无显性胸水的肺癌胸膜播种性转移:影像学检出和诊断

目的提高对无显性胸水的肺癌胸膜播种性转移的影像学检出和诊断水平。方法对12例无明显胸水征象而经手术和病理证实有胸膜播种性转移的肺癌病例的胸部平片、普通CT和高分辨率CT(HRCT)等影像学表现进行回顾性分析;并结合文献比较上述各种影像学手段对此种肺癌胸膜播种性转移的检出和诊断价值。结果本组12例肺癌胸膜播种性转移中,胸部平片、CT和HRCT对其检出率分别为8.3%、58.3%和91.7%。HRCT对肋胸膜和纵隔胸膜转移检出率为54.5%,对叶间胸膜转移的检出率为85.7%。胸壁胸膜播种性转移的HRCT表现有:(1)胸膜面毛糙和棘状小突起;(2)胸膜面凹凸不平;(3)胸膜面散在2~3 mm大小结节;(4)胸膜面5~10 mm左右圆形或半圆形结节;(5)胸膜面正常。叶间胸膜播种性转移的HRCT表现有:(1)叶间胸膜均匀增厚;(2)叶间胸膜不均匀增厚;(3)叶间胸膜上散在2~3 mm结节;(4)2~3 mm结节与增厚的叶间胸膜一起构成串珠状改变;(5)叶间裂附近成堆或散在2~3 mm结节,酷似位于肺实质内。结论HRCT是检出和诊断肺癌胸膜播种性转移的最佳影像学技术。

Imaging Detection and Diagnosis of Plural Dissemination in Pulmonary Carcinoma Without Obvious Pleural Effusion

Objective To improve imaging early detection and accurate diagnosis of pleural dissemination in lung cancer without obvious pleural effusion.Methods The chest plain films,CT and HRCT images of 12 patients with plueral dissemination in lung cancer but no obvious pleural effusion comfirmed pathology were retrospectively analysed.The value of chest plain films,CT and HRCT in detection and diagnosis of pleural dissemination were compared with literature reviewed.Results The pleural dissemination of lung cancer were detected in8.3% by chest plain films,58.3% by CT and 91.7% by HRCT respectively.Furthermore the sensitivity for detection of the pleural dissemination was 54.5% in costal and mediastinal pleural surfaces;85.7% in interlobar pleural surfaces.HRCT findings of the costal and mediastinal pleural dissemination in lung cancer included:(1) Coarse and spined pleural surface;(2)The irregular with convexities and concavities of pleural surface;(3)2~3 mm in diameter nodules scattered on pleural surfaces;(4)5~10 mm circlar and hemicirclar nodules on pleural surfaces;(5)Normal pleural surfaces.HRCT findings of the interlobar pleural dissemination in lung cancer were summarised as follows:(1)Uniformity thickenning of interlobar pleura;(2)Irregular thickenning of inter lobar pleura;(3)2~3 mm nodules scattered on interlobar pleura;(4)2~3 mm nodules and irregular thickenning of interlobar pleura as beaded string;(5)A cluster of 2~3mm nodules in pile or scatter near the interlobar pleural surfaces,that mimicking in pulmonary parenckyma.Conclusion HRCT is the optimal manner in diagnosing pleural dissemination in lung cancer,especially in the interlobar spaces.