孤立性肺结节良恶性的CT诊断

CT Diagnosis of Benign and Malignant Solitary Pulmonary Nodules

目的探讨采用薄层螺旋CT平扫及增强对孤立性肺结节良恶性的诊断意义。方法选取2017年1月至2019年1月,我院30例孤立性肺结节患者,采用SIEMENS SOMATOM Scope16排螺旋CT机常规扫描并用1.5mm层厚冠状位重建,CT增强扫描用高压注射器注射碘海醇后监测肺动脉达CT值达70Hu时,延迟6s后自动开始扫描,分别于36s、90s再对病灶次扫描。结果13例恶性SPN结节直径0.8cm^3cm;形态不规则、边缘毛糙,三维比值<1.78;1例为实性密度结节,2例为磨玻璃样密度结节,10例为混合密度结节;8例结节内可见泥沙样钙化或偏心样钙化;倍增时间为1~15个月;9例其内可见空气支气管征,7例其内可见空泡征;CT增强分别呈中、高度均匀、不均匀或环形强化。17例良性SPN结节直径0.4cm^2cm;形态规则、边缘光滑,三维比值>1.78;12例为实性密度结节,5例为磨玻璃样密度结节;8例肺结核球病例其内均见斑点样钙化,2例肺炎性假瘤病例其内分别见中心样钙化和层叠样钙化,3例错构瘤病例其内均见爆米花样钙化;1例韦格氏肉芽肿经治疗后变小消失,其余病例经2年随访,结节大小无明显变化;未见空气支气管征及空泡征;8例肺结核球病例中6例无强化,2例包膜强化呈环形,4例肺炎性假瘤病例呈高度均匀强化,3例错构瘤病例无强化,1例球形肺不张病例呈显著高度均匀强化,1例韦格氏肉芽肿病例呈高度环形强化。结论薄层CT平扫结合增强对孤立性肺结节良恶性的诊断具有极其重要的意义。

Objective To explore the diagnostic significance of plain and enhanced thin-slice spiral CT in the benign and malignant solitary pulmonary nodules. Methods Thirty patients with solitary pulmonary nodules in our hospital from January 2017 to January 2019 were selected,Routine SIEMENS SOMATOM Scope 16-slice spiral CT scan and coronal reconstruction with 1. 5 mm slice thickness,When the pulmonary artery was monitored by injecting iohexol with high pressure syringe to reach the CT value of 70 Hu,the scan was automatically started after 6 seconds delay,and the lesions were scanned again at 36 seconds and 90 seconds respectively. Results The diameter of malignant SPN nodules in 13 cases ranged from 0. 8 cm to 3 cm;The shape is irregular,the edge is rough,and the three-dimensional ratio is less than 1. 78;Solid density nodules in 1 case,ground-glass density nodules in 2 cases and mixed density nodules in 10 cases;Sediment-like calcification or eccentric calcification were found in 8 nodules;The doubling time is1-15 months;Air bronchial sign was seen in 9 cases and vacuole sign in 7 cases;CT enhancement was moderately,highly homogeneous,inhomogeneous or circular. The diameter of benign SPN nodules was 0. 4 cm ~ 2 cm in 17 cases;the shape was regular,the edge was smooth,and the three-dimensional ratio was more than 1. 78;12 cases were solid density nodules and 5 cases ground glass density nodules;Spot calcification was found in 8 cases of tuberculoma,central calcification and cascade calcification in 2 cases of pulmonary inflammatory pseudotumor,and popcorn calcification in 3 cases of hamartoma;1 case of Wegener’s granuloma became smaller and disappeared after treatment,and the other cases were followed up for 2 years. The size of nodules did not change significantly. There was no air bronchial sign or vacuole sign;Among 8 cases of tuberculoma,6 cases had no enhancement,2 cases had circular enhancement of capsule,4 cases had highly homogeneous enhancement of inflammatory pseudotumor,3 cases had no enhancement of hamartoma,1 case had markedly high homogeneous enhancement of spherical atelectasis,and 1 case had highly circular enhancement of Wegener’s granuloma. Conclusions Thin-slice CT plain scan combined with enhancement is of great significance in the diagnosis of benign and malignant solitary pulmonary nodules.