肺错构瘤的螺旋CT诊断

Spiral CT diagnosis of pulmonary hamartoma

目的:探讨肺错构瘤的螺旋CT特点,提高肺错构瘤的影像学诊断和鉴别诊断的正确性。方法:回顾性分析33例经手术病理证实的肺错构瘤患者的临床资料及螺旋CT图像。结果:本组肺错构瘤均为单发,左肺21例,右肺11例,位于下叶的共有23例,占69.7%(23/33)。本组肺错构瘤多位于胸膜(包括叶间胸膜)附近,瘤体与胸膜的平均距离是0.6cm。本组肺错构瘤的瘤体直径在0.8~2.7cm,瘤体平均直径1.8cm。本组肺错构瘤的瘤体边缘均清晰锐利,无毛刺。本组瘤体中观察到不同形态钙化影的有18例,占54.5%(18/33);观察到脂肪影的有7例,占21.2%(7/33);层厚1~2mm扫描时观察到的钙化影及脂肪影多于层厚5mm扫描时。利用螺旋CT的三维重建技术进行后处理,本组中观察到瘤体周围肺纹理走行自然、分布正常的有20例,占60.6%(20/33);观察到瘤体周围肺纹理轻度受压并呈握球状的有13例,占39.4%(13/33);全部病例均未观察到周围肺纹理的增粗、聚拢、牵拉等支气管血管集束征。结论:肺错构瘤具有明显的螺旋CT特点。螺旋CT薄层扫描和三维重建技术在肺错构瘤的诊断和鉴别诊断中具有重要的价值。

Objective To explore the characteristics of spiral CT of pulmonary hamartoma and to improve the accuracy of imaging diagnosis and differential diagnosis of pulmonary hamartoma.Methods The clinical data and spiral CT images of 33 patients with pulmonary hamartoma confirmed by surgery and pathology were retrospectively analyzed.Results In this group,all pulmonary hamartomas were single,with 21 cases of left lung and 11 cases of right lung.There were 23 cases in the lower lobe,accounting for 69.7% (23/33).Pulmonary hamartomas in this group were mostly located near the pleura (including interlobular pleura),and the average distance between the tumor and the pleura was 0.6 cm.The tumor diameter of this group of pulmonary hamartomas was 0.8~2.7cm,and the average diameter of the tumors was 1.8cm.The tumor edges of this group of pulmonary hamartomas were clear and sharp,without burrs.Among the tumors in this group,18 cases were observed with different forms of calcification,accounting for 54.5% (18/33);7 cases were observed with fat density,accounting for 21.2% (7/33);when the layer thickness was 1 to 2mm,more calcification and fat density were observed than when the layer thickness was 5 mm.Using three-dimensional reconstruction technology of spiral CT for post-processing,in this group,20 cases were observed with natural and normal distribution of the lung texture around the tumor,accounting for 60.6% (20/33);13 cases were observed with the slight compression of lung texture around the tumor,like a ball in the hand,accounting for 39.4% (13/33);no thickening,gathering,pulling,etc.of bronchovascular bundles were observed in all cases.Conclusion Pulmonary hamartoma has obvious characteristics of spiral CT.Spiral CT thin slice scanning and three-dimensional reconstruction technology have important value in the diagnosis and differential diagnosis of pulmonary hamartoma.