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MSCT对2cm以下周围型肺癌与炎性结节的诊断及鉴别

作者:李 庆 王万旗

所属单位:锦州医科大学附属第三医院放射科(辽宁 锦州 121000)

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摘要

目的 探讨2cm以下周围型肺癌与 炎性结节在MSCT常规扫描与HRCT上征象的 检出及表现,以提高诊断和鉴别诊断的准 确性。方法 收集了经病理和临床证实的 2cm以下的73例周围型肺癌和32例炎性结 节病例,分别采用7mm层厚和1mmHRCT重 建,分析了病变密度、小泡征、支气管充 气征、病灶边缘、分叶征、毛刺征、胸膜 凹陷征、血管集束征、小棘突征、病灶 周围模糊影及强化等征象表现。结果 7mm 层厚像对肺癌与炎性结节征象检出比较P <0.05,1mmHRCT对肺癌与炎性结节征象 检出比较P<0.05,1mmHRCT与7mm层厚像 对肺癌征象检出比较P<0.05,上述三者 均有统计学意义,1mmHRCT与7mm层厚像对 炎性结节征象检出比较P>0.05,无统计 学差异。小泡征、分叶征、毛刺征、胸膜 凹陷征、血管集束征、小棘突征多见于肺 癌。结论 1mmHRCT是周围型小肺癌与炎性 结节鉴别的首选检查技术,尤其对小肺癌 的诊断具有重要价值。

Objective An approach to detection and signs of peripheral lung cancer and inflammation nodules below 2cm between MSCT conventional scanning and HRCT scanning, to improve the accuracy of the diagnosis and differential diagnosis. Methods 73 cases with peripheral lung cancer and 32 cases with inflammatory nodules under 2cm which were confirmed by pathology and clinical were collected, 7mm thick and 1mm thick HRCT were used respectively to scan, analyzing the density of lesions, bubble signs, air bronchograms, edge of lession, lobulation, spiculation,pleural indentation,small spines, fuzzy shadow around the lesions, and strengthen signs. Results Compared lung cancer signs with inflammation nodules signs, the detection of 7mm thick imaging is significant difference(P<0.05), the detection of 1mm thick HRCT signs betweem lung cancer and inflammation nodules is significant difference(P<0.05), compared 7mm thick imaging with 1mm thick imaging, the detection of lung cancer signs is significant difference(P<0.05), compared 7mm thick imaging with 1mm thick imaging ,the detection of inflammation nodules signs is without significant difference(P>0.05). Small spines, lobulation, spiculation,pleural indentation were often found in lung cancer. Conclusion 1mm thick HRCT scanning shoud be as a preferred check technology in differentiating peripheral small lung cancer and inflammation nodules, especially with important value for the diagnosis of small lung cancer.

【关键词】肺结节;肺癌;炎症;体层摄影术;X线计算机

【中图分类号】R734.2

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.01.016

前言

孤立性肺结节(solitary pulmonary nodule SPN)是由多种良恶 性疾病引起的一种影像征象,影像诊断与鉴别始终是影像学的难点 和研究的热点[1-2],在SPN中周围型小肺癌(small peripheral lung cancer,SPLC)与炎性结节(pulmonary inflammatory nodule,PIN)占绝 大多数,两者的CT表现有很多相似性,特别是小病灶鉴别难度更大。 回顾性性分析了我院2010年10月~2015年2月间经病理和临床证实的 2cm以下的73例SPLC和32例PIN,分别采用常规7mm层厚和1mmHRCT图像 重建,对比分析两者在不同层厚CT图像上各种CT征象的检出和表现的 差异,目的是期望能提高CT对SPLC与PIN诊断和鉴别的准确性。