周围型小细胞肺癌的CT形态学特征及分型  

Morphological features and classifications of peripheral small cell lung cancer on CT

作　　者：张磊[1] 沈文荣[1] 蒋峰[1] 尹娜[1] ZHANG Lei;SHEN Wenrong;JIANG Feng;YIN Na(CT/MRI Room,Jiangsu Cancer Hospital&Jiangsu institute of Cancer Research&the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院江苏省肿瘤防治研究所南京医科大学附属肿瘤医院CT/MRI室,江苏南京210009

出　　处：《实用放射学杂志》2022年第1期30-33,共4页Journal of Practical Radiology

基　　金：江苏省卫生健康委员会保健局课题(BJ19032)。

摘　　要：目的 探讨3 cm以下周围型小细胞肺癌(SCLC)的临床表现、CT形态学特征及分型.方法 选取CT发现肺部周围型结节,经病理证实为SCLC 43例患者共43个病灶,所有病灶直径均≤3 cm,分析其临床表现及CT征象,并根据其形态学特征进行分型.结果 43例患者男性比例88.4%(38/43),年龄46~82岁,平均(64.05±7.37)岁,有吸烟史29例(67.4%),血清神经元特异性烯醇化酶(NSE)阳性17例(39.5%),伴慢性阻塞性肺疾病(COPD)24例(55.8%);43例患者共43个病灶;平均直径(2.26±0.58)cm;根据形状将SCLC分为3种类型:Ⅰ型(结节型)34例(79.1%),Ⅱ型(腊肠型)5例(11.6%),Ⅲ型(鹿角形)4例(9.3%);其中34例结节型病灶中,27例(79.4%)可见切迹,且切迹深、边缘圆钝;9例(26.5%)边缘见腊肠样突起,且突起较长、顶端圆钝,6例(17.6%)边缘见毛刺,2例(5.9%)见空洞,1例(2.9%)见空气支气管征,4例(11.8%)外周见血管纠集,3例(8.8%)远端见胸膜凹陷,8例(23.5%)远端见阻塞性炎症,无磨玻璃密度,无空泡征.结论 3 cm以下周围型SCLC多见于高龄、男性、重度吸烟患者,血清NSE常升高,常合并COPD;形态上可分为3型,多表现为Ⅰ型(结节型),边缘出现深且圆钝的切迹以及腊肠样的突起是其主要CT特征.Ⅱ型和Ⅲ型比例较低,确属周围型SCLC的特征性表现;周围型SCLC较少出现毛刺、空洞、空泡、磨玻璃密度、空气支气管征、胸膜牵拉及阻塞性炎症.Objective To investigate the clinical manifestations,morphological features and classifications on CT of peripheral small cell lung cancer(SCLC)less than or equal to 3 cm.Methods The small peripheral pulmonary nodules found by CT were collected.Finally,43 lesions of SCLC in 43 patients con firmed by histopathology were evaluated retrospectively.All the lesions were less than or equal to 3 cm.Their clinical and CT manifestations were analyzed,and the classifications were carried out according to their morphological characteristics on CT.Results Of the 43 patients,88.4%(38/43)were male,with the age rang from 46 to 82,mean(64.05±7.37).29 patients(67.4%)had a history of smoking,serum neuron-specific enolase(NSE)level was elevated in 17 patients(39.5%),and 24 patients(55.8%)suffered from chronic obstructive pulmonary disease(COPD).The 43 lesions in 43 patients had an average diameter of(2.26±0.58)cm,and were divided into three types according to the shape:Type I,nodular in 34 cases(79.1%).type D,botuliform in 5 cases(11.6%),and typeⅢ,antler-like in 4 cases(9.3%).Of the 34 cases of nodular lesions,27 cases(79.4%)showed notching which was deep with blunt edge.Nine lesions(26.5%)displayed botuliform protrusion at the edge,which were long with obtuse top.In addition,spicule sign in 6 cases(17.6%).cavity in 2 cases(5.9%),air bronchial sign in 1 case(2.9%),vascular convergence sign in 4 cases(11.8%).pleural indentation in 3 cases(8.8%),and obstructive pneumonia in 8 cases(23.5%)were observed,however,ground glass opacity and vacuole sign were not found.Conclusion The peripheral SCLC less than or equal to 3 cm is more common in the aged,male and heavy smoking patients.It’s often accompanied with serum NSE and COPD.Morphologically,it is divided into three types,mainly presenting as typeⅠ(nodular),with deep and blunt notching and botuliform like protrusions at the edge.The ratio of typeⅡand DI is low,with the characteristic of peripheral SCLC.Peripheral SCLC is less prone to spicule sign,cavity,vacuole sign,ground gla

关 键 词：小细胞肺癌 计算机体层成像 

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