多层螺旋CT检查对原发性肺淋巴上皮瘤样癌的诊断价值分析

Diagnostic value of MSCT in primary pulmonary lymphoepitheliomatoid carcinoma

目的 分析原发性肺淋巴上皮瘤样癌(lymphoepithelioma-like carcinoma,LELC)计算机断层扫描(computed tomography,CT)的影像学表现,研究多层螺旋CT检查对原发性肺LELC的诊断价值。方法 回顾性分析浙江省舟山市三家三级医院2001年1月至2022年3月54例经手术与病理证实的原发性肺LELC患者的CT影像学表现,从肿瘤数量及部位、直径、形态、密度、瘤周界面、强化方式、转移情况方面进行分析,归纳LELC影像学特征。结果 54例原发性肺LELC均为单发周围型,其中36例肿瘤位于胸膜下。肿瘤面积为7mm×9mm~50mm×30mm。32例肿瘤为类圆形软组织肿块伴有表面浅“分叶征”,12例肿瘤为哑铃状软组织肿块伴有表面深“分叶征”,7例肿瘤为软组织结节,3例肿瘤为不规则形态。18例肿瘤周围见“毛刺征”;36例容积再现重建肿瘤表面见棘状突起。48例肿瘤为均匀密度,6例肿瘤内见小灶性坏死区。36例肿瘤边缘清楚,18例肿瘤边界模糊。24例肿瘤周围见“胸膜牵拉征”,24例多平面重建见肺门侧见支气管中断。48例肿瘤表现为持续性轻中度均匀强化,6例肿瘤呈环形强化。12例肿瘤边缘见“血管包绕征”,最大密度投影图像上病灶内血管与肺动脉分支延续。18例肺门及纵隔淋巴结肿大并强化。结论 原发性肺LELC患者的CT表现有一定的特征性,对该病诊断有重要意义,在临床术前无创诊断中发挥重要作用。

Objective To analyze the computed tomography(CT)findings of primary pulmonary lymphoepithelioma-like carcinoma(LELC)and to study the diagnostic value of multi-slice spiral CT in primary pulmonary LELC.Methods The CT findings of 54 cases of primary pulmonary LELC confirmed by surgery and pathology were analyzed retrospectively in three tertiary hospitals in Zhoushan City,Zhejiang Province from January 2001 to March 2022.The imaging features were summarized from the aspects of tumor number and location,size,shape,density,peritumoral interface,enhancement mode and metastasis.Results A total of 54 cases of primary LELC of the lung were single peripheral type,36 of which were located under the pleura.The tumor volume was between 7mm×9mm and 50mm×30mm.32 tumors were round like soft tissue masses with superficial“lobulation sign”,12 tumors were dumbbell shaped soft tissue masses with superficial“lobulation sign”,7 tumors were soft tissue nodules,and 3 tumors were irregular in shape.18 cases showed“spicule sign”around the tumor;Spinous processes were found on the surface of tumor in 36 cases of volumerendering technique(VR)reconstruction.The tumors were homogeneous in 48 cases,and small necrotic areas were seen in 6 cases.The tumor margin was clear in 36 cases,and blurry in 18 cases.“Pleural traction sign”was seen around the tumor in 24 cases,and bronchial interruption was seen in the lateral hilum of lung in 24 cases after MPR reconstruction.48 cases showed continuous mild to moderate homogeneous enhancement,and 6 cases showed annular enhancement.In 12 cases,“vascular wrapping sign”was seen at the edge of the tumor,and the blood vessels in the lesion and pulmonary artery branches continued on MIP images.The hilar and mediastinal lymph nodes were enlarged and enhanced in 18 cases.Conclusion The CT findings of primary pulmonary LELC have certain characteristics,which is of great significance in the diagnosis of this disease and plays an important role in the non-invasive diagnosis of this disease before clinical operation.