摘要
目的 探讨临床I期周围型肺癌的 MDCT特征并分析误诊情况及鉴别要点。方 法 收集我院2010年5月至2015年11月期间 收治的周围型肺癌患者82例进行回顾性分 析,应用GE Light Speed VCT 64排CT扫 描机进行CT检查,统计患者病灶形态、瘤 肺界面、边缘形态、内部结构及邻近结构 改变,总结I期周围型肺癌的MDCT典型征 象。结果 I期周围型肺癌的T1a期、T1b 期、T2a期患者均以圆/类圆形为主、边界 多清晰,部分可见空泡征、支气管截断胸 膜凹陷与血管集束征。T1a期、T1b期多见 分叶与毛刺,少见棘状突起,T2a期患者 均可见分叶,少见毛刺与棘状突起。结论 I期周围型肺癌的MDCT具有明显特征性, 利于定位及定性诊断。此外,I期周围型 肺癌易被误诊为结核球、球形肺炎、炎性 假瘤、错构瘤,为提高临床检出率,需把 握鉴别诊断要点。
Objective To investigate the MDCT features of peripheral lung cancer in patients with stage I and analyze the misdiagnosis and differential diagnosis. Methods In our hospital in 2010 may to November 2015 admitted during the period of peripheral lung cancer patients 82 cases were retrospectively analyzed. Application of Ge light speed VCT 64 slice CT scanner of CT examination, statistical lesion morphology, tumor lung interface, edge shape, internal structure and adjacent structures change, summary of stage I lung cancer peripheral MDCT typical signs. Results The T1a phase, T1b phase and T2a phase of I stage lung cancer were all round/round/round, with clear boundary, partially visible vacuole sign, and the truncated pleural indentation and vascular bundle sign. T1a phase, T1b phase and the burr, a rare spike, T2a patients are visible in the sub leaf, a rare spike and spike like. Conclusion MDCT of peripheral lung cancer in I stage has obvious characteristics, which is beneficial to the location and qualitative diagnosis. In addition, phase I of peripheral lung cancer easily misdiagnosed as tuberculoma, spherical pneumonia, inflammatory pseudotumor, hamartoma, in order to improve the detection rate of clinical, need to grasp the main points of differential diagnosis.
【关键词】周围型肺癌;I期;MDCT;征 象;误诊
【中图分类号】R734.2
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2016.08.019
前言
肺癌为常见恶性肿瘤,发病率逐年升高,其中周围型肺癌由于早 期症状极不明显,确诊时往往已失去根治机会,因而早期诊断及鉴别 具有重要临床意义,也是临床影像诊断难题之一。CT为肺癌常用检查 方法,随着CT设备的更新换代,尤其是多排螺旋CT(MDCT)扫描技术与 后处理软件性能的改善,周围型小肺癌检出率获得明显提高。依据第 七版肺癌TNM临床分期标准,Ⅰ期周围型肺癌指病灶最大直径≤5cm且 未出现淋巴结与远处脏器转移,可取得良好预后[1]。大量临床研究显 示[2-3],Ⅰ期肺癌行根治性手术可获得较高生存率,其中IA期术后5年 生存率约为71%~90%,IB期约为42%~75%,可见实现周围型肺癌的早 期诊断对于改善患者预后具有重要意义。本研究以我院2010年5月至 2015年11月收治的周围型肺癌患者进行回顾性分析,对临床I期周围型 肺癌的MDCT特征、误诊情况及鉴别要点进行总结,以期提高Ⅰ期周围 型肺癌的临床诊断准确性,现报道如下。
中国CT和MRI杂志
第14卷, 第 8 期
2016年08月
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