MSCT对孤立性肺结节(≤2cm)胸膜凹陷征的诊断及鉴别诊断价值  

The value of MSCT in the diagnosis and differential diagnosis of pleural indentation of solitary pulmonary nodules (≤ 2cm)

作　　者：曹捍波[1] 王梅[1] 王和平[1] 

机构地区：[1]浙江省舟山医院放射诊断中心,浙江舟山316000

出　　处：《医学影像学杂志》2017年第8期1471-1474,共4页Journal of Medical Imaging

基　　金：浙江省舟山市科技计划项目(2015C31032)

摘　　要：目的探讨MSCT对肺部2cm以下孤立性结节胸膜凹陷征的诊断及鉴别诊断价值。方法分析经手术病理、穿刺活检证实的良性结节16例和早期周围型肺腺癌20例,通过靶重建、最小密度投影(MIP)、表面遮盖显示(SSD)及容积再现(VR)等后处理显示病灶的胸膜凹陷征,将胸膜凹陷征分Ⅰ型,、Ⅱ型、Ⅲ型,并比较良性结节及早期周围型肺腺癌胸膜凹陷分型差异。结果胸膜凹陷征Ⅰ型7例,良性结节2例,恶性结节5例;Ⅱ型18例,良性结节6例,恶性结节12例;Ⅲ型11例,良性结节8例,恶性结节3例。SSD图像中,2例良性结节和4例早期肺腺癌呈轻度胸膜凹陷;4例良性结节和12例早期肺腺癌胸膜凹陷呈星芒状改变,周围见多条扭曲、长短、粗细不一的凹槽,10例良性结节和4例早期肺腺癌胸膜凹陷呈圆洞样凹陷。12例良性结节见局部胸膜肥厚,3例早期肺腺癌见局部胸膜肥厚。良性结节及早期肺腺癌组的靶重建和MIP分型以及SSD胸膜凹陷分型差异具有显著性(P<0.05),良性结节胸膜凹陷征主要以Ⅱ和Ⅲ型多见,且局部胸膜增厚比例显著高于早期肺腺癌(P<0.001)。结论 MSCT靶重建配合各种后处理功能在显示肺小孤立性结节的胸膜凹陷征方面具有独特的优势,对肺结节良恶性的定性诊断提供了参考依据。Objective To investigate the value of MSCT in the diagnosis and differential diagnosis of pleural indentation of solitary pulmonary nodules （ ≤ 2 cm）. Methods 20 patients with early peripheral lung cancer and 16 patients with benign nodules, who were all confirmed by surgical pathology or biopsy, were analyzed. Through target reconstruction, minimum intensity projection （MIP）, shaded surface display （SSD）, and volume rendering （VR） after treatment, the lesions of pleural indentation were revealed. And then, the pleural indentation signs were divided into type Ⅰ, type Ⅱ and type Ⅲ, and the differences in types between the benign nodules and early peripheral lung cancer were compared. Results In type Ⅰ , 7 cases presented with pleural indentation sign, of which 2 eases were benign nodules and 5 eases were malignant nodules. In type Ⅱ, 18 cases presented with pleural indentation sign, of which 6 eases were benign nodules and 12 cases were malignant nodules. In type Ⅲ, 11 cases presented with pleural indentation sign, of which 8 cases were benign nodules and 3 cases were malignam nodules. On SSD images, 2 cases of benign nodules and 4 cases of early lung cancer presented with mild pleural indentation. 4 cases of benign nodules and 12 cases of early lung adenocarcinoma presented with pleural indentation signs, which were like stellate change and a plurality of grooves with distortion and variation of length and the thickness were seen around the lesions. The local hypertrophic pleura were seen in 12 cases of benign nodules and 3 cases of early lung cancer. The differences in target reconstruction and MIP type and SSD pleural indentation types between benign nodules and early lung adenocarcinoma were statistically significant （ P 〈 0.05 ）. The pleural indentation signs in benign pleural nodules mainly appeared in type Ⅱ and Ⅲ and the rate of local hypertrophic pleura was significantly higher than that of early lung adenoearcinoma （ P 〈 0. 001 ）. Conclusion MSCT target recon

关 键 词：肺肿瘤 体层摄影术 X线计算机 胸膜 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]