HRCT鉴别肺内淋巴结和肺癌的初步研究

Preliminary study on the differential diagnosis of intrapulmonary lymph nodes from lung cancer by using high-resolution CT

目的:探讨肺内淋巴结(IPLNs)和肺癌的CT特征,提高对两者的鉴别诊断能力.方法:收集经病理确诊的IPLNs 28例,肺癌37例,术前均行HRCT薄层扫描,记录肺小结节的位置、最大径、密度、形态、边界、边缘、内部结构、与邻近血管组织的关系及胸膜间距等,并行统计学分析.结果:2组肺结节密度、边界、边缘(分叶征、毛刺征)、空泡征、支气管充气征、线状密度影(<2条,2~4条,>4条)、肋胸膜间距(<10 mm,>20 mm)、吸烟史,差异均有统计学意义(均P<0.05).结论:通过HRCT薄层扫描观察肺小结节相关影像学特征(密度、边界、边缘、内部结构、邻近血管、组织的改变等),并结合病史,可对IPLNs和肺癌进行鉴别诊断,提高对肺小结节的诊断准确率.

Objective:To explore the imaging features of intrapulmonary lymph nodes(IPLNs)and lung cancer presenting as solitary nodules,in order to improve the ability of differential diagnosis between IPLNs and small nodule lung cancers.Methods:Twenty-eight cases of IPLNs and 37 cases of lung cancer confirmed by pathology were collected.All subjects were scanned with high resolution CT before operation.The location size,density,shape,border,margin,internal structure,changes in adjacent blood vessels and tissue and the distance from the pleura to small nodules in the two groups were observed,and statistical analysis of the above data was made.Results:There were significant differences in nodule density,border,marginal lobulated sign,spicule sign,vacuolar sign,bronchogram,linear density shadow(<2,2—4,>4),pleural space(<10 mm,>20 mm),smoking history between the two groups(all P<0.05).Conclusions:The IPLNs and lung cancer presenting as solitary nodules could be differentiated through observing the imaging features(density,boundary,margin,internal structure,adjacent blood vessels,tissue changes,et al)of pulmonary nodules and combining with the patient's history.It is helpful to improve the accuracy of clinical diagnosis of small pulmonary nodules.