非钙化结核球与周围型肺癌CT表现的对比研究

Comparative study of CT findings of non-calcified tuberculoma and peripheral lung cancer

目的对比研究非钙化结核球与周围型肺癌CT表现,减少将非钙化结核球误诊为周围型肺癌的概率。方法收集58例CT误诊为周围型肺癌的非钙化结核球及468例周围型肺癌,两组病例均由手术病理证实。对比分析两组病灶的大小、形状、密度、增强扫描后强化值、边缘、有无卫星病灶、发生部位及有无肺门纵隔肿大淋巴结等征象。结果相对于周围型肺癌,边缘光滑及卫星病灶多见于非钙化结核球(15.52%vs 8.97%、48.28%vs 10.47%),差异有统计学意义(χ^2=15.23、59.23,P<0.01)。而病灶边缘毛糙及胸膜凹陷少见于非钙化结核球(84.48%vs 91.03%、8.62%vs 25.00%),差异有统计学意义(χ^2=15.23、7.77,P<0.01)。58例CT误诊的非钙化结核球和468例周围型肺癌的最大径分别为(3.37±1.23)cm、(3.52±1.37)cm,差异无统计学意义(t=0.80,P=0.43)。非钙化结核球和周围型肺癌的平扫CT值及强化值差异无统计学意义[(28.43±8.95)HU vs(29.24±9.68)HU,t=0.61,P=0.55;(28.43±8.95)HU vs(30.63±16.52)HU,t′=1.99,P>0.05]。两组病灶的发生部位及有无肿大淋巴结等征象的差异无统计学意义(P>0.05)。结论非钙化结核球常表现为边缘光滑伴卫星病灶,而周围型肺癌多表现为边缘毛糙伴胸膜凹陷。

Objective To improve the differential diagnosis of non-calcified tuberculoma from peripheral lung cancer by comparative study of their CT findings. Methods The CT finding of 468 patients with confirmed peripheral lung cancer and 58 patients with non-calcified tuberculoma were compared. The shape, density, features of enhancement, margin, adjacent lymph nodes and satellite lesions were analyzed. Results Compared with peripheral lung cancer [8.97(42/468), 10.47%(49/468), respectively], smooth edge and satellite lesions were more commonly found in non-calcified tuberculoma(15.52% vs. 8.97% and 48.28% vs. 10.47, respectively,χ^2=15.23, P<0.01 and χ^2 =59.23, P<0.01). Rough edge and pleural indentation were more commonly seen in peripheral lung cancer(91.03% and 25.00%, respectively] compared with non-calcified tuberculoma(84.48% and 8.62%, respectively;χ^2=15.23, P<0.01 and χ^2=7.77, P<0.01). The mean diameter of non-calcified tuberculoma(3.37±1.23 cm) was similar to that of peripheral lung cancer(3.52±1.37 cm, t=1.32, P=0.32). Conclusion Smooth edge and satellite lesions are more commonly found in non-calcified tuberculoma, while rough edge and pleural indentation are more commonly seen in peripheral lung cancer.