肺良性结节与周围型肺癌HRCT表现及病理对照研究

Research on HRCT-pathologic correlation in benign pulmonary nodules and peripheral lung caner

[目的 ]探讨常见肺良、恶性孤立结节HRCT表现特点及其病理基础以提高诊断正确率。 [方法 ]分析经手术病理证实直径≤ 3.0cm肺孤立良性结节 39例、周围型肺癌 31例的HRCT征象 (包括边缘、内部及周围征象 )并与病理对照研究 ;全部行常规螺旋CT扫描 ,病灶同时行HRCT扫描(层厚 1 .5～ 2 0mm ,骨算法重建 ) ;其中良性结节有结核球 1 5例 ,炎性假瘤 1 2例 ,错构瘤 1 0例 ,其他 2例。 [结果 ]形态规则、边缘光滑、粗长毛刺及卫星病灶在良、恶性结节组间有显著差异 (P <0 .0 5 ) ;浅分叶、胸膜凹陷、血管集束、空洞及钙化在两组间无显著差异 (P >0 .0 5 ) ;深分叶、短细毛刺、棘状突起、空泡征及支气管气象多见于肺癌。虽然一些征象可同时出现在肺良、恶性结节 ,但其HRCT征象特点及病理基础不同。 [结论 ]HRCT能最大程度反映肺孤立性良、恶性结节边缘、内部和周围特征 。

To study the HRCT features and its pathologic basis of solitary pulmonary benign and malignant nodules(SPN) for improving correct diagnosis. The HRCT appearances including the edge and internal characteristics and its pathology were studied comparatively between 39 benign SPNs and 31 peripheral lung cancers less than 3cm in diameter and proved pathologically. All cases were scanned with conventional spiral CT and HRCT(1.5～2.0 mm thick with bone construction);The benign nodules include 15 tuberculoma ,12 penue-,10 harmatoma and 2 other nodules. The smooth, well-defined margin,coarse long spiculation and satellites were significant difference statistically( P <0.05) in these benign and malignant nodules, but there was no significant difference( P >0.05)of superficial lobulation,pleural indentation, vascular convergence, cavitation and calcification between them;The deep lobulation,short fine spiculation,spine,vacuole sign and air bronchograms were more appeared in lung cancers.Although some CT findings were found both in benign and malignant nodules, their HRCT features and pathologic basis were different..[Conclusion] HRCT of SPN can accurately reflect the edge, surrounding and internal characteristics and plays a important role in differential diagnosis of SPN.