HRCT在肺单发性磨玻璃样病灶鉴别诊断中的运用价值探析

Value of HRCT in the differential diagnosis of single ground-glass lesions of lung

目的探究高分辨率计算机断层扫描(HRCT)运用于肺单发性磨玻璃样病灶鉴别诊断中的效果。方法选取我院2013年5月至2016年5月接受的肺内磨玻璃密度影(GGO)患者108例,对所有患者给予HRCT诊断,分析HRCT征象在良恶性GGO中的分布及各病理类型的直径、密度情况。结果非典型腺瘤样增生直径均在10mm以内,炎性直径在10-30mm者比率为81.82%,恶性GGO在10-30mm者的比率为82.72%;单纯GGO以非典型腺瘤样增生及炎性为主,恶性GGO以腺癌为主。恶性GGO患者分叶征、毛刺征、血管集束征及胸膜凹陷征的例数分布显著高于良性GGO患者,差异有统计学意义(P<0.05);恶性GGO患者的空泡征、支气管充气征例数分布与良性GGO患者间的差异无统计学意义(P>0.05)。结论 HRCT在肺单发性磨玻璃样病灶患者中具有较高诊断价值,直径在10mm以上的GGO病变者需给予密切随访。HRCT上表现分叶征、毛刺征、血管集束征及胸膜凹陷征为GGO恶性病变的有效诊断依据,应对出现此类表现者需给予积极治疗。

Objective To explore the effect of high resolution computed tomography （HRCT） in the differential diagnosis of single ground-glass lesions of lung. Methods 108 patients with GGO were selected from May, 2013 to May, 2016 in our hospital. All the patients were diagnosed by HRCT. The distribution of HRCT in benign and malignant GGO and the pathological types were analyzed. Results The diameter of atypical adenomatoid hyper-plasia was less than 10 mm, the ratio of inflammatory diameter was 10-30 mm in 81.82%, and the ratio of malignant GGO in 10 -30 mm was 82. 72%. Simple GGO mainly had atypical adenomatous hyperplasia and inflammation, and malignant GGO mainly had adenocarcinoma. There was significant difference in the number of patients with malignant GGO （P 〈 0. 05 ）. The number of cases of malignant GGO was significantly higher than that of benign GGO patients （ P 〈 0. 05 ）. The was no significant difference in vacuole sign or bronchial aerated sign （ P 〉 0. 05 ）. Conclusion HRCT has a high diagnostic value in patients with solitary ground glassy lesions of lung. Patients with GGO lesions more than 10 mm in diameter should be closely followed up. HRCT shows lobulation sign, spicule sign, vascular bundle sign and pleural indentation sign for the effective diagnosis of GGO malignant lesions based on the response to the performance of those who need to be given active treatment.