细支气管腺瘤的CT影像特征

CT imaging features of bronchiolar adenoma

目的:探讨细支气管腺瘤(BA)的CT影像特征,以提高对该病的认识和术前诊断的准确度。方法:回顾性分析2018年12月至2020年11月在中国医学科学院北京协和医学院肿瘤医院经手术病理确诊的69例BA患者的临床、影像学和病理学资料,评估并记录病灶的类型、部位、与邻近胸膜关系、大小、形态学特征(分叶征、毛刺征、空泡征、胸膜凹陷征)及其CT随访资料。结果:69例BA中,25例术前胸部CT可检出病灶,44例胸部CT未能检出病灶。25例中,病灶为实性型8例、磨玻璃型8例、囊腔型6例、囊肿型3例;位于右肺上叶1例、右肺中叶2例、右肺下叶12例、左肺上叶5例、左肺下叶5例;10例病灶贴邻胸膜,15例病灶与邻近胸膜距离(10±7)mm。1例囊肿型BA病灶内见钙化。25例BA病灶直径4.4~30.3 mm,中位数9.6 mm;有分叶征20例、毛刺征11例、空泡征12例、胸膜凹陷征6例。11例BA患者接受术前随访,4例直径增长,其中实性型2例、磨玻璃型1例、囊腔型1例,生长速率0.43~2.14 mm/年,中位数1.67 mm/年;术前随访中新发毛刺征、空泡征和分叶征各1例。13例BA患者手术后复查胸部CT均未出现复发或转移。结论:BA的CT影像学表现多样,常为肺内单发的实性结节或磨玻璃密度结节,少数可呈囊腔型或囊肿型;病变可有分叶、空泡及毛刺,钙化罕见;少部分在随访过程中增大。

Objective To investigate the CT characteristics of bronchiolar adenoma(BA)in order to improve the understanding of the disease and to increase the accuracy of preoperative diagnosis.Methods The clinical,imaging and pathological data of 69 patients with BA confirmed by surgical resection and pathology at Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences from December 2018 to November 2020 were retrospectively reviewed.The type,the location and the size of the lesions,the distance from the lesion to the adjacent pleura,as well as the morphological characteristics including lobulation,spiculation,bubble lucency and pleural indentation were analyzed and recorded.The follow-up CT data were also reviewed.Results Among 69 BAs,pre-operation chest CT displayed visible lesion in 25 cases,and showed negative in 44 cases.According to the lesion density,the 25 BAs on CT images were classified into solid type(n=8),ground-glass type(n=8),cystic type(n=6)and cyst type(n=3).There were 15 lesions in the right lung(1 in the upper,2 in the middle and 12 in the lower lobe)and 10 lesions in the left lung(5 in the upper and 5 in the lower lobe).Ten lesions were found adjacent to the pleura.As for the other 15 cases,the distance between the lesion and the adjacent pleura was(10±7)mm.Calcification was displayed in one cystic type BA case.The maximum diameter of 25 BAs were 4.4-30.3 mm,with the median value of 9.6 mm.The lobulation,spiculation,bubble lucency,and pleural indentation of lesions were detected in 20,11,12,and 6 cases.In total there were 11 patients received the preoperative follow-up CT,and 4 cases showed enlargement in diameter(including 2 cases of solid type,1 of ground-glass type and 1 of cystic type).The growth rate was 0.43-2.14 mm/year,with the median value of 1.67 mm/year.Imaging signs including spiculation(n=1),bubble lucency(n=1)and lobulation(n=1)were newly discovered on the preoperative follow-up CT.Postoperative follow-up CT was performed in 13 cases,without any recurrence or metastasis found.Conclusions CT imaging features of BA usually display as a single pulmonary solid or ground-glass nodule,and also can be presented as cystic or cyst type in several cases.Lesions can appear the lobulation,spiculation and bubble lucency,with calcification rarely found.A few of BA cases can enlarge during follow-up.