肺内淋巴结薄层CT表现及其与胸膜下相似肺结节的鉴别诊断  

CT findings of intrapulmonary lymph nodes and its differential diagnosis with inferior pleural pulmonary nodules

作　　者：吴光耀[1] 唐丽萍[1] 邓宇[2] 吴重重[3] 熊婧彤 伍建林[1] WU Guang-yao;TANG Li-ping;DENG Yu;WU Chong-chong;XIONG Jing-tong;WU Jian-lin(Department of Radiology,Affiliated Zhongshan Hospital of Dalian University,Dalian Liaoning 116001,China;Department of Radiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Radiology,the Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,the Second Affiliated Hospital of Dalian Medical University,Dalian Liaoning 116027,China)

机构地区：[1]大连大学附属中山医院放射科,辽宁大连116001 [2]广州医科大学附属第一医院放射科,广东广州510120 [3]解放军总医院放射科,北京100853 [4]大连医科大学附属第二医院放射科,辽宁大连116027

出　　处：《中国临床医学影像杂志》2018年第9期624-628,共5页Journal of China Clinic Medical Imaging

基　　金：大连市科技局项目(2015E12SF120)

摘　　要：目的:探讨肺内淋巴结(Intrapulmonary lymph nodes,IPLNs)薄层CT表现特点,并与胸膜下相似肺良恶性结节CT表现进行对照,以提高IPLNs诊断与鉴别诊断水平。方法:收集多家医院经手术病理证实38例49个IPLNs资料,同期收集经手术病理证实75例80个恶性肺结节及经手术或临床证实28例33个良性肺结节对照研究;所有病例均经MSCT扫描并有1 mm薄层重建图像,分析比较3组间肺结节CT表现,采用SPSS 17.0统计学软件分析,以P<0.05为差异有统计学意义(两两比较以P<0.0167差异有统计学意义)。结果:3组间性别差异有统计学意义(P<0.05),恶性组女性发病率明显较高(66.7%);IPLNs均位于气管隆突水平以下,肺下叶者(71.4%)多于良恶性结节组(P<0.05);IPLNs平均直径(0.66±0.23)cm小于良恶性结节组(P<0.001),其CT值(32.9±66.1)HU明显高于恶性结节(-275.0±255.9)HU与良性结节组(-47.6±177.0)HU,差异有明显统计学意义(P<0.001)。IPLNs形态以类圆形多见(69.4%)多于良恶性结节组(P<0.05),其边界清晰锐利(98.0%)多于良恶性结节组(P<0.001);IPLNs毛刺征、分叶征、胸膜凹陷征及血管集束征均少于恶性结节组(P<0.001),但其细线状致密影(44.9%)明显多于良恶性结节组(P<0.001)。结论:IPLNs的CT表现具有相对特异性,大多可在术前作出或提示诊断;主要应与胸膜下相似的肺腺癌结节进行鉴别。Objective： To explore the CT findings of intrapulmonary lymph nodes （IPLNs） and compared with the benign and malignant pulmonary nodules inferior pleural, so as to improve the diagnosis and identification of IPLNs. Methods： A to tal of 38 patients with 49 IPLNs were enrolled in the study. 75 patients with 80 malignant pulmonary nodules were confirmed by operation and pathology. Twentyeight patients with 33 benign pulmonary nodules were examined by operation or clinically. All cases were scanned by MSCT and 1 mm thin slice postprocessing images were analyzed. Compared the CT findings a mong three groups of pulmonary nodules, and using SPSS 17.0 statistical software to analysis. P〈0.05 for the difference was statistically significant （P〈0.0167 for the difference was statistically significant between two groups）. Results： There was signifi cant difference in gender among the three groups （P〈0.05）, the incidence was significantly higher in the malignant group （66.7%）; IPLNs were located below the tracheal cartilage level, 71.4% were located the lower lobe（P〈0.05）. The average diam eter of IPLNs was （0.66±0.23）cm lower than that of benign and malignant nodules group （P〈0.001）, and the CT value was （32.9±66.1）HU higher than malignant nodules group （（275.0±255.9）HU） and benign nodules group（（47.6±177.0）HU）, the dif ference was statistically significant（P〈0.001）. The round shape of IPLNs were more common than benign and malignant nodules group（P〈0.05）, and the 98% of IPLNs were clear and smooth higher than benign and malignant nodules group（P〈0.05）; In IPLNs, lobulated sign, spicule sign, pleural depression syndrome, and vascular bundle sign were less than malignant nodules group （P〈 0.001） but the sign of narrow line（44.9%） was significantly higher than that of benign and malignant nodules group（P〈0.001）.

关 键 词：结节病 肺 淋巴结 体层摄影术 螺旋计算机 诊断 鉴别 

分 类 号：R655.3[医药卫生—外科学] R814.42[医药卫生—临床医学]