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中国防痨杂志 ›› 2018, Vol. 40 ›› Issue (7): 730-735.doi: 10.3969/j.issn.1000-6621.2018.07.012

• 论著 • 上一篇    下一篇

肺内多发结节的CT表现分析

过丽芳,张建梅,王仁贵(),赵桐,温廷国,张春燕,关晓姣,傅岩,王燕文,杨永革   

  1. 100038 首都医科大学附属北京世纪坛医院放射科
  • 收稿日期:2018-03-30 出版日期:2018-07-10 发布日期:2018-09-07
  • 通信作者: 王仁贵 E-mail:renguiwang@aliyun.com

CT findings of pulmonary multiple nodules

Li-fang GUO,Jian-mei ZHANG,Ren-gui WANG(),Tong ZHAO,Ting-guo WEN,Chun-yan ZHANG,Xiao-jiao GUAN,Yan FU,Yan-wen WANG,Yong-ge. YANG   

  1. Department of Radio-logy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2018-03-30 Online:2018-07-10 Published:2018-09-07
  • Contact: Ren-gui WANG E-mail:renguiwang@aliyun.com

摘要:

目的 探讨肺内多发结节影为主要表现患者的CT表现特点。方法 回顾性分析北京世纪坛医院影像资料库胸部CT出现肺内多发结节影的53例患者资料,其中肺结核19例、肺转移瘤23例、肺慢性炎症5例、弥漫性淋巴管瘤病6例,总结比较4种疾病的CT表现特征。结果 13例(68.4%,13/19)肺结核及18例(78.3%,18/23)肺转移瘤的结节最大径达10~20mm,3例(3/5)肺慢性炎症与3例(3/6)弥漫性淋巴管瘤病的肺内结节最大径范围为3~8mm。肺慢性炎症的CT表现为结节以无分叶且边缘光滑为主共69个(79.3%;69/87)、病灶邻近胸膜增厚粘连36个(41.4%;36/87),结节无钙化及空洞;肺结核的CT表现为结节以无分叶且边缘光滑为主共128个(82.1%;128/156)、钙化86个(55.1%;86/156)、空洞43个(27.6%;43/156)、病灶邻近胸膜增厚粘连71个(45.5%;71/156);肺转移瘤的CT表现为结节以边缘见分叶及毛刺为主共369个(60.0%;369/615)、钙化23个(3.7%;23/615)、空洞111个(18.0%;111/615)、病灶邻近胸膜增厚粘连114个(18.5%;114/615)。肺慢性炎症、肺结核出现结节边缘无分叶且边缘光滑的比率分别与肺转移瘤组比较,差异有统计学意义(χ 2=47.613,P=0.000;χ 2=88.095,P=0.000),肺结核与肺转移瘤出现钙化的比率两者差异有统计学意义(χ 2=270.707,P=0.000),肺结核与肺转移瘤出现空洞的比率差异有统计学意义(χ 2=7.048,P=0.008),肺慢性炎症与肺转移瘤、肺结核与肺转移瘤出现病灶邻近胸膜增厚粘连的比率差异有统计学意义(χ 2=23.670,P=0.000;χ 2=49.650,P=0.000)。肺转移瘤空洞类型:空泡样空洞发生率(34.2%,38/111)>囊样空洞发生率(26.2%,29/111)>小环形空洞发生率(22.5%,25/111)>不规则空洞发生率(17.1%,19/111);所有的空泡样空洞仅出现在腺癌肺转移中、78.9%(30/38)的空泡样空洞结节边缘均见分叶、毛刺。5例肺慢性炎症患者均见边缘模糊的结节,边缘见局限的片状浸润影及索条状影。弥漫性淋巴管瘤病的结节常呈弥漫或多灶性分布,累及多个部位并呈多发的大小不等的囊性病变,肺内结节均边缘光滑、密度均匀。 结论 肺结核、肺转移瘤、肺慢性炎症和弥漫性淋巴管瘤病出现肺内多发结节时,其病灶大小、分布、形态、边缘、密度及与邻近结构的关系等各自具有一定特点,CT扫描对4种疾病进行鉴别诊断时具有重要价值。

