肺原发血管肉瘤的CT表现  

CT features of primary pulmonary angiosarcoma

作　　者：曹敏 曾庆思[2] 黎剑宇[2] CAO Min;ZENG Qing-si;LI Jian-yu(Department of Radiology,the Panyu Health Management Center(Panyu Rehabilitation Hospital),Guangzhou 511490,China)

机构地区：[1]广州市番禺区健康管理中心(广州市番禺区康复医院)放射科,广州511490 [2]广州医科大学附属第一医院放射CT/DR科,广州510120

出　　处：《放射学实践》2021年第8期1016-1020,共5页Radiologic Practice

摘　　要：目的:探讨肺原发血管肉瘤的CT征象及其诊断价值。方法:回顾性分析7例经病理确诊的肺原发血管肉瘤(包括上皮样血管肉瘤)的CT表现,主要观察指标包括发病部位及分布特点、大小、形态、边缘、密度与强化特点、病灶内部情况、瘤周改变及胸腔内肺外表现等。结果:7例中4例表现为单发肺门或外周结节/肿块,3例表现为两肺多发外周结节/肿块,最大径线为23.0~55.0 mm,中位数为47.0 mm;5例边界清晰,2例边界不清;5例形态不规则或分叶,3例有少许长短毛刺。平扫密度均匀1例,密度不均匀6例;CT值21.0~50.0 HU,平均(34.9±9.3)HU;1例合并钙化。6例增强扫描后呈不均匀强化,其中5例呈轻中度强化、1例明显强化;动脉期CT值38.0~67.0 HU,平均(53.7±12.8)HU;实质期CT值39.0~109.0 HU,平均(59.2±25.7)HU;平扫与实质期CT差值3.0~79.0 HU,平均(24.7±27.8)HU。2例支气管闭塞伴肺不张,3例支气管或血管受推压改变,5例伴有纵隔或肺门淋巴结稍增大,平均直径(13.2±1.9)mm,5例胸膜增厚或邻近胸膜受牵拉/粘连,3例合并胸腔积液,1例出现胸椎转移。结论:肺原发血管肉瘤的CT表现有一定的特征性,最终诊断仍需依赖病理和免疫组化检查。Objective:The aim of this study was to explore the CT features and diagnostic value of primary pulmonary angiosarcoma.Methods:The CT findings of 7 cases with primary pulmonary angiosarcoma(including epithelioid angiosarcoma)confirmed by pathology were retrospectively analyzed,including the location and distribution,size,morphological and margin characteristics,density and enhancement changes,and extra-pulmonary thoracic changes.Results:Among the 7 cases,4 cases showed single hilar or peripheral nodule or masse,and 3 cases showed multiple peripheral nodules and masses in both lungs;the maximal diameter of nodules or masses was 23.0~55.0mm with median of 47.0mm.Clear boundary was found in 5 cases,and not in 2 cases;irregular or lobular shape was found in 5 cases with spiculation in 3 cases.In plain scan,only one case showed homogeneous density,the other 6 cases showed inhomogeneous density,with CT value of 21.0~50.0HU,with average value of(34.9±9.3)HU;calcification was found in one case.Six cases showed heterogeneous enhancement,including 5 cases with mild to moderate enhancement and one case with obvious enhancement.The CT value of the lesions on arterial phase was 38.0~67.0HU with average value of(53.7±12.8)HU;and that was 39.0~109.0HU with average value of(59.2±25.7)HU on parenchymal phase.The diffe-rence of CT value on parenchymal phase and unenhanced images was 3.0~79.0HU with means of(24.7±27.8)HU.There were 2 cases of bronchial occlusion with atelectasis,3 cases of bronchial or vascular compression,5 cases with slightly enlarged mediastinal or hilar lymph nodes,with an average of(13.2±1.9)mm.In 5 cases,thickened pleura or adjacent pleural traction/adhesion were found,pleural effusion in 3 cases,and thoracic vertebral metastasis in one case.Conclusion:Primary pulmonary angiosarcoma has certain characteristic CT features,but the final diagnosis depends on pathology and immunohistochemistry examinations.

关 键 词：肺肿瘤 血管肉瘤 体层摄影术 X线计算机 

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