The Comparative Study Of MSCT Between Peripheral Pulmonary Carcinoma With Tuberculoma

Objective: The aim of this study is to determine the comparison between peripheral pulmonary carcinoma with tuberculoma by using multi-slice CT scan.Material and Methods: A retrospective study and radiological analysis of 190 patients, with 100 peripheral pulmonary carcinoma and 90 tuberculoma (38 confirmed by pathology and the rest 52 were confirmed by radiological diagnosis with the supporting clinical materials and follow-up examination). The cases enrolled for this study were from 1st affiliated hospital of Dalian Medical University (and with the help from Tuberculosis hospital and 5th hospital of Dalian). The patient's clinical data (age, gender and presenting illness) and pathologic data were recorded separately to allow comparative data to be accumulated.All cases were analyzed for the CT findings like: lesion size, site of the lesion, for marginal characters we grouped into three: smooth, irregular and ragged. If a tumor margin was irregular, we evaluated whether there was presence or absence of lobulation, coarse spiculation, and also for special features like: pleural indentation, satellite lesions, bulging of interlobar fissure, convergence of peripheral vessels (lymphatic or vascular invasion), and halo sign of ground-glass opacity (GGO) areas in the surrounding lung field. As internal characteristics, cavitation (cystic air spaces), calcification, air bronchogram, bronchus sign, bullae sign (bubble lucencies), were assessed by using PHILIPS, GE 16-slice CT scanners. The size and internal density of each lesion was measured at the largest section of the lesion and a region of interest (ROI) was set on the whole area of the lesion. Great effort was made to avoid the vessels.Results: (1) In our study, 190 patients include: 100 peripheral carcinoma with 91 adenocarcinoma and 9 were Bronchiolo-alveolar carcinoma, 90 were tuberculoma. The size of all cases were ranging from 0.55 mm-38.4 mm (with average 22mm).(2) The CT signs of 100 peripheral pulmonary carcinoma appear as follows: more commonly it is irregular (oval or patchy) margin (96%, P<0.05), thin and short spiculation (61%, P<0.05), bronchus sign (57%, P=0.008), and cavity or cystic air spaces (47%, P<0.05). The sign rarely seen is satellite nodules (8%, P<0.05). These signs have no statistical difference: coarse or long spiculation (39%, P=0.381), air bronchogram (79%, P=0.056).(3) The CT signs of 90 tuberculoma appear as follows:tuberculoma having smooth (round or oval) margin (57.8%, P<0.05), cavity or cystic air spaces (19.1%, P<0.05), calcification (75.5%, P<0.05), satellite nodules (54.4%, P<0.05), bronchus sign (37.8%, P=0.08), These signs have no statistical difference: coarse or long spiculation (42.2%, P=0.381).Conclusion: (1) In our research,16-slice spiral CT scan has shown the importance in differentiating with pulmonary carcinoma and tuberculoma. Usually these nodules show some typical signs, but in some situation it shows atypical CT signs and difficult to differentiate between pulmonary carcinoma and tuberculoma.(2) CT signs highlighted for the differential diagnosis between peripheral pulmonary carcinoma and tuberculoma are as follows: a) smooth margin or irregular lobulated margin. b) short or long spiculation, c) calcification in the periphery, d) satellite nodules around the lesion, e) bronchus sign a characteristic sign for adenocarcinoma, f) cavity or cystic air spaces.