支气管树各部位肺类癌的CT影像表现

CT imaging characteristics of pulmonary carcinoid in different location of airway

目的分析气管支气管树不同位置发生的肺类癌的CT影像特点。方法回顾性选取2015年1月至2020年12月于广州医科大学附属第一医院就诊的肺类癌病例30例为研究对象,所有患者均行胸部CT平扫、动脉期和静脉期扫描,观察病灶的位置、大小、边缘、密度、病灶强化程度、病灶内部有无坏死区及钙化灶、淋巴结转移等。结果按照病灶在气管支气管树的位置,将其分为中央型、肺门型和周围型肺类癌。30例病例包括中央型肺类癌7例,肺门型肺类癌9例,周围型肺类癌14例。7例中央型肺类癌,病灶位于气管或主支气管管腔内,包括4例结节和3例肿块(均伴有管腔外生长)。9例肺门型肺类癌,病灶位于叶或段支气管,包括8例结节和1例肿块,其中2例合并1个肺叶的肺不张,1例合并远端支气管粘液栓形成,6例合并阻塞性炎症。14例周围型肺类癌,病灶位于更细小的支气管分支(即段支气管分支以下的小支气管,但不包括段支气管),包括12例结节和2例肿块,共有11例病灶边缘有分叶征。增强扫描动脉期90%的肺类癌病灶实性部分中度或重度强化,静脉期所有病灶的实性部分中度或重度强化。30例肺类癌病灶中,有18例病灶内部显示斑片样稍低密度区,另外12例病灶内部无低密度区。只有6例病例出现肺门及纵隔淋巴结肿大转移。所有病例均行手术切除或活检,30例病例包括17例典型类癌和13例不典型类癌。结论气管支气管树不同位置发生的肺类癌具有不同的典型影像表现,且肺类癌的密度和强化方式有典型的影像学特征。

Objective To analyze the CT imaging characteristics of pulmonary carcinoid in different locations of airway.Methods Thirty cases of pulmonary carcinoid admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2015 to December 2020 were retrospectively selected as the research objects.All patients underwent the plain,arterial and venous CT scan.The location,size,margin,density,enhancement degree,area of necrosis,calcification and lymph node metastasis were observed.Results According to lesions′location in the airway,the lesions were divided into the central type,the hilar type,and peripheral type.According to lesions′location in the airway,total 30 cases included 7 cases of central type,9 cases of hilar type,and 14 cases of peripheral type.In 7 cases of central type,4 nodules and 3 masses mainly located in trachea or main bronchial lumen.Especially,all masses were accompanied by extratubular growth.Nine cases of hilar type included 8 nodules and 1 mass in lobar or segmental bronchus,whose accompanied symptoms included 2 cases of pulmonary atelectasis,1 case of mucous embolus in distal bronchial lumen,and 6 cases of obstructive inflammation.14 cases of peripheral type in small bronchus(that is below the segmental bronchus)had 12 nodules and 2 masses,in which 11 cases had lobulation sign.The solid part of 90%lesions had moderate or severe enhancement in arterial phase,and the solid part of 100%lesions had moderate or severe enhancement in the venous phase.In 30 cases of pulmonary carcinoid,18 cases showed patchy low-density area in the lesion and 12 cases showed no low-density.Only six cases of Hilar and mediastinal lymphadenopathy metastases were observed.All cases were surgically removed or biopsied,which included 17 cases of typical and 13 cases of atypical carcinoid.Conclusion Pulmonary carcinoid has different typical imaging manifestations in different location of tracheal bronchial tree.The density and enhancement are also distinctive for pulmonary carcinoid.