5种不同病理类型肺部肿瘤的CT磨玻璃表现分析

CT image features analysis in 5 different pathological types of lung GGO

目的比较手术后5种不同肺部病理类型CT磨玻璃影(ground glass opacity,GGO)特征,为疾病的术前诊断提供依据。方法回顾性分析2012年8月-2015年10月于解放军总医院住院并接受肺部外科手术治疗病例76例,比较5种不同病理类型的病例在直径(mm)、密度(HU)、磨玻璃程度(%)以及形态等方面的CT特征表现。结果 76例中,男性31例(46.0±14.4)岁,女性45例(43.0±16.8)岁;其中不典型腺瘤样增生14例、原位腺癌15例、微浸润腺癌14例、高分化腺癌16例、中分化腺癌17例;5种不同肿瘤在CT影像中的大小、密度随恶性度的增加均有不同程度增高(P均<0.01),磨玻璃程度则呈下降趋势(P均<0.01);在形态方面,不同病理类型中圆形所占比例亦有统计学差异(F=9.94,P<0.01),其中高、中分化腺癌与微浸润腺癌有显著统计学差异(37.5%±4.8%vs 50.0%±5.3%,P<0.05;41.2%±7.2%vs 50.0%±5.3%,P<0.05)。结论 5种肺部肿瘤在CT图像上的大小、密度特征随着病理恶性程度的提高逐渐增加,磨玻璃程度逐渐降低;对于具有恶性特征的GGO表现病例,应尽量缩短随访时间并尽早干预治疗。

Objective To compare the CT（computed tomography） image features of lung GGO（ground glass opacity） in 5 different pathologic types and provide evidences for preoperative diagnosis. Methods Clinical data about 76 lung GGO cases who had undergone surgery treatment from August 2012 to October 2015 in Chinese PLA General Hospital were retrospectively analyzed and the CT image features of malignant lung GGO with 5 different pathologic types, including diameter（mm）, density（HU）, percentage of ground glass（%） and shape discrepancy, were compared. Results Of the 76 cases, there were 31 males with average age of（46.0±14.4） years and 45 females（43.0±16.8 years）. Fourteen cases had atypical adenomatous hyperplasia（AAH）, 15 cases with adenocarcinoma in situ（AIS）, 14 cases with microinvasive adenocarcinoma（MIA）, 16 cases with well differentiated adenocarcinoma（WDAC）, 17 cases with moderately differentiated adenocarcinoma（MDAC）. The diameter, density of 5 different types of lung tumor in CT image increased gradually with malignant severity（P〈0.01）, while the proportion of GGO decreased gradually（P〈0.01）, and there were statistically significant difference in proportion of circle shape between different pathological types of GGO（F=9.94, P〈0.01）, especially between well and moderately differentiated adenocarcinoma and microinvasive adenocarcinoma（37.5%±4.8% vs 50.0%±5.3%,P〈0.05;41.2%±7.2% vs 50.0%±5.3%,P〈0.05）. Conclusion The diameter, density of 5 different types of lung GGO in CT image increases gradually with malignant severity, while the proportion of GGO decreases gradually. For patients with GGO in lung with malignant characteristic, measures should be taken to shorten the observation time and patients should be treated as early as possible.