肺炎型细支气管肺泡癌的CT特点及CT导引穿刺活检的诊断价值

目的 探讨CT导引穿刺活检对CT拟诊为肺炎型细支气管肺泡癌（BAC）的诊断价值及肺炎性BAC的CT特点.方法 对25例CT拟诊为肺炎型BAC患者行CT导引穿刺活检,采用GE公司64排light speed VCT行常规扫描及增强CT扫描,所有图像由两名医师共同分析完成,依据增强扫描可疑肿瘤部位选择穿刺部位及垂直进针路径,确定理想活检部位后应用20 ml注射器进行负压针吸活检,多方向、多点抽吸,吸出物涂片迅速固定,应用活检枪切割活检,标本用福尔马林溶液固定送检.拔针压迫10min后包扎,再次行CT扫描观察有无出血及气胸等并发症发生.结果 25例患者均成功取到组织,病理证实为肺炎型BAC 14例,肺炎6例,真菌感染2例,干酪性肺炎3例.14例肺炎型BAC患者CT表现为实变肺组织内支气管充气征10例（71.4％）,实变肺组织内蜂房状气腔或空洞征5例（35.7％）,实变区周围呈磨玻璃密度影及多发结节影5例（35.7％）;增强CT扫描实变区可见混杂的低密度区内血管造影征11例（78.6％）,平均达峰时间为90s,时间密度曲线呈速升缓降型9例（64.2％）.结论 CT引导肺穿刺活检结合典型影像学表现可以大大提高肺炎型BAC的早期诊断率,肺段、叶性实变区内蜂窝状气腔及空洞、血管造影征、枯树枝征、周围多发腺泡结节及磨玻璃密度区,增强扫描实变区可见血管造影征,时间-密度曲线呈速升缓降型是肺炎型BAC的主要特点.

The CT imaging features of pneumonic type bronchioloalveolar carcinoma and the diagnostic value of CT-guided percutaneous puncture biopsy

Objective To investigate the CT imaging features of pneumonic type Bronchio-loalveolar carcinoma（BAC） and the value of CT-guided percutaneous puncture biopsy in pneumonic type BAC.Methods Twenty-five cases of suspected pneumonic type BAC were biopsied with CT-guided percutaneous puncture.GE 64-slices plain and post contrast CT scans were performed in all patients.Two radiologists finished imaging determination.Site of puncture was selected in suspicious areas of the tumor.The negative pressure aspiration needle were used to be biopsy in the ideal location after vertically into the needle and again performed CT scanning were performed to observe the complications such as hemorrhage,pneumothorax.Specimens were fixed by formalin.Results Twenty-five samples were successfully got from 25 patients.Pathology data showed that 14 cases were pneumonia with BAC,6 cases with pneumonia,2 cases with offungus infection,and 3 cases with caseous pneumonia.Of 14 cases （71.4%） with pneumonia type BAC,CT images of 10 cases showed air bronchogram of lung tissue,5 cases（35.7%） with alveolar gas cavity or cavity of lung tissue,5 cases（35.7%） with ground glass opacity and multiple nodules.Enhanced CT scanning the area of consolidation showed that 11 cases（78.6%） were with mixed low density area angiography and the mean peak time was 90 s,9 cases （64.2%） were with the time density curve of speed up and slow down type.Conclusion The method of CT guided lung biopsy combined with typical imaging findings can enhance early diagnosis rate of pneumonia type BAC.Meanwhile CT feature of pneumonia type BAC shows honeycomb air cavity,void,angiographic sign,dead branches syndrome,multiple peripheral acinar nodules and ground glass density.Enhanced scan area of consolidation shows visible angiogran sign,slow drop type of time density curve of a fast rise.