肺良恶性肿块的CT误诊分析

目的探讨肺良恶性肿块的CT征象,分析CT误诊的原因。方法收集经病理及临床、影像学随诊证实的肺癌患者87例及同期CT误诊的良性肿瘤43例,分析其影像学表现及CT误诊原因。结果 87例肺癌中,CT正确诊断46例,误诊41例;误诊和确诊的肺癌在分叶征、毛刺征、胸膜凹陷征及淋巴结肿大、浅/深分叶征象的出现率的差异有统计学意义（P均〈0.05）,而血管集束征和支气管气相征象的出现率的差异无统计学意义（P〉0.05）。依据分叶征、毛刺征、血管集束征、支气管气相和胸膜凹陷征分为3个等级,将肺癌出现上述征象0～1个为不典型（等级1）,2～3个为较典型（等级2）,4～5个为典型（等级3）,误诊和确诊肺癌在等级上差异有统计学意义（χ2=12.548,P=0.002）。结论导致CT误诊肺良恶性肿块,既有征象不典型、技术检查不足等原因,也有诊断医师对征象把握不准、经验不足等主观因素。

Analysis of CT misdiagnosis of benign and malignant pulmonary lesions

Objective To observe CT characteristics of benign and malignant pulmonary lesions, and to explore the causes of CT misdiagnosis. Methods Totally 87 patients with pathologically or clinical, imaging following-up proved lung cancer were enrolled, while 43 patients with benign lesions misdiagnosis by CT were collected over the same period. CT character- istics of the lesions and causes of misdiagnosis were analyzed. Results Among 87 patients with lung cancer, 46 were cor- rectly diagnosed, while 41 were misdiagnosed with CT. There were statistical differences for the occurrence of availability of lobulation, spiculation, pleural indentation sign, lymphadenectasis and shallow/deep lobulation between patients with misdiagnosed and correctly diagnosed lung cancer （all P〈0.05）, but not of vessels convergence, nor of bronchial gas clus- ter sign （P〉0.05）. The lung cancer patients were divided into 3 grades according to the occurrence of lobulation, spicula- tion, vessels convergence, bronchogram and pleural indentation. Grade 1 was not typical cancer with 0--1 above sign, grade 2 was relative typical cancer with 2--3 above signs, while grade 3 was typical cancer with and 4--5 above signs. Sta- tistical differences of grades were found between correctly diagnosed and misdiagnosed lung cancers （x2= 12. 548, P= 0. 002）. Conclusion Causes of CT misdiagnosis of benign and malignant pulmonary lesions include atypical CT manifesta- tions, not enough technical inspection, as well as lack of understanding of imaging findings, experience and other subjective factors.