球形肺不张的CT影像分析

CT analysis of rounded atelectasis of the lung

目的:分析球形肺不张的MSCT影像特点。方法:回顾性分析24例经临床诊断球形肺不张患者的MSCT薄层图像、高分辨图像、多平面重组(MPR)、容积再现(VR)后处理图像,总结球形肺不张的影像特征。通过病史调查,验证球形肺不张与石棉接触等的相关性。结果:24例患者共27个病灶。位于上叶6个(22.22%),右中叶2个(7.41%),下叶19个(70.37%)。27个病灶均出现"彗星尾"征、病灶同侧胸膜肥厚、病灶邻近血管弧形向病变移位(100%),胸膜钙化和胸膜斑9例(33.33%),7个病灶近肺门侧出现"含气支气管征"(25.92%)。8例增强扫描,病灶均有强化。PET-CT检查2例,无代谢增高。手术或穿刺活检6例,病理为胸膜增厚,肺泡萎陷和慢性炎症。动态观察见胸腔积液减少后出现结节影,约1个月后可见"彗星尾"征。有石棉接触史9例,胸腔积液8例。结论:球形肺不张的早期表现为胸腔积液相连的片状实变影,1个月后可形成典型表现。本病下叶多见,中叶和上叶也可发生。接触石棉是主要病因之一,也见于多种原因的胸腔积液。MSCT图像后处理技术有利于球形肺不张特征的显示。

Objective：The aim of this study was to analyse the characteristics of multi-slice spiral computed tomography（MSCT）imaging for rounded atelectasis（RA）.Methods：24 patients diagnosed with RA were retrospectively analysed through MSCT thin slice,high-resolution images,multi-planar reconstruction（MPR）and volume rendering（VR）images.The CT characteristics of RA were summarized.Also,the correlation of CT findings with asbestos exposure was verified through investigation of the patient＇medical history.Results：There were a total of 27 lesions found in 24 patients,including 6 masses in the upper lobe（22.22%）,2 in the right middle lobe（7.41%）,and 19 in the lower lobe（70.73%）.27 lesions showing the ＂comet tail sign＂,ipsilateral pleural thickening and adjacent vessels arch-like shifting towards the lesion.Different degrees of pleural calcifications and plaques were found in 9 patients（33.33%）.The air bronchogram sign in hilar area was apparent in 7 lesions（25.92%）.Contrast enhancement of lesions was observed in 8 patients.Two cases who underwent positron emission tomography-CT（PET-CT）scan showed no metabolic increase.Surgery or biopsy was performed in six cases with the pathology of chronic inflammation and pleural thickening.Dynamic observation in four cases showed that nodules were visible after the reduction of pleural effusion,and the ＂comet tail sign＂ appeared one month later.Conclusion：The initial appearances of rounded atelectasis of the lung in some patients include ipsilateral pleural effusion and patchy consolidation in the adjacent lung tissues.Typical features can be observed a month later.Lesions are more likely located in the lower lobe of the lung rather than in the middle and upper lobes.Exposure to asbestos is one of the main pathogenic factors of RA,and pleural effusion is another important factor.The post-processing technique of MSCT is helpful to reveal accurate diagnostic signs of RA.