不同大小肺炎性假瘤的CT形态学分析及淋巴结变化规律  

CT morphological analysis and changes of lymph nodes in pulmonary inflammatory pseudotumor of different sizes

作　　者：李晓冉 乔香梅 傅晓明 朱文莉 周科峰[1,4] LI Xiaoran;QIAO Xiangmei;FU Xiaoming;ZHU Wenli;ZHOU Kefeng(Department of Medical Imaging,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Ultrasound,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nan-jing 210008,China;Department of Medical Imaging,NanJing Gaochun People's Hospital,Nanjing 211300,China;Department of Medical Imaging,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院医学影像科,江苏南京210008 [2]南京大学医学院附属鼓楼医院超声科,江苏南京210008 [3]南京市高淳人民医院医学影像科,江苏南京211300 [4]南京大学医学院附属鼓楼医院医学影像科,江苏南京210008

出　　处：《医学影像学杂志》2024年第4期43-48,共6页Journal of Medical Imaging

摘　　要：目的 探讨不同大小肺炎性假瘤(pulmonary inflammatory pseudotumor, PIP)的计算机断层扫描(computed tomography, CT)形态学特征及其淋巴结的变化规律。方法 选取经组织病理学证实为肺炎性假瘤的患者56例,按病灶大小分为两组:A组(最大径≤3.0 cm34例),B组(最大径>3.0 cm22例),分析比较两组CT影像学特点及淋巴结表现差异。采用组内相关系数(ICC)及Kappa检验评价2位医师测量数据的一致性,并用Bland-Altman法进一步可视化一致性测量结果。结果 两组在支气管血管束增粗、桃尖征、血管集束征、邻近胸膜增厚及淋巴结肿大方面差异均有统计学意义(P<0.05),B组出现以上征象的比例更大。进一步比较两组淋巴结,发现同侧肺门淋巴结更容易在B组中显示,且大小显著高于A组,差异有统计学意义(P<0.05)。2位医师测量PIP相关数据的一致性均良好或优秀(ICC与Kappa值范围为0.61~0.85),Bland-Altman法分析显示,2位医师评价淋巴结径线的一致性和稳定性较好。结论 不同大小的PIP在CT检查表现存在一定的差异性,本文有助于影像科及临床医师更深刻地认识此病、减少误诊。Objective To investigate the morphological characteristics and lymph node changes in pulmonary inflammatory pseudotumor(PIP)of different sizes on computed tomography(CT).Methods A total of 56 patients identified as histopathological PIP were retrospectively collected,and divided into two groups according to the size of the lesions:the maximum diameter≤3cm group(34 cases)and the maximum diameter>3cm group(22 cases).The differences in CT imaging characteristics and lymph node manifestations between the two groups were analyzed and compared.Intraclass correlation coefficient(ICC)and kappa test were used to evaluate the consistency of data between two radiologists,and the Bland-Altman method was used to further visualize the consistency measurement results.Results There were significant differences in bronchovascular bundle thickening,peach-tip sign,vascular convergence sign,adjacent pleural thickening,and lymphadenectasis between the two groups(P<0.05),and the above signs were more common in the group with maximum diameter>3cm.Further comparison of lymph nodes between the two groups revealed that ipsilateral hilar lymph nodes(P<0.05)were more likely visible to the unaided eyes in the maximum diameter>3cm group,and the size was significantly larger than that in the maximum diameter≤3cm group.The consistency of PIP related data measured by two radiologists was good or excellent(ICC and Kappa ranged from 0.61 to 0.85).Bland-Altman analysis showed that the consistency and stability of lymph node diameter were good.Conclusion PIP of different sizes has certain differences in CT manifestations,which is helpful for radiologists and clinicians to understand this disease more deeply and to reduce misdiagnosis.

关 键 词：肺 炎性假瘤 淋巴结 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R814.42[医药卫生—内科学]