肺大细胞神经内分泌癌CT表现及其与小细胞肺癌的鉴别

CT Findings of Lung Large Cell Neuroendocrine Carcinoma and Differential Diagnosis with Lung Smallcell Carcinoma

目的探讨肺大细胞神经内分泌癌(LCNEC)的CT表现及其与小细胞肺癌(SCLC)的鉴别要点。方法回顾分析经病理证实的30例LCNEC及34例SCLC患者的CT影像资料并进行比较。结果 30例LCNEC常表现为双肺上叶80%,体积较大(>4cm者70%),边界清楚(70%),浅分叶(86%),平扫及增强扫描密度不均匀(73%、100%),轻到中度强化(90%),坏死常见(100%),且为多发或弥漫坏死(80%),肿瘤内部血管多变细、模糊(85%),常合并肺门及纵隔淋巴结的肿大(60%)及坏死(77%);而空洞(6%)、支气管血管征(3%)少见。LCNEC相比SCLC沿支气管血管束生长,肺门及纵隔侵犯,肺门及纵隔淋巴结肿大及融合比率均更低,差异具有统计学意义(均P<0.05)。结论 LCNEC具有一定CT特征,与SCLC相比存在一定鉴别点。

Objective To analyze CT features of large cell neuroendocrine arcinoma(LCNEC)and the differentiation with lung small cell carcinoma(SCLC).Methods The CT findings of 30 LCNEC and 34 SCLC confirmed pathologically were retrospectively analyzed and further contrasted.Results 30 LCNEC were mostly presented located in upper lobe(80%),diameter≥4 cm(70%),clear margin(70%),mildly lobulated(86%),uneven in density on plain and enhanced CT(73%,100%),slight or moderate enhancement(90%),tumor necrosis(100%),multiple or diffuse necrosis(80%).The blood vessels inside the tumor became thinner and indistinct(85%),enlargement(60%)of lymph node of the hilum or mediastinum and among 77%combining necrosis,cavity(6%)and air bronchogram(3%)were uncommon.The rate of LCNEC growth along the bronchovascular bundle,invasion of pulmonary hilar vessels or mediastinum,lymph nodes enlarged and blended each other were respectively lower than SCLC(P<0.05).Conclusion LCNEC has certain CT features and some discrimination with SCLC.