不典型肺癌的CT表现分析

目的：回顾性分析肺癌的不典型CT表现，旨在提高CT诊断准确率。方法：41例经病理证实的肺癌，根据CT表现分为结节型（24例）、实变型（15例）和多结节型（2例）。采用常规CT平扫和增强扫描，层厚、层距5mm-10mm。结果：结节型主要表现：结节位于肺外围或胸膜下（22例）、具有浅分叶（10例）、形状不规则（6例）、边界光滑（8例）、长毛刺（4例）、密度不均匀（8例）、小空洞（2例）、钙化（2例）、与胸膜广泛接触（2例）和卫星灶（5例）；实变型可为单叶或段实变（7例）、多叶或段实变（8例）、具有支气管充气相（12例）、毛玻璃样影（3例）和胸膜改变（4例）；多结节型较少，共2例，表现为一侧或两侧肺野弥漫分布细小结节影。病理证实为腺癌（26例）、细支气管肺泡癌（8例）、鳞癌（4例）、小细胞未分化癌（2例）和类癌（1例）。CT误诊为炎症（32例）、结核（9例）。结论：误诊主要原因是缺乏典型的CT表现。因此熟悉和了解各种不典型CT表现，必要时结合活检，方能提高CT诊断准确率，减少误诊。

Analysis of Atypical CT Appearance of Lung Cancer

Objective: To study the atypical CT appearance of lung cancer in order to improve the diagnostic accuracy. Meth-ods:According to the CT features, 41 cases of lung cancer proved by surgery and histopathology were divided into 3 types: (1) solitary nodule(r: =24) , (2) consolidation( n = 15) and (3) multi - nodules(n =2) . The pre and contrast CT scaning were used with 5- 10mm thickness and space respectively. Results: Solitary nodular type mainly located in peripheral or sub-pleu-ral area (n =22)and showed with light - lobulated(mass n = 10) , irregular shape (n = 6), smoothed margin (n = 8) , long spicule(n =4), heterogeneous attenuations (n =8), small caverna(n -2), calcification (n =2), extensively touched with pleural(n =2)and satellite lesions(n = 5) .Type of consolidation showed one lobar/segmental consolidation(n = 7), or multi-lobar/segmental consolidation (n =8), accompanying with air bronchogram sign (n =12), ground - glass shadow(n =3) and pleural changes(n =4). Multi- nodular type(n =2) was uncommon, presented with diffuse micronodules located in one or two lung fields. Pathologic results were adenocarcinoma( n =26), bronchioloalveolar carcinoma(n =8), squamous cell carcino-ma( n =4), small cell undifferentiated carcinoma(n =2) and carcinoid(n =1). CT misdiagnosed for inflammation(n =32) and tuberculosis(n =9). Conclusion: The main cause for misdiagnosis was lack of adequate or specific CT findings of the disease. To improve the diagnostic accuracy of lung cancer, it is essential to be familiar with its atypical CT features and, in some circumstances, biopsy is necessary to avoid or decrease misdiagnosis.