典型肺裂结节的HRCT表现特点及与相关结节的鉴别

HRCT characteristics of typical perifissural nodules and identification of related nodules

关键词:  肺裂结节  体层摄影术,X线计算机  肺内淋巴结

Key words:  perifissural nodules  tomography, X-ray computed  intrapulmonary lymph node

摘要:

目的　分析典型肺裂结节(PFN)的薄层HRCT表现，并与不典型PFN及非PFN的CT表现进行比较与鉴别，旨在提高典型PFN的术前诊断水平。方法　从2256例胸部CT体检中收集符合标准的148例199个肺结节分为典型PFN（174个）、不典型PFN（13个）及非PFN（12个）三组进行比较分析，观察其位置、与肺裂关系、大小、密度及形态、血管进入征、小叶间隔细线影以及随访变化等。结果　不典型PFN发生部位以右肺水平裂居多，典型PFN者与肺裂关系密切。非PFN直径(0.64±0.16) cm，大于其他两组且差异有统计学意义（P<0.05）。典型PFN均呈实性密度，三组结节在形态上的差异有统计学意义（P<0.05），典型PFN及不典型PFN三角形或类圆形多见，非PFN均为类圆形。血管进入征以非PFN多见（8/12，66.67%），小叶间隔细线影以典型PFN多见（96/174，55.17%），两者在三组间差异均有统计学意义（P<0.05）。在平均2.02年随访中，非PFN呈逐渐增大趋势，另两组无明显变化。结论　典型PFN与肺裂关系密切并有一定CT表现特点，其中三角形、方形或类圆形、伴有小叶间隔细线影且稳定的实性肺结节，可高度提示PFN的诊断。

Abstract:

Objective To improve the level of preoperative diagnosis of perifissural nodules (PFN), we analyzed the findings of thin HRCT of typical PFN and compared the CT findings of atypical PFN and non-PFN. Methods A total of 199 pulmonary nodules of 148 patients were divided into typical PFN (174), atypical PFN (13) and non-PFN (12) among 2256 cases of chest CT examination. Position and the relationship with the lung fissure, size, density, shape, vascular entry, interlobular septal thin line shadow and follow-up changes were observed. Results Atypical PFN occurred more in the right horizontal fissure. Typical PFN was closely related to pulmonary fissure. The diameter of non-PFN was (0.64 ± 0.16) cm, higher than that of the other two groups (P<0.05). All typical PFN were solid pulmonary nodules. There were statistically significant difference in morphology among the three groups (P<0.05). Triangles or rounds typical PFN and atypical PFN were more common and non-PFN were round. Vascular entry was more common in non-PFN (8/12, 66.67%), and interlobular septal thin line shadow was more common in typical PFN (96/174, 55.17%) (P<0.05). In follow-up of 2.02 years, non-PFN showed a gradual increase trend, yet the other two groups had no significant change. Conclusion Typical PFN is closely related to pulmonary fissure and has certain CT performance characteristics, including triangular, square, or round shape, accompanied by lobes thin lines and stable solid pulmonary nodules. These characteristics highly suggest the diagnosis of disease.