肺内淋巴结的多层螺旋CT特征分析

目的 探讨肺内淋巴结的多层螺旋CT影像特征。方法 回顾性分析2014年1月—2017年6月经手术及病理检查确诊的15例肺内淋巴结患者的影像与临床资料。其中男6例,女9例;年龄38～69(55.6±10.03)岁。15例患者均行肺低剂量CT平扫及肺结节高分辨CT扫描,其中3例同时行增强检查。观察肺内淋巴结的位置、数目、大小、影像学特点及伴随病变。结果 15例多层螺旋CT检查共发现19枚肺内淋巴结,直径4～10(5.53±1.50)mm。14枚肺内淋巴结位于右肺,其中右上叶1枚,中叶5枚,下叶8枚;5枚肺内淋巴结位于左肺,均在下叶。15枚肺内淋巴结发生在肺外带或叶间胸膜附近,病灶距离相邻胸膜的垂直距离3～16 mm,平均9 mm;4枚紧贴胸膜下。17枚边界清晰、锐利,2枚部分边缘毛糙。17枚密度均匀,2枚密度不均,但未见钙化或囊变。轴位图像上11枚肺内淋巴结呈类圆形,2枚呈三角形,6枚呈不规则形。12枚肺内淋巴结在轴位或冠矢状面重建图像上可见一条或多条均匀致密线状影与病灶相连。3例3枚淋巴结CT增强扫描,2枚无明显强化,1枚表现为渐进性强化。4例同时伴发同侧原发肺癌。结论 肺内淋巴结的多层螺旋CT表现有一定的特征性,熟悉这些表现特点,多数可在术前做出明确诊断。

Multislice spiral CT feature analysis of intrapulmonary lymph nodes

Objective To analyze image feature of multislice spiral CT of intrapulmonary lymph nodes. Methods The image features and clinical data of 15 cases with intrapulmonary lymph nodes were analyzed retrospectively between January 2014 and June 2017. All cases diagnosed by surgery and pathology. Among 15 cases, there were 6 males and 9 females, aged 38-69 years, with an average of 55.6 years. Low dose CT scan and high resolution CT scan were performed in all cases. Three cases received enhanced CT scan at the same time. The location, number, size, image features and accompanying lesions of pulmonary lymph nodes were observed. Results In total, 19 intrapulmonary lymph nodes were discovered in 15 cases by multi-slice spiral CT, with a maximum diameter of 4-10 (5.53±1.50)mm. There were 14 intrapulmonary lymph nodes situated at the right lung, 1 in the right upper lobe, 5 in the middle and 8 in the lower lobe. Other 5 intrapulmonary lymph nodes were all located at the inferior lobe of left lung. There were 15 lymph nodes occurred at the outside of sub-pleural area or near the interlobular pleura. The vertical distance between lesions and adjacent pleura were from 3-16 mm, with an average of 9 mm. Other 4 lymph nodes were closely attached to the sub-pleura. The boundary of 17 lymph nodes was clear and sharp, and other 2 were rough. The density of 17 lymph nodes was uniform and other 2 were uneven, without calcification or cystoid variation. In axial images, 11 pulmonary lymph nodes were round like, 2 triangular and 6 irregular. In 12 lymph nodes, one or more uniform and compact linear shadows were linked to the lesions on the axis image or reconstructed image of coronal and sagittal plane. Three intrapulmonary lymph nodes were found in 3 cases by enhanced CT scan. Two lymph nodes showed no obvious enhancement and 1 showed progressive delayed enhancement. There were 4 cases accompanied with primary lung cancer at the same time. Conclusions The image features of intrapulmonary lymph nodes represent some common characteristics. Learning about these futures will contribute to clear diagnosis before surgery.