依据影像学特征的原发性肺类癌的分型及鉴别意义

Classification and differential diagnosis of primary lung carcinoid based on imaging features

目的分析原发性肺类癌(primary lung carcinoid,PLC)的分型及临床鉴别诊断,比较典型类癌与不典型类癌影像征象差异,提高肺类癌影像诊断水平。方法回顾性分析54例经组织病理学证实的原发性肺类癌患者的临床及CT资料,其中典型类癌21例,不典型类癌33例,比较二者包括位置、大小、形态、走行、边缘、钙化、转移、平扫及增强CT值等指标。结果21例典型类癌与33例不典型类癌病灶位置分为中央型/周围型,二者分别为15/6例、4/29例(P<0.001),典型类癌以中央型为主,不典型类癌以周围型为主。21例典型类癌平均直径为(1.85±1.10)cm,18例呈结节,3例呈团块;33例不典型类癌平均直径为(4.36±2.54)cm,13例呈结节,20例呈团块,(P<0.05),典型类癌以结节型为主,不典型类癌比典型类癌更大,以团块型为主。典型类癌与不典型类癌边缘可分为分叶、光滑,典型类癌为13/8例,不典型类癌为5/28例(P<0.001)。典型类癌未发现转移灶,不典型类癌中15例可见转移(P<0.001)。典型类癌及不典型类癌的走形、钙化情况差异不大,不具有统计学意义(P>0.05)。CT平扫两者CT值分别为(37.32±19.26)Hu、(33.74±13.30)Hu;增强扫描二者平均强化值分别为(61.38±34.72)Hu、(51.87±27.86)Hu。结论典型类癌与不典型类癌的位置、大小、形态、边缘、钙化、强化和转移等CT影像特征部分存在差异,具有统计学意义,影像学征象鉴别二者具有临床意义。

Objective To analyze the classification and clinical differential diagnosis of primary lung carcinoid(PLC),to compare the differences between typical and atypical carcinoid imaging signs,and to improve the level of imaging diagnosis of lung carcinoid.Methods The clinical and CT data of 54 patients with primary pulmonary carcinoid confirmed by histopathology were retrospectively analyzed,including 21 cases of typical carcinoid and 33 cases of atypical carcinoid.The two patients were compared,including location,size,shape,progression,margin,calcification,metastasis,plain scan and enhanced CT values.Results The 21 cases of typical carcinoid and 33 cases of atypical carcinoid were divided into central type and peripheral type,15/6 cases and 4/29 cases respectively(P<0.001).The central type was dominant in typical carcinoid and the peripheral type was dominant in atypical carcinoid.The mean diameter of 21 cases typical carcinoid patients was(1.85±1.10)cm,with nodules in 18 cases and mass in 3 cases.The average diameter of 33 cases atypical carcinoids was(4.36±2.54)cm,13 cases were nodules,and 20 cases were clumps(P<0.05).Typical carcinoids were mainly nodules,while atypical carcinoids were larger than typical carcinoids and mainly clumped.The margins of typical carcinoid and atypical carcinoid were segmented and smooth,with 13/8 cases of typical carcinoid and 5/28 cases of atypical carcinoid(P<0.001).No metastases were found in typical carcinoids,and 15 cases of atypical carcinoids showed metastases(P<0.001).There was no significant difference in shape and calcification between typical carcinoid and atypical carcinoid(P>0.05).The CT values of plain scan were(37.32±19.26)Hu and(33.74±13.30)Hu,respectively.The average intensification values were(61.38±34.72)Hu and(51.87±27.86)Hu,respectively.Conclusions There were some differences in the location,size,shape,margin,calcification,enhancement and metastasis of typical carcinoid and atypical carcinoid,which were statistically significant(P<0.05).Understanding the differences in the above signs would help to distinguish the two carcinoids.