MSCT对肺部持续存在的局限性磨玻璃密度影诊断价值

Diagnostic value of MSCT on persistence pulmonary focal ground-glass opacity

目的通过对肺部持续存在的局限性磨玻璃密度影（fGGO）的影像病理分析,探讨MSCT诊断价值。方法2004年4月至2007年10月间在MSCT进行胸部检查的病例中,发现30例直径≤20mm的fGGO病例,经治疗或观察1.5-2个月后MSCT随访,23例病变持续存在。其中17例进行了胸腔镜活检或手术肺叶切除后送病理诊断,2例进行了血液检查确诊,4例仍在追踪复查中。结果23例持续存在的fGGO,经确诊支气管肺泡癌（BAC）9例,腺癌5例,非典型腺瘤样增生（AAH）1例,局灶性机化性肺炎2例,支原体、衣原体抗体阳性2例,4例复查病例中有1例高度建议手术,余3例病灶范围逐渐缩小或无变化,仍在随访观察中。对确诊19例fGGO进行CT大小测量和分型,14例恶性病例中,13例病灶≥10mm占92.86%（13/14）,磨玻璃密度影成分〉25%有10例占71.43%（10/14）,有1例磨玻璃密度影成分〈25%的发现远处脏器转移。说明持续存在的fGGO的大小、磨玻璃密度影成分量化与病变良、恶性及其预后有明显相关性。结论肺部持续存在的fGGO是早期腺癌或癌前病变的CT表现,MSCT确能早期正确诊断并能指导临床诊治方案的制定。

Objective To study the value of MSCT by analyzing the histological and radiological characteristics of pulmonary fGGO. Methods Thirty cases with pulmonary fGGO which were 420 mm in size were detected with MSCT in three and an half year. In the 23 patients with persistence of pulmonary fGGO after following-up for a period of 1.5--2 months, 17 ca- ses performed histopathology diagnosis with lung biopsy by thoracoscopy or lobectomy, 2 cases were confirmed with blood test, 4 cases were still following up. Results The histological diagnoses of these 17 cases included bronchioloalveolar carcinoma （BAC） （n= 9）, adenocarcinoma （n=5）, atypical adenomatous hyperplasia （AAH） （n= 1） and focal organize pneumonia （n=2）. The antibody of Chlamydia and mycoplasma of 2 cases were positive （n=2）, the total 14 malignant lesions, 13 fGGO ≥10 mm in size （13/14）, the proportion of the ground-glass opacity〉25% in 10 fGGO （10/14）. One case with the proportion of the ground-glass opacity 〈25% had metastases. The rate of malignancy and prognosis were highly correlated with the size and radiological characteristics of fGGO. Conclusion Persistent pulmonary fGGO was an CT indicator of early adenocarcinoma or pre-malignant lesion. MSCT is useful for early diagnosis and treatment guidance of fGGO.