磨玻璃结节性肺癌的CT特征分析

CT Features Analysis of Lung Cancer with Ground-glass Nodule

目的探讨表现为磨玻璃结节的早期肺癌和进展期肺癌影像学特征差异,旨在提高对早期肺癌的诊断水平。方法回顾性分析经手术病理证实的52例早期肺癌和进展期肺癌的CT影像图像,总结、比较病灶的影像征象,包括瘤肺界面情况、内部情况和周围情况共计3大类、13项资料。结果早期和进展期肺癌患者女性较多,发病部位均多见于右肺上叶和左肺下叶,临床分期以IA期为主,手术治疗方式主要为经胸腔镜切除术;早期肺癌和进展期肺癌的病灶CT值(t=-2.25,P=0.029)、表现为纯磨玻璃影的发生率(χ~2=4.713,P=0.030)、病灶出现脐凹征(χ~2=5.175,P=0.023)、分叶征(χ~2=3.860,P=0.049)方面差异均有统计学意义。早期肺癌CT值较低(-390.4±177.3)Hu,脐凹征少见,多见纯磨玻璃影和浅分叶;进展期肺癌CT值相对较高(-286.3±152.4)Hu,多呈混合磨玻璃结节(占87%),脐凹征多见,多见深分叶。毛刺(P=0.327)、晕征(P=0.938)、钙化成分(P=0.938)、空泡征(P=0.616)、空洞征(P=0.938)、血管集束征(P=0.894)、支气管截断征(P=0.938)、胸模凹陷征(P=0.115)、边缘局灶瘢痕(P=0.198),且差异无统计学意义(P均>0.05)。结论 CT值、纯(混合)磨玻璃发生率与脐凹征、分叶征均可提示早期肺癌与进展期肺癌的影像差别,可作为鉴别二者的诊断要点。

Objective To explore the differences in CT imaging features between early lung cancer and advanced lung cancer,aimed to improve the diagnosis of early lung cancer.Methods CT images of 52 cases of early lung cancer and advanced lung cancer confirmed by operation and pathology were retrospectively analyzed.The imaging features of the lesions were summarized and compared,including the interface,internal and peripheral conditions of the tumors and lungs,totaling 3 categories,13 data.Results The incidence of early and advanced lung cancer was mostly female,the locations of the disease were more common in the right upper lobe and the lower left lobe in the lungs,the clinical stage was mainly in the IA stage,and the surgical treatments were mainly through thoracoscopic resection.The difference of lobulated sign(χ^2=3.860,P=0.049),notch sign(χ^2=5.175,P=0.023),CT value of lesion(t=-2.25,P=0.029)and pure ground-glass nodule appearance rate(χ^2=4.713,P=0.030)was statistically significant between the two groups.Early lung cancer was more common in pure ground-glass nodule,CT value was relatively lower than the other group(-390.4±177.3)Hu,notch sign was rarer;advanced lung cancer was more common in lobulated sign,notch sign,CT value was relatively higher than the other group(-286.3±152.4)Hu,it was more common in mixed ground-glass nodule.The burr sign(P=0.327),halo sign(P=0.938),calcification(P=0.938),vacuole sign(P=0.616),cavity sign(P=0.938),the blood vessel cluster sign(P=0.894),bronchial truncation(P=0.938),performance of pleural retraction(P=0.115)and marginal focal scar(P=0.198)showed no significant difference between the two groups(P>0.05).Conclusion CT value,incidence of pure(mixed)ground glass,umbilical concave sign and lobulation sign can indicate the imaging difference between early lung cancer and advanced lung cancer,which can be used as the diagnostic points to differentiate them.