首次CT表现为肺炎、肺实变等肺癌患者的临床特点研究

目的探讨首次CT表现为肺炎、肺实变或肺不张等肺癌患者的特点,减少误诊率。方法回顾分析2004年4月—2010年9月北京安贞医院34例肺癌患者首次CT表现、氟代脱氧葡萄糖(18 F-FDG)肿瘤代谢显像结果、病理分型及首诊症状等,评价肿瘤代谢显像的诊断价值。结果 34例CT 13例表现为炎性实变;14例仅表现为炎症,无实变;7例为肺不张。18F-FDG符合线路单光子发射计算机断层成像术(SPECT)肿瘤代谢显像31例为阳性,3例为阴性。病理证实13例为鳞癌,8例腺癌,1例大细胞癌,6例小细胞癌,2例高度可疑肺癌;1例胸腔积液找到瘤细胞;2例临床恶液质死亡未做病理;1例骨显像示多发骨转移未做病理。首诊症状无特异性,2例有慢支病史,1例于心脏搭桥围术期确诊肿瘤。结论对于初次CT表现为肺炎、肺实变、肺不张、未见明确占位,首诊症状无特殊的患者,18F-FDG符合线路SPECT显像有很高的诊断价值。临床和影像医师可资借鉴,减少漏诊。

The Clinical Characteristics of Lung Cancer Presented with Pneumonia,Consolidation of Lung by Initial CT

Objective To investigate the characteristics of lung cancer presented with pulmonary pneumonia,lung consolidation or atelectasis by initial CT so as to reduce the rate of misdiagnosis.Methods The data of 34 cancer patients,from April 2004 to September 2010,were retrospectively analyzed,including the results of initial CT,cancer imaging of 18F-fluorodeoxyglucose single-photon-emission computer tomography(18F-FDG-SPECT) pathological patterns and symptoms at initial visit,and then the diagnostic significance of 18F-FDG-SPECT was evaluated.Results With CT,13 patients showed inflammatory consolidation;14 showed only inflammation with no real change;7 showed atelectasis.With 18F-FDG-SPECT coincidence imaging: 31 were positive,and 3 were negative.Pathological examination confirmed 13 cases of squamous cell carcinoma,8 cases of adenocarcinoma,and 1 case of large cell carcinoma,6 cases of small cell carcinoma,and 2 case of highly suspicious lung cancer;there were 1 patient with pleural effusion from which tumor cells were found.2 who died of cachexia with no pathological examination,and 1 with multiple bone metastases revealed by bone scintigraphy and in absence of pathological examination.No specific symptoms was found at first diagnosis,there were 2 patients who had a history of chronic bronchitis and 1 patient who was diagnosed with tumor during peri-operative cardiac bypass.Conclusion For the patients with pneumonia,lung consolidation,atelectasis,no clear footprint,and no special symptoms at first visit,18F-FDG-SPECT with coincidence imaging is of high diagnostic value.Clinical and imaging physicians can learn to reduce misdiagnosis.