目的 分析原发性肺鳞癌CT表现特点.方法 回顾性分析大连大学附属中山医院2015年1月至2017年2月64例经病理证实原发性肺鳞癌患者的CT资料,依据CT表现分为中央型和周围型,其中中央型分为Ⅰ型(支气管腔内小结节,最大径≤2.0 cm)、Ⅱ型(肺门结节与肿块)和Ⅲ型(支气管铸形生长);双盲法对各型肺鳞癌CT表现特点进行分析.结果 64例患者依据肺癌发生部位分为中央型48例(75％)、周围型16例(25％).中央型肺鳞癌占大多数(48/64,75.0％),其中Ⅰ型4例(8.3％),平均径(1.0±0.6)cm,2例行增强扫描均呈中度均匀强化;Ⅱ型35例(72.9％),其中7例难以确认CT征象未统计,余28例中不规则形23例(82.1％)、边界模糊17例(60.7％)、深分叶6例(21.4％)、空洞7例(25.0％)、坏死7例(25.0％),多伴阻塞性肺炎或肺不张(64.3％、7.1％)及淋巴结转移(71.4％);21例增强扫描患者中9例呈均匀强化,12例呈不均匀强化;Ⅲ型9例(18.8％),均见指套状、分支状影,6例增强扫描时肿瘤组织强化,黏液嵌塞无强化.周围型肺鳞癌16例(16/64,25％),大多数边界清晰(13/16,81.2％)、可见毛刺征(31.3％)、棘突征(43.7％)、深分叶征(31.3％)、空洞(12.5％)、坏死(31.3％)及胸膜宽基底相贴(37.5％),伴淋巴结转移(31.3％),8例行增强扫描,其中2例呈轻度均匀强化、2例呈中度均匀强化、4例呈不均匀强化.结论 原发性肺鳞癌具有一定的CT表现特征,可辅助临床作出提示性诊断.%Objective To analyze computed tomography (CT) findings of primary lung squamous cell carcinomas (LSCCs). Methods The CT images of 64 LSCCs pathologically confirmed were retrospectively analyzed. According to CT findings, LSCCs were divided into central and peripheral types. The central type was divided into type Ⅰ (intrabronchial small nodule, maximal diameter no more than 2.0 cm), type Ⅱ (nodule and mass in the hilum of lung), type Ⅲ (bronchial cast growth), and the CT features of various types of LSCC were analyzed by a double-blind study. Results Central type accounted for the majority of the LSCCs (48/64, 75％), especially type Ⅱ (35/48, 72.9％). Type Ⅰ were 4 cases (8.3％) with an average diameter of (1.0±0.6) cm;2 patients had moderate enhancement. The 28 lesions of type Ⅱ LSCC had irregular shape (23/28, 82.1％), unclear border (17/28, 60.7％), deep-lobulation (6/28, 21.4％), cavitation (7/28, 25.0％), necrosis (7/28, 25.0％), obstructive pneumonia and atelectasis (64.3％, 7.13％), and lymph node metastasis (20/28, 71.4％). Among them, 21 patients underwent enhanced scans;9 cases had uniform enhancement, and 12 cases had uneven enhancement. Type Ⅲ were 9 cases (18.8％) with finger-like, branch-like shadow. Six cases underwent enhanced scan, tumor tissue was enhanced, and non-enhanced zone was mucoid impaction. The 16 lesions of peripheral LSCC (16/64, 25％) had clear border (13/16, 81.2％), speculation (31.3％), spinous protuberant sign (43.7％), deep-lobulation (31.3％), cavitation (12.5％), necrosis (31.3％), broad contact with pleural (37.5％) and lymph node metastases (31.3％). Eight patients underwent enhanced scans, 2 cases showed mild and uniform enhancement, 2 cases moderate and uniform enhancement, and 4 cases uneven enhancement. Conclusion There are certain CT characteristics in primary lung squamous cell carcinoma, which can help clinical diagnosis.
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