肺内孤立性结节的影像诊断

目的：探讨良、恶性肺内孤立性结节胸部X线平片和CT表现，提高良、恶性肺内孤立性结节的鉴别诊断。方法：经手术和临床证实的孤立性肺结节60例均行胸部正、侧、斜位片检查，53例行CT(30例CT增强扫描，10例CT靶扫描)，2例行CT导引下经皮肺穿刺活检。结果：恶性肺结节(52例)表现为边缘分叶或(和)毛刺征，结节密度不均匀，有空泡征或(和)支气管充气征，胸膜凹陷征和血管集中征，模糊绒毛影，CT增强有明显强化。良性(8例)表现为边缘光滑而锐利，密度较高而均匀，结节中可见钙化，CT增强无或轻度强化。结论：CT对肺内孤立性结节的诊断价值优于常规X线平片。对X线平片诊断出的恶性或疑似恶性病例应行CT，可提高对肺内孤立性结节的鉴别诊断。

Imaging Diagnosis of Isolated Pulmonary Nodules

Objective:To discuss the findings on chest radiography and computed tomography(CT)of benign or malignant isolated pulmonary nodules,and to improve the differential diagnosis between benign and malignant lesions. Metho- ds:Posteroanterior,lateral and oblique views of radiography were performed in sixty cases of isolated pulmonary nodules(clinically and surgically proven).CT was performed in 53 cases including CT enhancement in 30 cases and high resolution CT scan in 10 cases with smaller nodules.Percutaneous CT-guided biopsy was performed in 2 cases.Results:Fifty-two cases were proved to be malignant nodules and 8 cases benign nodules.Benign nodules manifested as smooth edge,symmetrical hyperdensity with calcification,without or with mild enhancement.Malignant nodules presented as lobulated or speculated edge,asymmetrical hyperdensity with vacuole sign,air-bronchogram,pleural retraction,convergence of peripheral vessels and obvious enhancement.Both chest radiography and CT could detect benign and malignant isolated pulmonary nodules.Conclusion:CT is superior to conventional X-ray plain film on diagnosis of isolated pulmonary nodules.Malignant or suspected malignant nodules diagnosed by X-ray plain film should undergo CT examination routinely,which can improve the differential diagnosis.