表现为“局灶性磨玻璃密度”的肺肿瘤性病变的CT鉴别诊断

CT differentiation of pulmonary neoplastic diseases which appear as focal ground-glass opacity

目的探讨表现为局灶性磨玻璃密度的肺肿瘤性病变的CT鉴别特点。方法收集45例表现为磨玻璃密度的肿瘤性病变,腺癌17例,支气管肺泡癌19例,淋巴瘤5例,肺不典型腺瘤样增生4例。对其CT征象进行回顾性分析。CT征象包括:磨玻璃密度病变的种类、部位、大小、内部结构、边界及周围肺野情况。结果单纯性磨玻璃密度主要见于不典型腺瘤样增生(n=4)和支气管肺泡癌(n=6);混合性磨玻璃密度主要见于腺癌(n=13)和支气管肺泡癌(n=13)。按照病变大小分为两组(≤1cm组和>1cm),两组的病变性质构成比有显著性差异(χ2=9.12,P<0.05),≤1cm组主要为不典型腺瘤样增生和支气管肺泡癌,>1cm组主要为腺癌和支气管肺泡癌。按照磨玻璃占整个病灶的比例分为两组(>50%组和≤50%组),把两组的病变性质构成比进行比较,发现有显著性差异(χ2=8.24,P<0.05),>50%组主要为不典型腺瘤样增生和支气管肺泡癌,而≤50%组主要为腺癌。结论综合分析磨玻璃密度的类别、内部结构、边缘和大小有助于鉴别诊断,在表现为磨玻璃密度的肿瘤性病变中,较小的单纯磨玻璃密度多见于不典型腺瘤样增生,支气管充气征多见于支气管肺泡癌,实性成分较多的混合性磨玻璃密度多见于腺癌。

Objective To investigate the characteristic CT features in differentiation of pulmonary neoplastic diseases which appear as focal ground-glass opacity. Methods Forty-five cases of neoplastic diseases （including 17 cases of adenocarcinomas, 19 cases of bronchioloalveolar carcinoma, 5 cases of lymphoma, and 4 cases of atypical adenomatous hyperplasia） which appeared as focal ground-glass opacity were collected, and their CT manifestations including type of GGO, location, size, internal structure, margin and surrounding change, were analyzed. Results Pure GGO was mostly seen in atypical adenomatous hyperplasia （n = 4） and bronchioloalveolar carcinoma （n = 6） ; mixed GGO was mostly seen in adenocarcinoma （n = 13） and bronchioloalveolar carcinoma （n= 13）. All the lesions were classified into two groups including ≤1 cm and 〉1 cm in size. There was significant difference in constituent ratio of different nature of lesion between two groups （χ^2= 9.12, P〈0.05）. In ≤1 cm group, the common nature of disease was atypical adenomatous hyperplasia and bronchioloalveolar carcinoma, while in 〉1 cm group,, the common diseases were adenocarcinoma and bronchioloalveolar carcinoma. All the lesions were classified into two groups including 〉50% group and ≤50% group according to the percentage of GGO in the entire lesion. There was significant difference in constituent ratio of different nature of lesion between two groups （χ^2=8.24, P〈0.05）. In 〉50% group, the common diseases were atypical adenomatous hyperplasia and bronchioloalveolar carcinoma, while in ≤50% group, the common disease was adenocarcinoma. Conclusion Comprehensively analyzing the type, internal structure, margin and size is very helpful for differentiation of focal GGO. In the pulmonary tumor which appears as GGO, small pure GGO is common in atypical adenomatous hyperplasia, air bronchogram is common in bronchioloalveolar carcinoma, and mixed GGO which had large area of solid lesion is common in adenocarcinoma.