Wang R H, Xu K, Li L, Wu Z F, E L N
Department of CT, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, China.
Department of Rheumatology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan 030032, China.
Zhonghua Zhong Liu Za Zhi. 2020 Aug 23;42(8):665-669. doi: 10.3760/cma.j.cn112152-20191218-00820.
To investigate the CT features and dynamic changes of new developed lung cancer in patients with connective tissue disease-related interstitial lung disease (CTD-ILD). A series of chest CT images of 58 CTD-ILD patients during follow-up were collected. The CT features of interstitial lung disease, the initial appearance time of lung cancer, the time of diagnosis of lung cancer, the morphological characteristics (location, shape, size) of lung cancer lesions and the dynamic changes of CT features were analyzed. Among 58 patients, rheumatoid arthritis was the most common (31 cases). Chest CT images showed coexistence of two or more interstitial CT signs. During the follow-up, a total of 59 lung cancer lesions were found. The median time of lung cancer lesion occurred was 289 days. The median delay in diagnosis was 43 days. There were 44 cases of non-small cell lung cancer (including 23 cases of squamous cell carcinoma and 19 cases of adenocarcinoma), 12 cases of small cell lung cancer. Forty-three (72.9%) lesions were located in the lower lobes and 41 (69.5%) lesions were located in the area of pulmonary interstitial fibrosis. According to CT morphological characteristics of lung cancer, nodular type (37 cases), inflammatory consolidation (12 cases) and intra-honeycomb type (10 cases) were identified. The chest CT features of patients with CTD-ILD are complex. New developed lung cancer is easily missed or misdiagnosed in the early stage. Pay attention to the special CT characteristics of CTD-ILD with lung cancer is helpful for early diagnosis.
探讨结缔组织病相关间质性肺疾病（CTD-ILD）患者新发肺癌的CT特征及动态变化。收集58例CTD-ILD患者随访期间的一系列胸部CT图像，分析间质性肺疾病的CT特征、肺癌的初始出现时间、肺癌诊断时间、肺癌病灶的形态学特征（部位、形状、大小）及CT特征的动态变化。58例患者中，类风湿关节炎最为常见（31例）。胸部CT图像显示两种或更多种间质性CT征象并存。随访期间，共发现59个肺癌病灶。肺癌病灶出现的中位时间为289天。诊断延迟的中位时间为43天。非小细胞肺癌44例（包括鳞状细胞癌23例、腺癌19例），小细胞肺癌12例。43个（72.9%）病灶位于下叶，41个（69.5%）病灶位于肺间质纤维化区域。根据肺癌的CT形态学特征，分为结节型（37例）、炎性实变型（12例）和蜂窝内型（10例）。CTD-ILD患者的胸部CT特征复杂。新发肺癌在早期易被漏诊或误诊。关注CTD-ILD合并肺癌的特殊CT特征有助于早期诊断。
