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目的 回顾性分析细支气管肺泡癌 (BAC)的CT表现和误诊原因 ,提高影像诊断准确率。材料与方法 42例经病理证实的BAC ,根据CT表现分为结节型、实变型和多结节型 ,分别为 2 3、16和 3例 ,其中误诊 12例 (2 8.6 % )。结合文献资料分析各型肺泡癌的CT征象。结果 结节型BAC主要表现为 :结节位于肺外围 (95 .7% ) ,有分叶 (91.3 % )、毛刺 (6 9.6 % )、空泡征或支气管气相(6 5 .2 % )、密度不均 (6 5 .2 % )、胸膜牵引 (6 0 .9% )和毛玻璃影 (5 2 .2 % ) ;实变型BAC可为单叶 /段实变 (37.5 % )、多叶 /段实变(6 2 .5 % )、支气管气相 (87.5 % )、囊状影 (81.3 % )、毛玻璃影 (4 3 .8% )和叶间胸膜膨出 (37.5 % ) ;多结节型BAC较少见 ,表现为以中下肺野分布为主的弥漫性腺泡结节 ,部分见空泡。临床误诊 8例和CT误诊 4例中 ,7例为实变型 ,主要原因是对BAC的重视和认识不够。结论 熟悉BAC各型CT征象 ,必要时借助穿刺活检和纤支镜检 ,能提高BAC的诊断准确率 ,减少误诊
Objective To retrospectively analyze the CT manifestations and misdiagnosis causes of bronchioloalveolar carcinoma (BAC) and improve the diagnostic accuracy of imaging. Materials and Methods 42 cases of pathologically confirmed BAC were divided into nodular, solid and multinodular type according to CT manifestations, which were 23, 16 and 3 cases respectively, of which 12 cases (28.6 %) were misdiagnosed. Combined with literature data, CT signs of various types of alveolar carcinoma were analyzed. Results Nodule-type BAC mainly manifested as: nodules located at the periphery of the lung (95.7%), segmented (91.3%), burr (69.6%), vacuoles, or bronchial gas phase (65.2%). Inhomogeneous density (65.2%), pleural traction (60.9%) and frosted glass shadow (52.2.2%); solid-varying BAC can be single leaf/segment consolidation (37.5 %), multiple leaf / Segment consolidation (62.5%), bronchial gas phase (87.5 %), cystic shadow (81.3 %), glomerular shadow (43.8%), and interlobular pleural bulge (37.5%); multinodular type BAC is less common, with diffuse acinar nodules dominated by the middle and lower lung fields, and partial vacuoles. Clinical misdiagnosis was misdiagnosed in 8 cases and CT was misdiagnosed in 4 cases. 7 cases were consolidations. The main reason was that the importance and awareness of BAC were not enough. Conclusion Familiar with the CT signs of various types of BAC, if necessary, with biopsy and fibrobronchoscopy, can improve the diagnostic accuracy of BAC and reduce misdiagnosis.