多层螺旋CT对同时多原发肺癌的诊断价值

目的探讨多层螺旋CT对同时多原发肺癌的诊断价值及其误诊原因。方法回顾性分析40例83个病灶同时多原发肺癌的CT征象及组织病理类型;分析X线胸片及CT漏误诊病变原因。结果同时多原发肺癌同侧肺发病率高于双侧肺(34∶6),周围型多见,占94%。组织学类型以腺癌最多见,占79.5%(66/83),腺癌中以女性发病更多见(55.2%)。周围型病灶边缘见毛刺者占76.9%(60/78),胸膜牵拉者占70.5%(55/78)。腺癌组和非腺癌组病灶的密度(非实性结节、部分实性结节、实性结节)、结节形态(圆形或类圆形、不规则形)、边缘分叶差异有统计学意义(P值均0.05)。CT第一诊断非恶性病灶共12个,术后均为腺癌,其中4个病灶随访3～6个月后复查,病灶增大,经手术病理证实。X线胸片漏诊周围型病灶24个(22个直径≤1.5cm;12个为非实性结节),均由胸部CT扫描检出。结论同时多原发肺癌不同癌灶大多具有原发肺癌的典型CT表现,并与其病理类型有一定关系。X线胸片漏诊率高,多层螺旋CT对检出小癌灶和非实性癌灶尤为重要。初次影像表现恶性征象不典型病灶,密切随诊非常重要。

Diagnostic value of multi-slice spiral CT in synchronous multiple primary lung cancer

Objective To investigate diagnostic value of multi-slice spiral CT in synchronous multiple primary lung cancer and possible reasons of misdiagnosis. Methods Chest radiography, CT and histopathologieal findings of synchronous multiple primary lung carcinoma in 40 cases were analyzed retrospectively, and the reasons of missed diagnosis and misdiag- nosis of chest radiographies or CT were analyzed. Results Ipsilateral pulmonary lesions and peripheral lesions occurred more frequently. Adenocarcinoma was the most common histopathological type in synchronous multiple primary lung cancer （79. 5%, 66/83）. The incidence of primary multiple adenoearcinomas was higher in female （55.2%）. The spicule sign and pleural indentation were found in peripheral lesions, accounting for 76. 9% and 70. 5%. Statistic differences between adenocarcinoma and non-adenocarcinoma group were found in consistency （ non-solid nodules, part solid nodules, solid nod- ules）, shape, and lobulation （P 〈0. 05, respectively）. CT detected all the 24 lesions including 12 non-solid nodules and 22 small nodules （diameter≤ 1.5cm） which were missed by chest radiography. There were 12 adenocarcinoma nodules without typical malignant characteristics which were misdiagnosed by initial CT scan, in which 4 nodules enlarged after 3 to 6 months＇ follow-up and were confirmed pathologically as adenocarcinoma after surgery. Conclusion Most lesions of synchro- nous multiple primary lung carcinoma have typical primary lung cancer imaging features. There are certain relations between the imaging features and histopathological types. The misdiagnosis of small pulmonary nodules and non-solid nodules were more on chest radiography than on CT. Multi-slice spiral CT is essential in detecting small pulmonary nodules and non-solid nodules. The nodules which are unable to make a definite diagnosis need close follow-up.