直径小于3cm的孤立性局灶性机化性肺炎CT征象分析

目的分析直径小于3cm的孤立性局灶性机化性肺炎(FOP)的CT表现,以期提高与周围型小肺癌(SPLC)的鉴别诊断水平。方法回顾性分析26例手术病理证实的直径小于3cm的孤立性FOP的CT征象。结果24例紧贴或邻近胸膜,其中17例位于各胸膜交界区。病灶呈类圆形12例,不规则形9例,三角和多角形5例。病灶边缘呈向心性弓形凹陷12例,其形态均为不规则形和三角、多角形;粗长毛刺征9例,其中7例病灶形态呈不规则形和三角、多角形;细短毛刺征5例,病灶形态均呈类圆形;分叶征4例,3例病灶为类圆形;另外出现血管纠集征9例,棘状突起征4例,支气管空气征6例,空洞征2例,空泡征3例,病灶内液化5例;病灶明显强化率为60%。病灶在不同层面的表现显著不同14例,其形态均呈不规则形和三角、多角形。结论直径小于3cm的孤立性FOP与胸膜关系密切,形态呈不规则形和三角、多角形的常与SPLC鉴别不难,而呈类圆形的常与SPLC鉴别困难。

CT features of solitary focal organizing pneumonia with diameter less than 3 cm

Objective To analyze CT features of solitary focal organizing pneumonia (FOP) with diameter less than 3 cm and investigate differential diagnosis with small peripheral lung cancer (SPLC). Methods CT features of solitary FOP with diameter less than 3 cm in 26 pathologically-proved cases were retrospectively studied. Results Twenty-four cases were located near the pleural surface and 17 cases were located in the pleural junctional zone. The sharps of lesion were round-like (n= 12), irregular (n=9), triangular and polygonal (n=5). 12 cases had inward bow indentation and all were irregular sharps or triangular and polygonal sharps. 9 cases had coarse long spiculation and among them 7 cases were irregular sharps or triangular and polygonal sharps. 5 cases had thin short spiculation and all were round-like sharps. 4 cases had lobulation and among them 3 cases were round-like sharps. The lesions also demonstrated convergence of vessels in 9, spiculate protuberance in 4, air bronchogram in 6, cavity in 2, vacuole sign in 3 and liquefaction in 5.12 lesions (60%) were obviously enhanced on contrast enhanced CT scan. CT findings of the lesions were obviously different on its adjacent slice in 14 and their sharps were all irregular or triangular and polygonal. Conclusion CT findings of solitary FOP with diameter less than 3 cm are intimately relate to the pleura, and it is easy to differentiate the lesion of irregular sharp or triangular and polygonal sharp with SPLC while the lesion of round-like sharp is similar to SPLC.