关键词: 多发性肺结节, 体层摄影术, X线计算机, 诊断显像, 诊断, 鉴别

Abstract:

Objective To investigate the morphologic characteristics of pulmonary multiple nodules (PMN) on chest computed tomography (CT).Methods Fifty-three patients from the Beijing Shijitan Hospital with PMN were retrospectively reviewed, including 19 cases with pulmonary tuberculosis, 23 cases with pulmonary metastasis, 5 cases with chronic pulmonary inflammation and 6 cases with diffuse lymphangiomatosis. The CT morphologic characteristics of PMN in the above four diseases were analyzed.Results 68.4% (13/19) of pulmonary tuberculosis patients and 78.3% (18/23) of pulmonary metastasis patients possessed PMN with maximum diameter ranging from 10 mm to 20 mm, while 60% (3/5) of chronic pulmonary inflammation patients and 60.0% (3/6) of diffuse lymphangiomatosis patients were detected PMN with maximum diameter ranging from 3 mm to 8 mm. The CT findings of chronic pulmonary inflammation group showed that there was no calcification and cavity in the nodules, 79.3% (69/87) cases had nodules with smooth edge and no lobule septum, 41.3% (36/87) cases had pleural thickening and adhesion adjacent to the lesions. The rates of no lobule septal nodule with smooth edge, calcification, cavity, and adjacent pleural thickening and adhesion in pulmonary tuberculosis group were 82.1% (128/156), 55.1% (86/156), 27.6% (43/156), and 45.5% (71/156), respectively. For the pulmonary metastasis group, the rates of no lobule septal nodule, calcification, cavity, and adjacent pleural thickening and adhesion were 60.0% (369/615), 3.7% (23/615), 18.0% (111/615), and 18.5% (114/615), respectively. Compared to the pulmonary metastasis group, the rates of no lobule septal nodule in chronic pulmonary inflammation group and pulmonary tuberculosis group were statistically significant (χ 2=47.613, P=0.000; χ 2=88.095, P=0.000). There were statistical differences in calcification and cavity between the pulmonary tuberculosis group and pulmonary metastasis group (χ 2=270.707,P=0.000; χ 2=7.048,P=0.008). Compared to the pulmonary metastasis group, the rates of adjacent pleural thickening and adhesion in chronic pulmonary inflammation group and pulmonary tuberculosis group were statistically significant (χ 2=23.670,P=0.000; χ 2=49.650,P=0.000). The types of cavity in pulmonary metastasis group were as follows: the incidence of vacuolar cavity, 34.2% (38/111) > cystic cavity, 26.2% (29/111) > small annular cavity, 22.5% (25/111) > irregular cavity 17.1% (19/111). In addition, all the vacuolar cavities were only detected in the pulmonary metastasis of adenocarcinoma and 78.9% (30/38) of vacuolar cavity nodules possessed characteristic of lobule septal and rag margin. All the five patients in chronic inflammation group showed nodules with poorly defined margins, surrounded by flaky infiltrating shadows and stripe shadows. The nodules of diffuse lymphangiomatosis showed a diffuse or multifocal growth pattern, involving multiple regions with multiple cystic lesions of unequal size, and the pulmonary nodules were smooth in margin and homogeneous in density. Conclusion When the pulmonary tuberculosis, pulmonary metastasis, chronic pulmonary inflammation, and diffuse lymphangiomatosis showed PMN, the specific visual characteristics on CT, such as lesion size, location, morphology, edge, density and adjacent tissue have important value in the differential diagnosis of the above four diseases.

Key words: Multiple pulmonary nodules, Tomography, X-ray computed, Diagnostic imaging, Diagnosis, differential