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目的 进一步探讨小肺癌的HRCT影像学特征,提高术前诊断的准确性。方法 男性45例,女性11例,年龄2 5～76岁,3 0岁以下3例,3 1～5 0岁以下2 2例,5 0岁以上3 1例(占全部病例的5 5 3 % )。手术46例,穿刺活检10例,其中鳞癌16例,腺癌2 9例,细支气管肺泡癌11例;影像学资料:常规扫描从肺尖至肋膈角等距离扫描,其中3 9例作病灶局部的HRCT扫描,增强扫描3 2例,注射造影剂3 0～40s后开始扫描第一期,5min后再对病灶用同一条件做延迟扫描,对扫描资料进行图像后处理,在结节的实质部分分别测量增强前后第一期及延迟扫描的CT值,10例作了病灶的3D、MIP和CTA重建。结果 病灶部位及类型病灶位于右肺3 1例(上叶前段4例,后段1例,中叶11例,下叶15例) ,左肺2 5例(上叶前段2例,舌叶9例,下叶14例) ;结节的HRCT平扫征象:病灶呈类圆形、椭圆形、小结节形及不规则的斑片状影,病灶内见“空泡征”或“细支气管充气征”2 1例,占3 7 5 % ,“小结节堆积征”3 8例;占67 9% ,病灶周围呈分叶者47例(明显分叶3 6例,浅分叶11例) ,占83 9% ,毛刺42例,占75 0 % ,棘状突起5例,占8 9% ,血管纠集7例,占12 5 % ,“胸膜凹陷征”2 8例,占5 0 0 %。增强后表现:其中腺癌2 9例,病灶强化程度为2 6～69Hu ,平均为(4 8 9±17 8)Hu ,细支气管肺泡癌11例,
Objective To further investigate the HRCT features of small lung cancer and improve the accuracy of preoperative diagnosis. Methods 45 males and 11 females, aged 25 to 76 years old, 3 years old under 3 years old, 21 cases under 3 1 ~ 5 0 years old, 31 cases over 5 0 years old (accounting for 53.3% ). 46 cases of surgery, biopsy in 10 cases, including 16 cases of squamous cell carcinoma, 29 cases of adenocarcinoma, bronchioloalveolar carcinoma in 11 cases; imaging data: conventional scanning from apex to costophrenic angle scan, of which 39 cases Local HRCT scans, enhanced scanning of 32 cases, injection of contrast agent 30 ~ 40s after the first scan, 5min after the same conditions to do delayed scan of the lesion, the scan data after image processing in the nodules In the essential part, the CT values of the first and the second post-contrast scan and delayed scan were measured respectively, and 3D, MIP and CTA reconstruction of 10 cases were made. Results The lesion and type of lesion were located in the right lung in 31 cases (4 in the anterior superior segment, 1 in the posterior segment, 11 in the middle lobe and 15 in the lobe), 25 in the left lung (2 in the anterior lobe, 9 in the tongue , 14 cases of inferior lobe); HRCT scan nodules signs: lesions were round, oval, nodular and irregular patchy shadow, the lesion see “vacuolar sign” or “bronchial tube inflatable Sign of ”21 cases, accounting for 37.5%,“ small nodules accumulation sign ”38 cases, accounting for 67.9%, lesions were divided in 47 cases (significant lobectomy 36 cases, shallow lobulation in 11 cases) , Accounting for 83.9%, burr in 42 cases, accounting for 75%, spicular process in 5 cases, accounting for 89%, blood vessel collection in 7 cases, accounting for 125%, “pleural depression sign” 28 cases, accounting for 500% . After the enhancement, there were 29 cases of adenocarcinoma, 26-26 cases of enhancement of the lesion, 488.88 ± 17.8 of Hu on average, 11 cases of bronchioloalveolar carcinoma,