不典型肺结核球与周围型小肺癌的MRI鉴别诊断

目的探讨不典型肺结核球(APT)与周围型小肺癌(SPLC)的MRI鉴别诊断。资料与方法收集经病理或随访证实的APT与SPLC患者各20例。所有患者均行MRI平扫、多期增强扫描及DWI检查,分析其MRI表现。结果 APT组及SPLC组患者中,分叶征、血管集束征及胸膜凹陷征分别有1例、2例、4例,7例、13例、11例,两组差异均有统计学意义(P<0.05)。APT组9例T1WI呈等信号,7例呈稍低信号,4例呈外高内低信号;11例T2WI呈等信号,5例呈高信号,4例呈外高内低信号;13例DWI呈高信号,7例呈等信号。SPLC组15例T1WI呈稍低信号,5例呈等信号;12例T2WI呈高信号,7例呈等信号,1例呈外高内低信号;15例DWI呈高信号,5例呈等信号。APT与SPLC组T2WI信号值(243.99±95.34比303.98±52.41)、ADC值(1.616±0.422)×10^-3mm/s^2比(1.141±0.150)×10^-3mm/s^2]、强化峰值(319.13±57.16比428.11±72.95)及强化增值(92.97±65.33比224.63±47.66)比较,差异均有统计学意义(P<0.05);而T1WI信号值差异无统计学意义(P>0.05)。APT组中,呈环形强化、均匀强化及不均匀强化分别有18例、1例、1例,SPLC组分别有2例、5例、13例。结论 MRI形态学改变、信号值及强化特点是鉴别诊断APT与SPLC的重要征象。

Differential Diagnosis of Atypical Pulmonary Tuberculoma and Small Peripheral Lung Cancer by Using MRI

Purpose To investigate the differential diagnosis between atypical pulmonary tuberculoma(APT) and small peripheral lung cancer(SPLC) by MRI. Materials and Methods Twenty patients with APT and 20 patients with SPLC confirmed by pathology or follow-up service were selected. MRI scan, muitiphasic contrast-enhanced scan and DWI examination were performed to all patients, and the MRI manifestations were analyzed. Results In APT group, there were 1 lobulation sign, 2 vascular convergence signs and 4 pleural indentationare. In SPLC group, the corresponding cases were 7, 13 and 11 cases, respectively. The difference was of statistical significance(P<0.05). Among patients in APT group, there were 9 cases of T1WI isointensity, 7 cases of slight hypointensity and 4 cases of surrounding hyperintensity and hypointensity, 11 cases of T2WI isointensity, 5 cases of hyperintensity and 4 cases of surrounding hyperintensity and hypointensity as well as 13 cases of DWI hyperintensity and 7 cases of isointensity. Among patients in SPLC group, there were 15 cases of slight hypointensity, 5 cases of isointensity, 12 cases of T2WI isointensity, 7 cases of isointensity and 1 case of surrounding hyperintensity and hypointensity as well as 15 cases of DWI hyperintensity and 5 cases of isointensity. Difference of T2WI value(243.99±95.34 vs. 303.98±52.41), ADC value(1.616±0.422)×10^-3 mm/s^2 vs.(1.141±0.150)×10^-3 mm/s^2, peak height value(319.13±57.16 vs. 428.11±72.95) and peak enhancement value(92.97±65.33 vs. 224.63±47.66) for patients in APT and SPLC value with statistical significance(P<0.05). However, difference of T1WI signal value was of no statistical significance(P>0.05). In APT group, there were 18 cases showing marginal rim enhancement, 1 case showing homogeneous density and heterogeneous density respectively. In SPLC group, the corresponding cases were 2, 5 and 13 cases, respectively. Conclusion MRI morphological changes, signal value and enhancement characteristics are significant signs to identify and diagnose APT and SPLC.