肺肉瘤样癌多层螺旋CT特征  

Multislice Spiral CT Features of Pulmonary Sarcomatoid Carcinoma

作　　者：王中领[1] 陆紫微[2] 钱农[1] 葛晓敏[1] 杜娅[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院放射科,常州213003 [2]苏州大学附属第一医院放射科

出　　处：《临床放射学杂志》2013年第7期951-955,共5页Journal of Clinical Radiology

摘　　要：目的回顾分析肺肉瘤样癌(PSC)及普通型非小细胞肺癌的多层螺旋CT(MSCT)特征表现,以获得对肺内PSC的诊断及鉴别诊断具有价值的MSCT特征。方法选取经手术和病理证实的13例PSC患者和109例普通型非小细胞肺癌患者影像及临床资料。用χ2检验、Fisher确切概率法对比分析两组之间是否存在统计学意义。结果 PSC的MSCT表现:所有病例均表现为肺内肿块,11例为周围型,其中位于右中、上叶7例(53.8%),肿块最大径3.2～11.7 cm,平均7.6 cm;肿块呈分叶状3例(23.1%),边缘可见细毛刺4例(30.8%),空泡征2例(15.4%),棘突征3例(23.1%),胸膜凹陷征4例(30.8%),增强后其中9例(69.2%)肿瘤呈薄壁或厚壁边缘环形强化,9例(69.2%)肿瘤内部可见大片状均匀或不均匀弱强化区,胸膜侵犯8例,肺内或肺门、纵隔淋巴结转移6例,4例伴有胸腔积液。肿瘤的部位(多位于右中上叶)、大小(直径>5 cm)、瘤体内部大片状弱强化区及周边环形强化、肿瘤较少见分叶及边缘细毛刺(P<0.01)在两组之间差异具有显著统计学意义;棘突征及胸膜凹陷征(P<0.05)在两组之间差异具有显著统计学意义。结论 PSC的MSCT表现具有一定特征性。肿瘤的部位、大小、边缘(少见分叶及细毛刺)、瘤内大片状弱强化区及肿瘤周边薄壁或厚壁环形强化对诊断和鉴别PSC与普通型非小细胞肺癌有重要的价值。Objective To investigate the MSCT features of pulmonary sarcomatoid carcinoma and traditional nonsmall cell pulmonary carcinoma in order to improve its diagnostic accuracy. Methods The MSCT findings of 13 cases with pul- monary sarcomatoid carcinoma and 109 cases with traditional nonsmall cell pulmonary carcinoma verified by pathology were retrospectively analyzed. The date were evaluated by using X2 test and the Fisher exact test. Results MSCT features of pulmonary sarcomatoid included： All cases presented with a spheroid solid lung mass. Of 13 cases, 10 were peripheral ,7 ca- ses located in the upper and middle lobe of the right lung, diameters ranging from 3.2 cm to 11.7 cm. Lobulated （n = 3 ） , speculation sign （ n = 4 ）, vacuole sign （ n = 2 ）, spinous protuberance （ n = 3 ）, pleural indentation sign （ n = 4 ）. Nine cases showed irregular peripheral heterogeneous contrast enhancement, pleura invasion （ n = 2 ） , enlargement of lymph node of the hilum and mediastium（ n = 6）. Site and diameter of tumor, weak enhancement in the central area and irregular peripheral heterogeneous enhancement showed significant difference（ P 〈 0.01 ）between the two groups. Lobulated, speculation sign, spinous protuberance and pleural indentation were rare sign, which showed significant diference（ P 〈 0.01 or P 〈 0.05 ） be- tween the two groups. Conclusion Pulmonary sarcomatoid carcinoma has typical MSCT features. Site of tumor, diame- ter, periphery of tumor and weak enhancement in the central area and irregular peripheral heterogeneous enhancement are important characteristics for diagnosis and differentiating pulmonary sarcomatoid carcinoma from traditional nonsmall cell pulmonary carcinoma.

关 键 词：肺肿瘤 肉瘤样癌 体层摄影术 X线计算机 病理学 

分 类 号：R734.2[医药卫生—肿瘤]