两上肺机化性肺炎的CT和PET-CT表现及鉴别诊断

发布时间：2018-07-18 10:11

【摘要】：目的探讨发生在两上肺的机化性肺炎的螺旋CT及PET-CT特征以提高对其的诊断及鉴别能力。方法对83例经手术病理证实的两上肺机化性肺炎螺旋CT表现及其中7例PET-CT进行回顾性分析,探讨病变的发生部位、形态、大小、边缘、密度、增强及糖代谢水平等影像学特征。结果病变在肺野外、中、内带均有发生,病灶呈团块、结节、不规则条片态及楔形等多种形态,以长轴/短轴比值平均1.7的不规则条片状及楔形最具特征,边缘多毛糙、模糊,78例(93%)边缘可见长、短毛刺,38例(46%)出现胸膜增厚或牵拉,22例(27%)平扫病灶内示单或多发类圆形透亮区,5例(6%)出现形态不规则空洞,增强后平扫出现的类圆形透亮区均无强化,8例出现单、多发类圆形无强化低密度或蜂窝状改变,仅3例呈环形强化,实变区域以明显强化为主且有延时强化趋势,部分病灶内出现完整的肺血管树影。7例PET-CT均有不同程度糖代谢增高,均值达10。结论胸膜下楔形实变影或不规则长条片影,内有多发小圆形透亮区/无强化区和完整的肺血管影,相邻胸膜条带状增厚,糖代谢水平不同程度增高是上肺机化性肺炎CT及PET-CT常见表现,加深对这些特点的认识,能提高其诊断准确性及尽量避免误诊。
[Abstract]:Objective to investigate the features of spiral CT and PET-CT in the diagnosis and differential diagnosis of two upper lungs. Methods the CT findings of 83 cases of bilateral upper lung organized pneumonia confirmed by operation and pathology and 7 cases of PET-CT were retrospectively analyzed. The imaging features such as location, shape, size, margin, density, enhancement and glucose metabolism were discussed. Results in the field of lung, the lesions occurred in the middle and inner zones. The lesions were mass, nodules, irregular strips and wedges, etc. The irregular strips and wedges with an average long axis / short axis ratio of 1.7 were the most characteristic, and the edges were rough. There were 78 cases (93%) with long margin, 38 cases (46%) with short burr, 22 cases (27%) with pleural thickening or pulling, 5 cases (6%) with irregular cavity in single or multiple round clear area on plain scan. No enhancement was found in 8 cases of circular transparent areas after enhancement, and no enhancement of low density or honeycomb was found in multiple round areas, but only 3 cases showed circular enhancement. The consolidation areas were mainly enhanced and had a tendency of delayed enhancement. In some lesions, intact pulmonary vascular tree shadow was found in 7 cases of PET-CT with increased glucose metabolism in varying degrees, with a mean value of 10. 5%. Conclusion the subpleural wedge-shaped solid shadow or irregular long film with multiple small circular transparent area / unenhanced area and intact pulmonary vascular shadow, the adjacent pleural strips are thickened. Elevated glucose metabolism is a common manifestation of CT and PET-CT in patients with upper lung organic pneumonia. Understanding these characteristics can improve the diagnostic accuracy and avoid misdiagnosis as far as possible.
【作者单位】：广州医科大学附属第一医院放射科;中山大学第一附属医院胸外科;
【分类号】：R563.1;R816.4

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