处脑转移灶,其中17例腺癌患者检出75处转移灶,12例鳞癌患者检出41处转移灶,7例小细胞癌患者检出40处转移灶,2例大细胞癌患者检出5处转移灶,2例腺鳞癌患者检出4处转移灶。40例肺癌脑转移瘤患者中,以多发病灶为主,占62.5%(25/40);瘤周水肿多为中~重度,占77.5%(31/40)。腺癌及小细胞癌脑转移瘤中,多发转移灶的比例较高,分别为76.5%和71.4%;鳞癌脑转移瘤中,单发转移灶的比例较高,为58.3%。腺癌及小细胞癌脑转移瘤中,混杂密度比例较高,分别为40.0%和35.0%;鳞癌、大细胞癌及腺鳞癌脑转移瘤中,等密度比例较高,分别为43.9%、40.0%和50.0%。不同病理类型比较,腺癌中合并出血的比例最高,为56.0%;鳞癌中未合并出血的比例最高,为82.9%。肺癌脑转移瘤的强化方式以结节性强化比例最高(45.5%),环形强化次之(37.0%),不强化的比例最低(2.4%)。腺癌脑转移瘤中,环形强化的比例最高,为50.7%;鳞癌、小细胞癌、大细胞癌、腺鳞癌脑转移瘤中,结节性强化的比例均最高,分别为68.3%、37.5%、60.0%和50.0%。结论不同病理类型肺癌脑转移瘤的CT平扫及增强扫描具有一定的特征性。

Objective To analyze the CT plain scan and enhancement features of brain metastases in different pathological types of lung cancer. Method Brain CT scan and enhanced scan data of 40 patients with brain metastases of lung cancer patients were collected and the number of lesion, density characteristics, peritumoral edema and enhancement features of different pathological types were analyzed and compared retrospectively. Result In 40 cases of lung cancer with brain metastases, 165 metastatic lesions were detected by CT scan and enhanced scan, among which 75 metastatic lesions were detected in 17 cases of adenocarcinoma, 41 metastatic lesions were detected in 12 cases of squamous cell carcinoma, 40 metastatic lesions were detected in 7 cases of small cell carcinoma, 5 metastatic lesions were detected in 2 cases with large cell carcinoma, and 4 metastatic lesions were detected in 2 cases with adenosquamous carcinoma. Among the40 cases of lung cancer with brain metastases, multiple lesions were the majority, accounting for 62.5%（25/40）; the peritumoral edema was mostly moderate to severe, accounting for 77.5%（31/40）. The proportions of multiple metastases were relatively high in adenocarcinoma and small cell carcinoma, 76.5% and 71.4% respectively; the proportion of solitary metastases was relatively high in squamous cell carcinoma（58.3%）. In adenocarcinoma and small cell carcinoma, the proportions of mixed density were 40.0% and 35.0%, while the ratios of equidensity were 43.9%, 40.0% and 50.0% in squamous cell carcinoma, large cell carcinoma and adenosquamous carcinoma. The proportion of bleeding was the highest in adenocarcinoma（56.0%）, and the proportion of non-bleeding was the highest in squamous cell carcinoma（82.9%）.The nodular enhancement rate of lung cancer brain metastases was the highest（45.5%）, followed by ring enhancement（37.0%）, and the proportion of non-enhancement was the lowest（2.4%）. In adenocarcinoma brain metastases, the rate of ring enhancement was the highest（50.7%）, while in the brain metastases of squamous cell carcinoma, small cell carcinoma, large cell carcinoma and adenosquamous carcinoma, the proportions of nodular enhancement were the highest, accounting for 68.3%, 37.5%, 60.0% and 50.0%, respectively. Conclusion CT plain and enhancement scan of brain metastases in different pathological types of lung cancer have relatively specific characteristics.