胸膜凹陷征的病理基础及其HRCT诊断价值

目的：为了从ＨＲＣＴ角度评价胸膜凹陷征的病理基础及其在周围型小肺癌中的诊断价值，提高对完整胸膜凹陷的认识水平。材料和方法：搜集经手术和／或病理证实的周围型小肺癌１０１例，其中５２例为ＨＲＣＴ前瞻性研究组，简称“前瞻”组；４９例为回顾性常规ＣＴ薄扫组，简称“薄扫”组；良性小结节４８例（３０例为ＨＲＣＴ扫描）。比较观察“前瞻”组、“薄扫”组、良性对照组及术后标本胸膜凹陷ＨＲＣＴ表现。结果：通过比较分析，经统计发现完整胸膜凹陷在“前瞻”组见３０例（５７．７％）；“薄扫”仅１例（２％）；对照组２例（４．２％）。研究发现，ＨＲＣＴ扫描技术是显示完整胸膜凹陷的关键，良、恶性组之间完整胸膜凹陷的发生率有明显差异。胸膜凹陷的中心位置与肿瘤生长的部位相关。结论：胸膜凹陷的形成除了与肿瘤内的瘢痕收缩等因素有关外，还与肿瘤发生的部位及其所致的节段性肺不张有关，ＨＲＣＴ像上完整胸膜凹陷征系周围型小肺癌的重要诊断依据之一

Pathologic Basis of Pleural Indentation and Its Diagnostic Value with HRCT

OBJECTIVE:The purpose of this study was to evaluate the pathologic basis of pleural indentation (PI) and its diagnostic value in small peripheral lung cancer (SPLC).MATERIALS AND METHODS:One hundred and one patients of SPLC (prospective HRCT scans in 52 cases and standard scans with thin section in 49 cases) and 48 cases of benign lesions HRCT scan in 30 patients as controlled group) confirmed by surgery and /or pathology were collected in this paper. A correlative study was done among these three groups.RESULTS:The data revealed that the integrated PI was seen in 57.7% cases (30/52) of prospective HRCT, but only 2% (1/49) in conventional thin section group, 4.2% (2/30) in controlled group. It suggested that the perfect technique of CT scanning be the key for reflecting the integrated PI and there be siginficant difference in its occurrence between benign and malignant lesions.CONCLUSION: The correlation of the position of PI center with that of SPLC suggested that the segmental atelactasis and fibrosis may be the potential cause of the formation of Pl. Since the integrated PI was usually seen in SPLC but rarely found in benign group. We believed that a complete PI became one of the important signs in the diagnosis of SPLC.