SPN的CT强化效应与鉴别诊断:不强化肺癌的病理因素分析

目的探讨在增强CT扫描中肺癌不强化的病理因素。方法回顾性分析32例不强化肺癌患者的术前CT和术后病理，男性27人。女性5人；年龄在46～74岁，中位年龄57岁。CT检查采用病灶中心层面同床位增强前后动态扫描，依据定位片上病灶的大小决定层厚和层距(2～10mm)。使用非离子型对比剂优维显80—100ml(300mg/ml)，压力注射器给予，流率为2～3ml／s。测量注射对比剂前和注射后即刻、1分钟、2分钟、3分钟时病灶同一位置CT值，以两者之差≥30Hu作为病灶有强化的下限：手术标本先裸眼解剖观察，然后用石蜡包埋切片、H—E染色或／和免疫组化染色观察，获得组织学诊断。结果病灶位于两肺上叶者11例．右肺中叶者6例，两肺下叶者15例。病灶长径在18—56mm之间，平均37mm。病理组织分型中鳞癌19例，腺癌5例，腺鳞癌2例，大细胞未分化癌4例．肺泡细胞癌2例。增强扫描CT强化值在29—213Hu间者17例。19—10Hu间者11例，9Hu以下者4例。结论增强CT扫描中肺癌不强化主要与病灶大小和组织类型有关，多见于癌灶大于3cm者和鳞癌、大细胞未分化癌及腺癌(包括肺泡细胞癌)。

CT contrast effect and differential diagnosis in solitary pulmonary nodules:unenhanced lung cancer analysis pathologically

Purpose To explore the pathologic factors of unenhanced lung cancers in the CT scanning after administration of contrast material. Methods The preoperative CT images and postoperative specimen pathology of thirty-two patients with bronchiogenic pulmonary carcinomas were retrospectively investigated. They respectively underwent the plain and contrast CT scanning before operation. There were twenty-seven males and five females, age ranged from 46 to 74 years old(average 57 yrs). The dynamic CT in same position of lesions was performed before and after administration of nonion iodine medium intravenously. Measuring the attenuation values of lesion in plain scanning and the 30,60,120,180 seconds after onset of injection, 30Hu was setted as the lowest criteria of lesion enhancement. Postoperative specimen were sectioned and stains with H-E or/and immunohistochemistry. Results There were 11 cases in superior lobes of bilateral lungs, 6 cases in middle lobe of right lung, and 15 cases in inferior lobes of bilateral lungs. The masses of 32 cases were from 18 to 56 mm in diameter(average 37mm). According to pathologic cell types, the lung cancers could be divided into squamous cell carcinoma(n=19), adenocarcinoma(n=5), adenosquamocarcinoma(n=2), large cell carcinoma(n=4), and bronchioalveolar cell carcinoma(n=2). In the group,the enhanced value were alphabetically followed as 29-20 Hu(n=17), 19-10Hu(n=11), and below 9Hu(n=4). Conclusion The unenhanced factors of lung cancer in contrast CT are mainly correlated with the diameter of masses and pathologic cell types.