高分辨率CT对肺孤立性结节的诊断价值

目的 评价高分辨率CT(HRCT)与常规螺旋CT(CSCT)为准确诊断肺孤立性结节(SPN)提供信息的能力。方法 18例经手术、痰细胞学或临床证实为SPN的息者均经HRCT与CSCT检查。18例患者中，良性结节(BSPN)13例，其中炎性病变8例，结核球3例，以及错构瘤2例；恶性结节(MSPN)5例，均为原发性肺癌。所有结节的直径介于0．5cm～3．0cm之间，平均为2．2cm。对18例SPN在HRCT与CSCT发现之内部、边缘及周围征象进行了分析。结果 在HRCT像上，分叶征见于4例BSPN(31％)和5例MSPN(100％)，毛刺征见于4例BSPN(31％)和5例MSPN(100％)，胸膜凹陷征见于4例BSPN(31％)和3例MSPN(60％)，棘状突起见于1例BSPN(8％)和2例MSPN(40％)。支气管充气征仅见于2例BSPN(炎性结节)(15％)，结节内脂肪成分仅见于2例BSPN(错构瘤)(15％)。周围型肺气肿仅见于2例BSPN(结核球)(15％)。CT晕征仅见于3例BSPN(23％)。然而，坏死区，锯齿状边缘，卫星病灶，以及限局性胸膜增厚则仅见于MSPN。CSCT虽能证实全部病例的SPN存在，但上述多数HRCT上显示的征象是看不到的。结论 HRCT对SPN内部、边缘及周围征象的评价明显优于CSCT，且能在多数病例中将BSPN同MSPN加以鉴别。

Usefulness of HRCT in the diagnosis of solitary pulmonary nodules

Objective To evaluate the capability of high-resolution computed tomography (HRCT) versus conventional spiral computed tomography(CSCT) to provide informations for accurate diagnosis of solitary pulmonary nodules(SPN).Methods Eighteen patients with surgically,sputum-cytologically or clinically proved SPN underwent the examinations of HRCT and CSCT.Among 18 cases with SPN,benign solitary pulmonary nodules(BSPN)were 13 cases(8 inflammatory lesions,3 tuberculomas,2 hamartomas),malignant solitary pulmonary nodules(MSPN) were 5 cases(all to be primary pulmonary carcinomas).The diameter of all SPN ranged from 0.5 cm to 3.0 cm,mean diameter was 2.2 cm.The inner,marginal,and surrouding signs of SPN in all cases were analyzed by using HRCT with or without contrast enhancement and CSCT.Results On HRCT images,the lobulated signs were found in 4 BSPN(31 %) and 5 MSPN(100 %),spicules in 4 BSPN (31 %) and 5 MSPN(100 %),pleural retraction in 4 BSPN (31 %)and 3 MSPN (60 %),spinous process in 1 BSPN (8 %) and 2 MSPN (40 %).Air bronchogram was only found in 2 BSPN (inflammatory lesions) (15 %).Intranodular falty component was only found in 2 BSPN (hamartomas) (15 %).Peripheral pattern emphysema was only found in 2 BSPN (tuberculomas) (15 %).CT halo sign was only found in 3 BSPN (23 %).However,Necrotic areas,serrated margin,satellite lesions and circumscribed pleural thickening were only found in MSPN.Although CSCT could demonstrate the presence of SPN in all cases but could not reveal above most signs seen on HRCT.Conclusion HRCT is significantly superior to CSCT in the assessment of the inner structure,contour and margin of SPN and it can enable a differentiation of BSPN from MSPN in the majority of cases.