肺内孤立病灶的MSCT形态学误诊分析

摘要

Objective To study the misdiagnosing causes of solitary pulmonary lesions. Methods 54 cases of solitary pulmonary lesions(benign lesions in 21 and malignant lesions in 33 ) misdiagnoscd by MSCT confirmed by pathology or clinical follow-up were retrospectively analyzed. MSCT features were comparatively analysed with pathologic findings. Results 21 cases with benign lesions including 16 cases of focal organized pneumonia) FOP) ,3 cases of tuberculosis misdiagnoscd as malignant tumors, 1 case of crypto-coccus pneumonia and 1 case of sclcrosing hemangioma. 33 cases with malignant lesions, including 28 cases of adcnocarcinoma,3 cases of squamous cell cancer, 1 case of carcinoid and 1 case of adenomatoid hypcrplasia( AAH ) misdiagnoscd as benign lesions by CT. MSCT findings including heterogeneous density of lesions, air-bubble sign ,air-bronchogram,typical lobular sign,spiculation, spinous process and plcural indentation(PI) appeared more in malignant group than the benign group. The heterogeneous density and air-bubble sign were significant different between the two groups (P<0. 05). The frequencies of all MSCT features were different between the lesions with ＞3 cm and≤3 cm size in diameters. Conclusion MSCT findings including air-bubble sign, air-bronchogram sign, integrated PI and spinous process arc most important signs, which may be the signs to suggest lung cancer in a certain degree. Comprehending these MSCT features can cut down the misdiagnosis rate. And the way to show features distinctly is to reconstruct the lesions with thin slice,which is the key to avoid diagnostic errors.%目的 探讨肺孤立性病灶的CT形态学误诊原因.方法 回顾性分析经多排螺旋CT(MSCT)诊断,手术病理或随访证实的误诊病例54例,分良、恶性2组进行MSCT征象和病理学对照研究,分析病灶大小等征象.结果 良性组误诊为周围型肺癌21例,其中炎症或局灶性机化性肺炎(focal organized pneumonia,FOP)16例,结核3例,隐球菌感染1例,硬化性血管瘤1例;恶性组 MSCT误诊为良性病变33例,其中腺癌28例,鳞癌3例,类癌1例,腺瘤样增生(adenomatoid hyperplasia,AAH)1例.密度不均匀、空泡征、细支气管充气征、典型分叶、短细毛刺、棘状突起和完整胸膜凹陷征(pleural indentation,PI)在恶性组出现率均高于良性组,其中密度不均匀、空泡征出现的概率在2组间有统计学意义(P＜0.05),病灶最大径＞3 cm和≤3 cm的MSCT征象出现率存在差异.结论 空泡征、细支气管充气征、完整PI和棘状突起可一定程度上提示肺癌,正确把握这些征象可降低误诊率;薄层靶重建有利于征象的显示,是规避误诊的关键.