肺局灶性磨玻璃结节的高分辨CT表现与病理对照分析

A comparative analysis of solitary pulmonary GGN through high resolution CT manifestation with pathology in changes

目的探讨肺局灶性磨玻璃密度结节(f GGN)的高分辨力CT表现,并与病理对照。方法搜集局灶性肺部局灶性磨玻璃密度结节80例,浸润前病变(不典型腺瘤样增生和原位腺癌)21例、微浸润腺癌(MIA)32例和浸润性腺癌(IAC)27例,分析其CT表现。结果 80例f GGN中纯磨玻璃密度结节(p GGN)47例,混合磨玻璃密度结节(m GGN)33例。p GGN中,浸润前病变21例,微浸润性癌20例,浸润性腺癌6例,m GGN多为浸润性腺癌,对3组病灶的病灶密度、形状、边缘毛刺、边缘分叶、边界情况、内部空泡以及胸膜凹陷进行对比分析。结果浸润前病变均表现为纯磨玻璃结节,形态规整,多为圆形或类圆形,边界多较清晰;MIA可表现为纯磨玻璃结节或混合密度的磨玻璃结节,边缘多清晰,多为圆形或类圆形;IAC多为混合密度的磨玻璃结节,不规则形多见,内部空泡及胸部凹陷征多见。结论熟悉磨玻璃结节的高分辨CT表现,对诊断和鉴别诊断肺部浸润前病变、MIA和IAC具有重要价值。

Objective To explain the correlation between high resolution CT manifestations and pathology in changes of solitary pulmonary GGN. Methods Eighty cases of solitary pulmonary ground glass nodules（ GGNs） were collected including preinfiltrating lesion（ atypical adenomatous hyperplasia and adenocarcinoma in situ） 21 cases,microinfiltrating adenocarcinoma（ MIA） 32 cases and infiltrating adenocarcinoma（ IAC） 27cases; and then followed by analysis of their CT manifestations. Results All 80 cases of pulmonary GGN showed as pure GGN in 47 cases and as mixed GGN 33 cases. The pure GGNs were further be divided into preinfiltrating lesion（ AAH and AIS） 21 cases and infiltrating lesion（ IAC） 6 cases,microinfiltrating adenocarcinoma（ MIA） 20 cases. The mixed GGNs were majorly as infiltrating adenocarcinoma. The lesions of the foremansined 3 groups were depicted and compared precisely according to their densities,morphologies,peripheral spiculations,lobulations,marginations,internal vacuolations and pleural indentations. The results presented as all preinfiltrating lesions with pure GGNs,regular shape of delineated margins in round or ovoid outlines; MIA with pure GGNs or mixed dense GGNs together with delineated round or ovoid margins; and IAC with mixed dense GGNs,majorly of irregular shape,internal vacuolations and pleural indentations.Conclusion Familiar with high resolution CT manifestations of pulmonary GGN would provide valuable emphasis on the diagnosis and differential diagnosis for the pulmonary preinfiltrating lesions,MIA and IAC.