孤立性肺结节高分辨率CT诊断及病理对照  

The diagnosis of HRCT and imaging- pathologic correlationof solitary pulmonary nodule

作　　者：孟菲[1] 魏经国[2] 邓立新[1] 陶光鑫[1] 王佳伟[1] 常悦杰[1] 柳铁宏[1] 

机构地区：[1]武警黑龙江总队医院放射科,哈尔滨150076 [2]第四军医大学唐都医院放射科,西安710038

出　　处：《武警医学》2004年第4期255-258,共4页Medical Journal of the Chinese People's Armed Police Force

摘　　要：目的 研究孤立性肺结节(SPN)界面影像分布特征、病理基础,探讨其定性诊断价值。方法 分析病理证实的37例周围型肺癌的瘤周高分辨率CT(HRCT)影像分布特征,并随机选择23例肺良性结节作对照,双盲法观察SPN瘤-肺交界区近端和远端HRCT的影像改变。其中25例周围型肺癌及16例肺良性结节的病灶肺叶术后标本行Heitsman法固定48-72 h后HRCT扫描,再将标本制成病灶肺全叶切片及病灶组织切片,观察结节-肺界面HRCT表现的病理基础。结果 瘤-肺交界区HRCT表现为远端模糊和(或)毛糙、毛刺影,周围型肺癌79％,肺良性结节22％(P<0.05);光整,周围型肺癌14％,良性结节74％(P<0.05)。术后标本HRCT、大体病理切片的变化完全吻合。结论 瘤-肺交界区HRCT的模糊和(或)毛糙、毛刺影等影像改变的不对称性远端优势分布,对小于3.5cm的周围型肺癌的定性诊断有重要价值。病理基础是癌灶所致的支气 管阻塞及癌结节远端淋巴管回流障碍、肺间质内纤维组织增生及癌细胞浸润。Objective To study the high resolution CT image distribution,pathological basis and diagnostic value of interface imaging of solitary pulmonary nodule in lungtumor. Methods The features of image distribution was analysed in 37 pathologically proved patients with peripheral lung cancer (PLC),compared with 23 randomly selected patients with benign lung nodules. A double-blind method was used to observe the HRCT images of lung nodules in proximal and distal lung-tumor interface. In 25 pathologically proved cases of PLC and 16 cases of benign lung nodules, postoperative lung specimens were fixed for 48 -72 hours by Heitzman method, scaned by HRCT technique, and sectioned, and the pathological changes of lung-tumor interface indiated by HRCT images were observed. Results Blurred or rough, spiculate HRCT images in distal lung-tumor interface were observed in (79%) of PLC and (22%) of benign nodules; whereas smooth images in (14%) of PLC and (74%) of benign nodules. The HRCT manifestations of postoperative specimens completely coincided with the findings that of pathological sections . Conclusions The asymmetrical distal dominant distribution of blurred or rough,spiculate HRCT images of lung-tumor interface play an important role in qualitative diagnosis of PLC ( ≤ 3.5 cm). The pathological basis of asymmetrical distribution of interface images in PLC is bronchial obstraction,lymphatic refluent disturbance in cancerous nodes, pulmonary interstitial fibrous tissue proliferation,and cancer cell infiltration caused by cancerous foci.

关 键 词：孤立性肺结节 高分辨率CT 诊断 周围型肺癌 影像特征 病理学 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]