【摘要】 目的 探讨良恶性肺部孤立局灶性磨玻璃密度结节(fGGO)的CT特征,以提高早期肺癌的诊断准确率。方法 对50例经病理证实的fGGO(其中浸润前病变组19例、浸润性腺癌组10例和良性病变组21例)CT图像进行矢状位、冠状位、最大密度投影(MIP)、最小密度投影(minIP)及VR后处理。fGGO与支气管的关系分为4型:Ⅰ型,支气管被结节截断;Ⅱ型,支气管进入结节后锥形狭窄;Ⅲ型,结节内走行的支气管管腔保持通畅;Ⅳ型,支气管紧贴结节边缘走行。fGGO与血管的关系分为3型:Ⅰ型,血管在结节内或结节外走行自然;Ⅱ型,血管进入结节后管径变窄或锥形截断;Ⅲ型,血管被结节截断。统计分析各组病例的临床资料、病灶类型、边缘、内部结构(空气支气管征/气泡征)、邻近结构(血管纠集征/胸膜凹陷征)及病灶与邻近的支气管、血管的关系。结果3组病理类型患者的性别及结节的类型对鉴别良恶性没有价值。患者的平均年龄有统计学意义(P=0.005),良性病变组的平均年龄小于浸润前病变、浸润性腺癌组。病灶的边缘、内部特征、周围情况均有统计学意义(P<0.05)。fGGO与支气管分型关系中,浸润前病变及浸润性肺癌以Ⅱ型、Ⅲ型多见,尤其浸润性肺癌以Ⅱ型多见,良性病变以Ⅲ型、Ⅳ型多见,尤其Ⅳ型仅见于良性病变组。fGGO与血管分型关系中,浸润前病变以Ⅱ型多见,浸润性腺癌以Ⅲ型多见,良性病变仅见Ⅰ型。结论 患者的年龄较大,病灶的边缘呈分叶和/或毛刺状,病灶内部出现支气管充气征、气泡征,病灶周围出现胸膜凹陷征,血管纠集征,支气管、血管在结节外被截断或者进入结节后逐渐变窄呈锥形狭窄或截断则恶性可能性大,利用薄层图像进行后重建技术有助于上述征象的充分显示。更多还原

【Abstract】 Objective To analyze the imaging features of solitary focal ground-glass opacity nodules(fGGO) by multi-slice spiral CT(MSCT) reconstruction technique in order to improve the differential diagnosis between benign and malignant fGGO and the diagnosis of early-stage lung cancer.Methods 50 lesions confirmed by pathology were divided into three groups including preinvasive nodules in 19,invasive adenocarcinoma in 10 and benign ones in 21.All CT images were processed by coronal and sagittal reconstruction,maximum and minimum intensity projection(MIP & minIP) and VR.The relationships between fGGO and bronchus were divided into four types:Type Ⅰ with abruptly obstructed bronchus by the fGGO;Type Ⅱ with penetrated and conical interrupted bronchus by the fGGO;Type Ⅲ with normal bronchus;and Type Ⅳ with fGGO neighboring the bronchus.In addition,the relationships between fGGO and vessel were divided into three types:Type Ⅰ with normal vessel in or near the fGGO;Type Ⅱ with taper-like narrowed or interrupted one in fGGO;and Type Ⅲ with obstructed one by the fGGO.The clinical data,lesion type,margin,internal structure(air bronchograms/vacuole sign),adjacent structures(vascular convergence/pleural retraction) and the relationships between lesion and adjacent bronchus or vessel were statistically analyzed.Results No statistical differences between three groups were found in the sex of patient and lesion type.A significant difference was found in the age of patients(P=0.005) with less age in benign group than that in preinvasive or invasive adenocarcinoma group.The margin,internal and adjacent structures of the lesions were significantly different(P<0.05).Among the different types of relationship between fGGO and brochus,type Ⅱ and Ⅲwere often seen in the preinvasive and the invasive adenocarcinoma groups(the invasive adenocarcinoma often with type Ⅱ),and the type Ⅲ and Ⅳ were in the benign group(benign nodules only with the type Ⅳ).Among the types of relationship between fGGO and vessel,type Ⅱ seen commonly in the preinvasive group,type Ⅲ often in the invasive adenocarcinoma group,and type I only in the benign group.Conclusion The suggested signs with malignant possibility may include the older age,the lesions with lobulated and/or speculated margin,air bronchograms,vacuole sign,pleural retraction around the lesion,vascular convergence sign,and obstructed or cone-shaped narrowed bronchi or vessels in or near the nodules.Thin-section imaging reconstruction techniques help to fully display these signs.更多还原