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目的回顾分析肺肉瘤样癌(PSC)及普通型非小细胞肺癌的多层螺旋CT(MSCT)特征表现,以获得对肺内PSC的诊断及鉴别诊断具有价值的MSCT特征。方法选取经手术和病理证实的13例PSC患者和109例普通型非小细胞肺癌患者影像及临床资料。用χ2检验、Fisher确切概率法对比分析两组之间是否存在统计学意义。结果 PSC的MSCT表现:所有病例均表现为肺内肿块,11例为周围型,其中位于右中、上叶7例(53.8%),肿块最大径3.2～11.7 cm,平均7.6 cm;肿块呈分叶状3例(23.1%),边缘可见细毛刺4例(30.8%),空泡征2例(15.4%),棘突征3例(23.1%),胸膜凹陷征4例(30.8%),增强后其中9例(69.2%)肿瘤呈薄壁或厚壁边缘环形强化,9例(69.2%)肿瘤内部可见大片状均匀或不均匀弱强化区,胸膜侵犯8例,肺内或肺门、纵隔淋巴结转移6例,4例伴有胸腔积液。肿瘤的部位(多位于右中上叶)、大小(直径>5 cm)、瘤体内部大片状弱强化区及周边环形强化、肿瘤较少见分叶及边缘细毛刺(P<0.01)在两组之间差异具有显著统计学意义;棘突征及胸膜凹陷征(P<0.05)在两组之间差异具有显著统计学意义。结论 PSC的MSCT表现具有一定特征性。肿瘤的部位、大小、边缘(少见分叶及细毛刺)、瘤内大片状弱强化区及肿瘤周边薄壁或厚壁环形强化对诊断和鉴别PSC与普通型非小细胞肺癌有重要的价值。
Objective To retrospectively analyze the features of multislice spiral CT (MSCT) in patients with pulmonary sarcomatoid carcinoma (PSC) and common non-small cell lung cancer (NSCLC) so as to obtain the MSCT characteristics that are valuable in the diagnosis and differential diagnosis of PSC in lung. Methods The imaging and clinical data of 13 patients with PSC and 109 patients with non-small cell lung cancer who were confirmed by operation and pathology were collected. With χ2 test, Fisher exact test was used to compare the two groups whether there is statistical significance. Results MSCT manifestations of PSC: All the cases showed pulmonary masses, 11 cases were peripheral ones, of which 7 cases (53.8%) were located in the right middle and upper lobe with the largest diameter of 3.2 ~ 11.7 cm (average 7.6 cm) There were 3 (23.1%) lobes, 4 (30.8%) burr margins, 2 (15.4%) vacuoles, 3 spondyloceles (23.1%) and 4 pleural indentations (30.8% Among the 9 cases (69.2%) tumors, 9 cases (69.2%) of the tumors showed ring-shaped enhancement on the edge of thin-walled or thick wall, 8 cases of pleural invasion, 8 cases of intrapulmonary or hilar invasion , Mediastinal lymph node metastasis in 6 cases, 4 cases associated with pleural effusion. The size of the tumors (> 5 cm in diameter), the lesser extent of the lesion in the tumor and the surrounding annular enhancement, the less tumor lobes and the edge of the tumor (P <0.01) The difference between the two groups was statistically significant; spine signs and pleural indentation (P <0.05) in the difference between the two groups was statistically significant. Conclusion MSCT performance of PSC has certain characteristics. Tumor location, size, margins (rare lobes and fine burr), intratumoral lamellar weakenhancement area, and thin-walled or thick-wall annular enhancement around the tumor have important value in the diagnosis and differential diagnosis of PSC and common non-small cell lung cancer .