84例细支气管肺泡癌的影像学分析

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1、上海医学影像2010年12月第19卷第4期ShanghaiMedicalImaging,2010,Vol.19,No.4-307-84例细支气管肺泡癌的影像学分析贾书杰【摘要】目的　回顾性分析细支气管肺泡癌的CT表现和误诊原因,提高影像诊断准确率。方法　84例经病理证实的细支气管肺泡癌,根据CT表现分为孤立结节型、实变型和多结节型,分别为46、32和6例,其中误诊24例。结合文献资料分析各型肺泡癌的CT征象。结果　孤立结节型细支气管肺泡癌主要表现为:结节位于肺外围,有分叶、毛刺、空泡征或支气管气相、密度不均、胸膜牵引和毛玻璃影;实变型细支气管肺泡癌可为单叶或段实变、多叶或段实变、支气管气相、

2、囊状影、毛玻璃影和叶间胸膜膨出;多结节型细支气管肺泡癌较少见,表现为以中下肺野分布为主的弥漫性腺泡结节,部分见空泡。误诊24例中,20例为实变型,主要原因是对细支气管肺泡癌的重视和认识不够。结论　熟悉细支气管肺泡癌各型CT征象,必要时借助穿刺活检和纤支镜检,能提高细支气管肺泡癌的诊断准确率,减少误诊。【关键词】肺肿瘤;细支气管肺泡癌;断层摄影术;X线计算机Imaginganalysisof84casesofbronchioloalveolarcarcinomaJIAShu-jie(DepartmentofRadiology,GongliaoHospitalofXuchang,Henanpro

3、vince461000,China)【Abstract】ObjectiveTostudytheCTfindingsofbronchioloalveolarcarcinoma,toincreasethediagnosticaccuracy,andtoanalyzethecausesofmisdiagnosis.Methods84casesbronchioloalveolarcarcinomawithpathologically-provedweredividedinto3types:(1)solitarynodule(n=46),(2)lobarconsolidation(n=32)and(3

4、)multi-nodular(n=6)type.24casesweremisdiagnosed.CTfeatureswereanalyzedwithreferringtotheliteratures.Resultssolitarybronchioloalveolarcarcinomademonstratedperipheralorsub-pleuralinlocation,lobulated,spiculated,bubble-likelucencyorairbronchogramsign,heterogeneousattenuations,pleuraltagandground-glass

5、.Lobarconsolidationbronchioloalveolarcarcinomashowedonelobar/segmentalconsolidation,orseverallobar/segmentalconsolidationsaccompanyingwithairbronchogramsign,cysticairspaces,ground-glassshadowandbulgedinterlobarfissure.Multi-nodularformwasveryrare,presentedasdiffusenodulesbeinglocatedmainlyinthemidd

6、leandlowerlungfields,someofthemshowingbubble-likelucency.Themaincauseformisdiagnosingwaslackofadequateattentiontoandunderstandingofthedisease.ConclusionToincreasethediagnosticaccuracyofbronchioloalveolarcarcinoma,itisessentialtobefamiliarwithitsCTfeatures,andinsomecircumstances,percutaneousthoracic

7、biopsyorbronchoscopyisnecessary.【Keywords】lungcancer;Bronchioloalveolarcarcinoma;Tomography;X-raycomputed细支气管肺泡癌是肺腺癌的一种特殊类型,影像（3.1±1.2）cm,均位于肺外围或胸膜下.右上叶16例,[1-2]学表现呈多样性,易被误诊。本文回顾性分析84例右中叶6例,右下叶6例,左上、下叶分别为12