MSCT对中央型小细胞肺癌与肺鳞癌支气管改变的比较研究

The Study of Multi Slice Spiral CT in Bronchial Abnormity:Comparision with Center-type SmalI Cell Lung Cancer and Squamous Cell Carcinoma

目的对比分析中央型小细胞肺癌和肺鳞癌对支气管改变的特征性CT表现。方法回顾性分析89例中央型肺癌患者的胸部CT图像,根据病理分为两组:小细胞肺癌组(43例)、鳞癌组(46例)。根据受累支气管在肿块中阻断点的情况分为三型:Ⅰ型,阻断点深入肿块不到1/3;Ⅱ型,阻断点深入肿块1/3至2/3处;Ⅲ型,阻断点深入肿块的2/3以上或完全穿透无阻断。由两名放射科医师进行分型,并测量肿块长径及对有无坏死空洞、阻塞性炎症、不张及支气管壁情况进行评估。采用独立样本t检验和χ^(2)检验比较差异。结果小细胞肺癌组:Ⅰ型9例,Ⅱ型10例,Ⅲ型24例;鳞癌组:Ⅰ型29例,Ⅱ型8例,Ⅲ型9例,两组有显著性差异(P<0.05),小细胞肺癌组Ⅲ型为主,鳞癌组Ⅰ型为主。小细胞肺癌组的肿块长径、支气管壁光滑增厚、肺不张、阻塞性肺炎、坏死空洞分别为(62.31±19.76)mm、31例、29例、13例、4例;在鳞癌组中分别为(53.15±19.15)mm、8例、33例、18例、15例。阻塞性肺炎及肺不张的检出无显著性差异(P>0.05),其余均有显著性差异(P<0.05)。结论中央型小细胞肺癌和肺鳞癌支气管改变具有特征性CT表现,可作为其鉴别诊断的重要依据。

Objective To compare and analyze characteristic CT findings of bronchial changes in central-type small cell lung cancer and lung squamous cell carcinoma.Methods The chest CT images of 89 patients with central lung cancer were retrospectively analyzed,and they were divided into 2 groups according to pathology:small cell lung cancer group(43 cases)and squamous cell carcinoma group(46 cases).According to the blocking point of the affected bronchus,the cases were divided into three types:TypeⅠ,where the blocking point penetrates less than 1/3 of the tumor;TypeⅡ,where the blocking point penetrates 1/3 to 2/3 of the tumor;TypeⅢ,the blocking point penetrates more than 2/3 of the mass or completely penetrates without blocking.Two radiologists performed classification,and measured the length of the mass and evaluated the presence of necrotic cavities,obstructive inflammation,atelectasis,and bronchial walls.Independent sample t test and χ^(2) test were used to compare the differences.Results Small cell lung cancer group:9 cases of typeⅠ,10 cases of typeⅡ,24 cases of typeⅢ;squamous cell carcinoma group:29 cases of type I,8 cases of typeⅡ,and 9 cases of typeⅢ.There was a significant difference between the two groups(P<0.05),the small cell lung cancer group is predominantly typeⅢ,and the squamous cell carcinoma group is predominantly typeⅠ.In the small cell lung cancer group,the mass diameter,bronchial wall smooth and thickened,atelectasis,obstructive pneumonia,and necrotic cavity were(62.31±19.76)mm,31 cases,29 cases,13 cases,and 4 cases,respectively;in the squamous cell carcinoma group Among them were(53.15±19.15)mm,8 cases,33 cases,18 cases,and 15 cases.There was no significant difference in the detection of obstructive pneumonia and atelectasis(P>0.05),and the others had significant differences(P<0.05).Conclusion Central small cell lung cancer and lung squamous cell carcinoma bronchial changes have characteristic CT findings which can be used as an important basis for their differential diagnosis.