原发性肺黏液腺癌的影像学表现

摘要

目的：探讨原发性肺黏液腺癌（PPMA）的影像和临床、病理特征及影像诊断价值。方法收集2011年3月—2014年3月宁波大学医学院附属医院经手术病理或穿刺活检证实的7例 PPMA 患者的临床、影像及病理资料。7例患者均行 CT 平扫，其中4例行 CT 多期增强扫描，1例行 MR 平扫及 MR 多期增强扫描。观察其影像学表现并与临床和病理结果进行对照。结果4例单发结节型，1例多发结节型，2例实变型，共9个病灶。外围及胸膜下分布8个，另1个占据整个肺左下叶。最大径0.5~17.3 cm，平均（4.9±5.0）cm。7例病变均未见出血、钙化，分叶、空泡征、血管集束征各4例，空气支气管征、支气管截断征、晕征、胸膜凹陷征各3例，细小短毛刺、棘状突起、碎石路征、卫星播散病灶、血管造影征、肺叶膨隆各2例；3例呈囊实性，实性成分均以边缘分布为主或内部散在斑片样分布；1例 MR 白肺征，实性成分弥散加权成像（DWI）明显高信号，表观扩散系数（ ADC）值明显降低。6例术后病理均为浸润型肺黏液腺癌，分期为Ⅰa 期1例，Ⅱa 期1例，Ⅲa 期4例。1例穿刺活检证实为肺黏液腺癌。结论 PPMA 的影像及病理表现有一定的特异性，正确认识其病理学特点，有助于提高对其影像征象的理解和认识。对怀疑肺黏液腺癌的肺实变患者应常规行 MR 重 T2加权像（T2WI）及 DWI。%Objectjve To study the imaging,clinical and pathologic characteristics of primary pulmonary mucinous adenocarcinoma(PPMA)and their diagnostic value. Methods Seven patients with histopathologically or needle biopsy proved PPMA in the Affiliated Hospital of School of Medicine of Ningbo University from March 2011 to March 2014,were selected as study subjects,the imaging,clinical and radiographic data of the subjects were collected. All patients underwent CT plain scan, among them,4 patients underwent CT multi - phase enhanced scan,and 1 patient underwent MR plain scan and multi - phase enhanced scan. Imaging findings were analyzed and compared with clinical and pathologic findings. Results 7 patients had 9 lesions,among whom 4 patients had solitary nodule,1 patient had multiple nodule and 2 patients had nodular consolidation. Of the 9 lesions,8 lesions were located in peripheral areas or under the pleural membrane,another lesion occupied the whole of the left lower lobe. The maximum diameter of the lesions ranged from 0. 5 to 17. 3 cm〔 mean value was(4. 9 ± 5. 0 ) cm〕. Hemorrhage and calcification were not found among all lesions in 7 patients;lobulated sign,vacuole sign and vascular convergence sign was found in 4 cases respectively;air bronchograms,bronchial cut - off sign,halo sign and pleural indentation sign was found in 3 cases respectively;spiculation,spiculate protuberance,crazy paving pattern,′ satellite′ disseminated nodules,angiogram sign and lung lobe distention was found in 2 cases respectively;3 cases had solid cystic lesions,solid components showed marginal distribution or internal scattered patchy distribution;MRI features of the lesion in 1 case showed〞 white lung sign〞,diffusion weighted imaging( DWI)of solid components showed obviously high signal and the apparent diffusion coefficient ( ADC ) value decreased obviously. 6 patients had histopathologically proved invasive mucinous adenocarcinoma of lung,among whom 1 was in stage Ia,1 was in stage Ⅱa,4 were in stage Ⅲa. Conclusjon PPMA had specific imaging and pathologic characteristics,understanding of the pathologic characteristics correctly can contribute to improving the image understanding. Lung consolidation patients with suspected pulmonary mucinous adenocarcinoma should undergo routinely MRI heavy T2WI and DWI.