Mancini J, Feragalli B, Ciccotosto C, Storto M L, Guidotti A
Istituto di Scienze Radiologiche dell'Università G. D'Annunzio, Chieti.
Radiol Med. 1999 Jun;97(6):479-85.
To describe the radiological appearance of overlooked malignant pulmonary lesions at CT and to analyze the reasons of misdiagnosis.
Ten patients with pulmonary malignant lesions (PML) overlooked at first CT examination were selected among patients with lung cancer who were referred to our institution between 1994 and 1997. CT scans were evaluated by consensus of two chest radiologists with different experience in chest radiology, who were blinded to the final diagnosis.
The overlooked pulmonary lesions were 5 endobronchial cancers and 5 central solitary nodules. The mean diameter of the lesions ranged 1 to 2 cm. Furthermore, 7 patients had associated pleural and/or parenchymal abnormalities. The technical quality of CT examinations was considered good in 2 cases, acceptable in 6 cases, poor in 2 cases. PML were correctly identified in 6/10 cases by the first (more experienced) radiologist and in 4/10 by the second radiologist. Four cases were considered suspect for the presence of PML by the first radiologist, 2 by the second.
Endobronchial location of the tumors and their small size were the most frequent causes of misdiagnosis of PML at chest CT in our series. However, a systematic evaluation of CT scans can reduce the percentage of missed lesions.
描述CT检查中被漏诊的肺部恶性病变的影像学表现，并分析误诊原因。
从1994年至1997年间转诊至我院的肺癌患者中，选取10例首次CT检查时被漏诊的肺部恶性病变（PML）患者。由两位在胸部放射学方面经验不同的胸部放射科医生在不知最终诊断结果的情况下，通过共识对CT扫描进行评估。
被漏诊的肺部病变为5例支气管内癌和5例中央型孤立结节。病变的平均直径为1至2厘米。此外，7例患者伴有胸膜和/或实质异常。CT检查的技术质量在2例中被认为良好，6例中可接受，2例中较差。首位（经验更丰富）放射科医生在10例中有6例正确识别出PML，第二位放射科医生在10例中有4例正确识别。首位放射科医生认为4例可疑存在PML，第二位放射科医生认为2例可疑。
在我们的系列研究中，肿瘤的支气管内位置及其小尺寸是胸部CT误诊PML的最常见原因。然而，对CT扫描进行系统评估可降低漏诊病变的百分比。
