中央型小细胞肺癌的CT诊断及鉴别诊断

目的:探讨中央型小细胞肺癌(Small Cell Lung Cancer,SCLC)的CT表现特点,并找出与非小细胞肺癌(NSCLC)、肺结核、结节病、纵隔淋巴瘤的鉴别诊断要点。方法:回顾性分析经病理证实的57例中央型SCLC、60例NSCLC,5例肺结核,2例结节病,3例纵隔淋巴病的胸部平片及CT资料,全部病例均行胸部平片和CT平扫、增强检查。结果:57例中央型SCLC,CT主要表现为沿支气管长轴生长的肺内肿块,肺门与纵隔广泛淋巴结肿大,而肺不张相对少见。NSCLC60例主要表现为肺门肿块,支气管阻塞性改变相对多见。5例肺结核表现为肺内结节和肺门、纵隔淋巴结肿大,伴有同侧和/或对侧肺内结核病灶。2例结节病,表现为双侧肺门对称性淋巴结肿大。3例纵隔淋巴病表现为中前纵隔的弥漫性软组织肿块。结论:沿支气管长轴生长的肺内肿块、肺门及纵隔淋巴结肿大。支气管阻塞改变少见,随访1～2个月,肿块体积增大1倍以上,是中央型SCLC的CT诊断要点,据此特征诊断正确率达80％。结合临床与其他检查方法可与NSCLC、肺结核、结节病、纵隔淋巴瘤鉴别。

CT diagnosis and differential diagnosis of center type small cell lung cancer

Objective: To study CT features of center type small cell Lung cancer(SCLC) ,and to differentiate it from NSCLC, tuberculosis, sarcoidosis ,mediastinal lymphoma Methods: Plain film and CT findings of 57 cases center type SCLC ,60 NSCLC,5 tuberculosis,2 sarcoidosis and 3 mediastinal lymphoma pathologically proved were analyzed retrospectively, All cases were examined by chest plain film and CT. Results: 57 cases of center type SCLC were presented as pulmonary mass distributing along bronchi and mediastinal mass without obstructive atlectasis. 60 NSCLC presenting as hilar mass were accompanied obstructive change of lung fields. 5 pulmonary tuberculosis were manifested as pulmonary node and hilar, mediastinal mass with pulmonary tuberculosis lesion; 2 sarcoidosis were presented as double hilar mass and 3 mediastinal lymphoma were soft-tissue mass in middle and anterior mediastinum. Conclusion: Pulmonary mass distributed along bronchi, hilar and mediastinal mass without obstructive change,mass doubling time being a month are specific CT findings for diagnosis of SCLC, with diagnostic possibility of 80% . CT scan combined with clinic and other examination methods can differ SCLC from NSCLC, tuberculosis, sarcoidosis and mediastinal lymphoma.