29例肺硬化性肺泡细胞瘤的MSCT诊断及误诊分析

Diagnosis and misdiagnosis of multi-slice computed tomograpgy for 29 cases of pulmonary sclerosing pneumocytoma

目的总结29例经病理证实的肺硬化性肺泡细胞瘤(pulmonary scleroing pneumocytoma,PSP)的多层螺旋CT(multi-slice computed tomograpgy,MSCT)表现,并对16例术前误诊病例进行原因分析,以期提高术前诊断率。方法回顾性分析经病理证实的29例肺硬化性肺泡细胞瘤的MSCT表现及临床资料,并复习相关文献。结果 29例病例中术后诊断为肺硬化性肺泡细胞瘤仅13例,误诊率达55%。29例病例共计病灶30个,结节型病灶23个,肿块型病灶6个,26个病灶呈圆形或类圆形,2个病灶有浅分叶征,1个病灶呈磨玻璃样结节样。19例密度均匀,10例密度不均匀,增强扫描的16例病灶呈持续轻~中度强化,MSCT经MPR、VR后处理可见血管贴边征(6例)、抱球征(3例)、晕征(7例)。结论肺硬化性肺泡细胞瘤好发于中年女性,多为单发孤立病灶,MSCT检查具有一定的特殊征象(如贴边血管征、血管抱球征、晕征),增强扫描呈持续中度强化,临床工作中应紧密结合病史,避免误诊,提高术前诊断正确率。

Objective To summarize the multi-slice computed tomograpgy( MSCT) findings of 29 cases of pathologically-proven pulmonary sclerosing pneumocytoma and analyze the clinical data of 16 cases of preoperative misdiagnosis in order to improve the preoperative diagnosis rate. Methods The MSCT findings and the clinical data of 29 cases of pulmonary sclerosing pneumocytoma confirmed by pathology were retrospectively reviewed,and related literatures were reviewed. Results Among the 29 cases of pulmonary sclerosing pneumocytoma,only 13 cases were diagnosed,with the misdiagnosis rate of 55%. In the 29 cases,there were 30 lesions,23 nodular lesions,and 6 mass lesions. And 26 lesions were round or round-like,2 lesions showed shallow lobulation,and 1 lesion showed ground glass-like nodules. And 19 cases showed uniform density and 10 cases showed uneven density. Enhanced scanning of the lesions of 16 cases showed sustained mild to moderate enhancement. The MSCT after MRP and VR treatment showed welt vessel sign in 6 cases,ball-holding sign in 3 cases,and halo sign in 7 cases. Conclusion Pulmonary sclerosing pneumocytoma occurs usually in middle-aged women and mostly shows single-shot lesions. MSCT has certain special signs( such as welt vessel sign,ball-holding sign and halo sign) and enhanced scanning shows continuous mild to moderate enhancement. In clinic,we should avoid misdiagnosis and improve the accuracy of preoperative diagnosis on the basis of close combination of the patient’s medical history.