肺硬化性血管瘤的多层螺旋CT 特征与其病理基础分析

Multislice CT features and pathological analysis of pulmonary sclerosing hemangioma

摘要:

目的：归纳肺硬化性血管瘤（pulmonary sclerosing hemangioma，PSH）的多层螺旋CT（multislice CT，MSCT）特征表现及其相关病理基础的认识，旨在提高对此病的诊断水平。方法：收集我院经手术及病理确诊为PSH共19例，所有病例均行CT平扫及增强扫描；回顾性分析患者MSCT图像特征表现，并对具有较高特异性的征象与病理组织学基础进行分析。结果：（1）18例单发，1例多发（2个病灶），共20个病灶；其中11个（约57.9%）病灶为周围型，9个病灶为中央型。（2）所有病灶界限清楚，呈圆形或卵圆形；4例（约21.1%）病灶呈浅分叶，3例（15.8%）病灶内见小点钙化。（3）所有病灶均呈不同程度持续性渐进性强化；14例病灶边缘见“血管贴边征”，4例见病灶周缘伴“肺气肿带包绕征”，5例病灶周围见磨砂玻璃征象，即“晕征”。（4）增强扫描，5例病灶呈均匀性强化，14例病灶呈不均性强化，有明显强化区及未强化区，这与病灶内血管瘤样区、乳头区、实变区和硬化区组织成分以不同比例混合存在相关。结论：中年妇女患者肺门旁或肺外带单发的光滑圆形或卵圆形结节，增强后不均性强化；病灶周围出现“血管贴边征”，“肺气肿带包绕征”和“晕征”征象，高度提示PSH诊断；明确诊断仍需病理学检查。

Abstract:

Objective：To discuss the multislice CT（MSCT） findings and pathologic characteristics of pulmonary sclerosing hemangioma（PSH） in order to improve the diagnosis of this disease. Methods：Totally 19 cases of PSH confirmed by operation and histopathology were collected. All cases underwent plain and enhanced CT scan. Retrospective analysis of MSCT features of PSH was done，moreover，the rare but specific CT findings and correlated pathologic basis were discussed. Results：（1）Eighteen cases had isolated lesion and 1 case had 2 lesions，20 lesions in total；among the 20 lesions，11（57.9%） were located in peripheral and 9 in central lung. （2）All lesions were round or oval in shape with well-defined boundary. Lesions of four cases（21.1%） had slight lobulation and lesions of 3 cases（15.8%） had calcification like sand. （3）All lesions were enhanced progressively and persistently at different extents；14 cases（73.7%） showed ‘blood vessel marginating sign’，4 cases（21.1%） showed ‘air meniscus sign’ and 5 cases（26.3%） with round glass opacity around lesions，namely ‘halo sign’. （4）All cases received enhanced scan，5 cases showed marked homogeneous enhancement whereas 14 cases（73.7%） showed intense and patchy heterogeneous enhancement，which was associated with different tissue compo－nents and proportions in hemorrhagic area，papillary area，solid area，sclerotic area of lesions. Conclusions：PSH usually occurs in the middle-aged female patients and locates near lung hilar or lung periphery with isolated lesions round or oval in shape；intense and patchy heterogeneous enhancement of lesions can be seen after enhanced CT scan. ‘Blood vessel marinating sign’，‘halo sign’ and ‘air meniscus sign’ around lesions are highly indicative of PSH，however，pathological check is still needed.