【摘要】 目的 研究肺亚实性结节(SSNs)与支气管、血管的关系及类型,并探讨MSCT对其诊断价值。方法 回顾性分析40例经临床病理证实的SSNs MSCT图像。将SSNs与支气管的关系分为5型:Ⅰ型,支气管在SSNs的实性成分中截断;Ⅱ型,支气管在SSNs的实性成分中走行,可伴或不伴有扭曲扩张;Ⅱ型,支气管在SSNs的磨玻璃成分中走行,并伴有扭曲扩张,但未进入实性成分;Ⅳ型,支气管在SSNs的磨玻璃成分中正常走行,无扭曲扩张;Ⅴ型,支气管在SSNs旁绕行。将SSNs与供血血管的类型分为4型:Ⅰ型,血管从SSNs旁绕行;Ⅱ型,完整的血管穿过SSNs,无扭曲扩张;Ⅱ型,血管在SSNs内扭曲扩张;Ⅳ型,其他复杂的血管征象。对不同病理类型SSNs进行统计学分析。结果 40例SSNs中,4例为原位腺癌,6例为微浸润癌,30例为浸润性腺癌。40例SSNs与供血血管的关系4种类型(Ⅰ～Ⅳ)分别为0,8,21,11例,Ⅲ型最多。11例Ⅳ型均为浸润性腺癌,21例Ⅲ型中17例为浸润性腺癌,其余2例为原位腺癌,2例为微浸润腺癌,Ⅲ型+Ⅳ型为浸润性腺癌的可能性非常大,且3组SSNs与供血血管的关系类型有统计学意义(χ~2=15.190,P=0.004)。40例SSNs与支气管的关系5种类型(Ⅰ～Ⅴ)分别为20,5,6,9,0例,Ⅰ型最多。20例Ⅰ型17例为浸润性腺癌,1例为原位腺癌,2例为微浸润癌,且3组SSNs与支气管的关系类型有统计学意义(χ~2=23.811,P=0.001)。结论不同病理类型SSNs与支气管及供血血管的关系及类型不同,对结节性质的判定有一定帮助。更多还原

【Abstract】 Objective To investigate the relationships and types between pulmonary subsolid nodules and bronchi and vessels,and their diagnostic values in differentiating subsolid nodules.Methods MSCT images of 40 subsolid nodules were retrospectively reviewed.The relationships between subsolid nodules and bronchi were divided into five types.Type Ⅰ:the bronchi were "cutoff" in the solid part of nodules.Type Ⅱ:the bronchi were distortion and extension in the solid parts of nodules.Type Ⅲ:the bronchi were distortion and extension in the GGO parts of nodules.Type Ⅳ:the bronchi were normal course in the GGO parts of nodules.Type Ⅴ:the bronchi were circumvent nodule lesions.The relationships between subsolid nodules and vessels were categorized into four types.Type I:vessels passing by SSNs;Type Ⅱ:intact vessels passing through SSNs;Type Ⅲ:distorted,dilated or tortuous vessels seen within SSNs;Type Ⅳ:more complicated vessels other than described above.The relationship types were correlated to pathologic and/or clinical findings of subsolid nodules.Results Of 40 subsolid nodules,4 were preinvasive nodules,6 micro infiltrating adeocarcinomas and 30 invasive ones that were pathologically proven.Types Ⅰ,Ⅱ,Ⅲ and Ⅳ vascular relationships were observed in 0,8,21 and11 subsolid nodules,respectively.Type Ⅲ relationship was the dominating one.All 11 subsolid nodules were invasive adenocarcinomas,when the relationship between subsolid nodules and vessle was type Ⅳ.There were 17 invasive adenocarcinomas,2 preinvasive ones,and 2 infiltrating ones when the relationship between subsolid nodules and vessel was type Ⅲ.Correlation analysis showed strong correlation between invasive adenocarcinoma and type Ⅲ and Ⅳ relationships.There was significantly statistical significance among 3 groups of relationships between subsolid nodule and vessels(χ~2=15.190,P=0.004).Types Ⅰ,Ⅱ,Ⅲ,Ⅳ and V brochi relationships were observed in 20,5,6,9and 0 subsolid nodules,respectively.Type Ⅰ relationship was the dominating relationship.There were 17 invasive adenocarcinomas,1 preinvasive one,2 micro invasive ones when the relationship between subsolid nodules and bronchi were type I.There was significantly statistical significance among 3 groups of relationships between subsolid nodule and bronchi(χ~2=23.811,P=0.001).Conclusion Different subsolid nodules have different relationships with bronchi and vessels.Understanding and recognizing the characteristic subsolid nodule-bronchi and subsolid nodule-vessel relationships may help to identify which nodules are more likely to be malignant.更多还原