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目的提高对无显性胸水的肺癌胸膜播种性转移的影像学检出和诊断水平。方法对12例无明显胸水征象而经手术和病理证实有胸膜播种性转移的肺癌病例的胸部平片、普通CT和高分辨率CT(HRCT)等影像学表现进行回顾性分析;并结合文献比较上述各种影像学手段对此种肺癌胸膜播种性转移的检出和诊断价值。结果本组12例肺癌胸膜播种性转移中,胸部平片、CT和HRCT对其检出率分别为8.3%、58.3%和91.7%。HRCT对肋胸膜和纵隔胸膜转移检出率为54.5%,对叶间胸膜转移的检出率为85.7%。胸壁胸膜播种性转移的HRCT表现有:(1)胸膜面毛糙和棘状小突起;(2)胸膜面凹凸不平;(3)胸膜面散在2~3 mm大小结节;(4)胸膜面5~10 mm左右圆形或半圆形结节;(5)胸膜面正常。叶间胸膜播种性转移的HRCT表现有:(1)叶间胸膜均匀增厚;(2)叶间胸膜不均匀增厚;(3)叶间胸膜上散在2~3 mm结节;(4)2~3 mm结节与增厚的叶间胸膜一起构成串珠状改变;(5)叶间裂附近成堆或散在2~3 mm结节,酷似位于肺实质内。结论HRCT是检出和诊断肺癌胸膜播种性转移的最佳影像学技术。
Objective To improve the imaging detection and diagnosis of pleural somatic metastases in lung cancer without significant pleural effusion. Methods The chest radiographs, common CT and high-resolution computed tomography (HRCT) images of 12 lung cancer cases with pleural effusion metastasis confirmed by surgery and pathology were analyzed retrospectively. The above-mentioned various imaging methods are useful for detecting and diagnosing the pleural somatic metastasis of lung cancer. Results Among 12 lung cancer pleural somatic metastases in this group, the detection rates of plain chest radiograph, CT and HRCT were 8.3%, 58.3% and 91.7%, respectively. The detection rate of rib pleural and mediastinal pleural metastasis by HRCT was 54.5%, and the detection rate of pleural metastasis between leaves was 85.7%. The HRCT features of somatic metastasis of the chest wall pleura include: (1) rough pleural and spinous processes; (2) uneven pleural surface; (3) pleural nodules scattered between 2 and 3 mm; (4) pleural surface 5 ~10 mm round or semicircular nodules; (5) normal pleural surface. The HRCT features of sow pleural seed somatic metastasis include: (1) uniform pleural thickening between leaves; (2) uneven pleural thickening between leaves; (3) internodal pleural scattered between 2-3 mm nodules; (4) The 2~3 mm nodule together with the thickened interfoliar pleura constitute beaded changes; (5) The interlobular fissures are piled up or scattered in 2~3 mm nodules, which resembles that in the lung parenchyma. Conclusion HRCT is the best imaging technique for detecting and diagnosing pleural somatic metastasis of lung cancer.