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1、中华现代影像学杂志JournalofChineseModernImaging2007年第4卷第9期·789··论著·小肺癌与肿块型肺炎胸部DR摄片加CT增强扫描鉴别诊断的探讨(附113例分析)钮建武[摘要]目的探讨胸部数字化摄片(DR)技术加CT增强扫描,对小肺癌与肿块型肺炎的鉴别诊断价值。方法分析113例最后确诊为小肺癌和肿块型肺炎的病例胸部DR正侧位片加胸部CT增强扫描X线征象异同点。结果最后确诊为小肺癌者共97例。其中65例经病理证实;32例在随访观察中长大或转移而证实。确诊为肿块型肺炎者有16例,经抗炎治疗及活检证实。误诊为肺癌者有7例。结论DR技术加CT增强扫描检查对肺部小肿块特征
2、及细节的显示有明显的帮助。分叶征和毛刺征并非肺癌所特有,在肿块型肺炎有时也出现。CT增强扫描病灶强化程度二者无显著区别,只能作为诊断参考,不能作为定性依据;CT薄层靶扫描能清晰反映病变边缘、内部结构,如分叶征、胸膜凹陷征、空泡征、小结节堆积征等,有助于肺癌的诊断。[关键词]数字化摄片;体层摄影术,X线计算机;小肺癌;肿块型肺炎[中图分类号]R81614[文献标识码]A[文章编号]1681-2824(2007)09-0789-03DifferentiationdiagnosisofDRandCTenhancedscanonsmalllungcancerandtumorouspneumonia:
3、areportof113casesNIUJian2wu.DepartmentofRadiology,ShanghaiZhongyeHospital,Shanghai200941,China[Abstract]ObjectiveTodiscussthediagnosticvalueofDRandtheenhancedCTscanindifferentiatingthesmalllungcancerandthetumorouspneumonia.Methods113caseswerefinallyconfirmedforthesmalllungcancerorthetumorouspneumon
4、iabyoperation,biopsyandclinicalinformation.ThesimilaritiesanddifferenceswereanalyzedinthefeaturesofDRandtheenhancedCTscanimaging.Results97caseswereconfirmedforthelungcancer,65casesofwhichbybiopsyand32ofwhichbythecancergrowingandtransfering.16caseswerediag2nosedforthetumorouspneumoniaconfirmedbyvani
5、shingafteranti2inflammatoryorbybiopsy.7caseswerefalselydiagnosedforthelungcancer.ConclusionTheDRandenhancedCTscantechnologyhaveagreathelpinobserv2ingthefeaturesofthesolitarypulmonarynodule(SPN).“Signoflobulation”and“spiculesign”notonlyexistinthelungcancer,butalsoexistinsomeofthetumorouspneumonia.Th
6、eenhancementdegreesofSPNenhancedbyCTcontrastmediadon곰thaveanotabledifferencebetweenthecancerandthepneumonia,sowecannotdiagnoseSPNonlythroughit.Multi2slicetargetCTcandistinctlydisplaytheshapeoftheedgeandinterioroftheSPN,suchas“signoflobulation”,“rabbit2earsign”,“vacuolesign”,“node2accumulatingsign”,
7、whichareusefultodiagnosethelungcancer.[Keywords]digitalradiology;tomography,X2raycomputed;smalllungcancer;tumorouspneumonia肺癌和肺炎是临床日常工作中的常见病,其中X线表现例;年龄38～85岁。不典型的小肺癌和肺部炎性块影历来是X线诊断与鉴别诊112临床表现110例有咳嗽、咳痰、发热。48
