肺腺癌经支气管肺转移的CT表现  

The CT findings of endobronchial spread in lung adenocarcinoma

作　　者：吕平欣[1] 周新华[1] 骆宝建[2] 任小刚[3] 

机构地区：[1]北京市结核病胸部肿瘤研究所放射科,101149 [2]北京市结核病胸部肿瘤研究所胸外科,101149 [3]河北北方学院第二附属医院外科

出　　处：《中华放射学杂志》2007年第5期475-479,共5页Chinese Journal of Radiology

摘　　要：目的认识肺腺癌经支气管播散肺转移的 CT 表现和规律。方法回顾性分析15例经病理证实为腺癌或细支气管肺泡癌经支气管肺转移患者的 CT 表现,重点关注病变的发展特点。结果15例肺癌患者在 CT 上原发病灶均为实变型肺癌,在同侧或对侧肺内出现多发性、与支气管分布有明确相关的病灶,胸膜不受累。在初诊的 CT 上表现为小叶中心性结节5例、树芽征7例、腺泡结节2例、磨玻璃影10例和实变13例,其中5例仅有小叶中心结节(单一型),10例为多种形态病变共存(复合型),曾全部被误诊为结核或炎症,经抗结核或抗炎治疗无效。在平均4个月的 CT 随访中,单一型转移者进展缓慢,结节融合形成边界相对清晰的实变影;初诊为复合型的病变恶化较快。结论肺腺癌经支气管转移的 CT 表现有一定规律,但诊断仍须结合临床及实验室检查,以区别于结核和炎性反应。Objective To analyze the CT findings of endobronchial spread in lung ad Methods The CT findings of 15 lung adenocarcinomas or bronchioloalveolar carcinomas with endobronchial spread were reviewed, the distribution and the progression of the spread were evaluated. Results All of the primary tumors were consolidation form. The spread lesions distributed in one side of the lung or both sides along the bronchus. The pleural surface was spared. The CT findings of the spread included centrilobular nodules （ n = 5）, tree-in-bud （ n = 7 ）, acinar nodules （ n = 2）, ground-glass opacities （ n = 10） and airspace consolidations （n = 13 ） in the first CT examination. 5 cases of the spread lesions only presented centrilobular nodules（ single form） and 10 cases presented several appearances （complex form ）. All of the cases were diagnosed as tuberculosis or pneumonia, and antituberculotic or antibiotic therapy was taken with no effect. The follow-up CT scans showed progression in all cases, and the spread lesions with single form became multiple consolidations. The spread lesions with complex form deteriorated faster than the single one. Conclusion Although the CT findings of the endobronchial spread of the lung adenocarcinoma is specific, the clinical history and laboratory examination also are important for the differential diagnosis with tuberculosis and other infectious diseases.

关 键 词：肺肿瘤 肿瘤转移 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤]