增强CT检查在磨玻璃结节样肺腺癌诊断中的价值

Diagnostic value of contrast-enhanced CT scans in identifying lung adenocarcinomas manifesting as ground glass nodules

目的探讨增强CT检查在平扫CT图像中表现为纯磨玻璃结节或混合磨玻璃结节的浸润前病变、微浸润腺癌（MIA）和浸润性腺癌（1AG）诊断中的价值。方法回顾性分析194例肺部磨玻璃结节患者的术前平扫和增强CT的影像学特征，其中浸润前病变组64例，MIA组80例，IAC组50例。依据平扫和增强CT图像显示的病灶内实性成份最大径对病灶的病理类型进行预判，与病理结果进行对照分析。结果64例浸润前病变组患者中，增强CT扫描后CT值升高59例，实性成份增大5例。80例MIA组患者中，增强CT图像显示实性成份增大50例，CT值升高30例。50例IAC组患者中，48例均表现为实性成份增大，仅2例表现为CT值升高。与平扫CT比较，浸润前病变组和MIA组患者增强CT扫描图像中病灶CT值升高分别为（45．88±15．97）HU和（66．47±44．54）HU，差异有统计学意义（P=0．001）；病灶内实性成份增大分别为（1．55±0．73）mm和（1．88±0．75）mm，差异有统计学意义（P=O．032），结论增强CT检查可提高术前CT诊断磨玻璃结节样肺腺癌的准确率。

Objective To investigate the value of contrast-enhanced CT scans in differential diagnosis of atypical adenomatous hyperplasia （AAH） , adenocarcinoma in situ （AIS） , minimal invasive adenocareinoma （MIA） and invasive adenocarcinoma （IAC） in patients who manifested as ground glass nodules （GGNs） or mixed GGNs （mGGNs） in unenhaneed CT imaging. Methods The unenhanced and enhanced CT images of 194 patients with GGNs in the lung were retrospectively analyzed, including 64 cases with pre-invasive lesions, 80 cases with MIA, and 50 cases with IAC. The prediction of pathological types was based on maximal diameters and the solid portions of the lesions displayed on unenhanced and enhanced CT images, and then compared with pathological diagnosis. Results In 64 patients with pre-invasive lesions, the CT value increased in 59 cases after contrast-enhanced administration, whereas the solid portions increased in 5 cases. Ill the 80 patients with MIA, solid portions increased in 50 cases and the CT value increased in 30 cases after contrast administration. In 50 cases with IAC, almost all of them showed increased solid portions, whereas only 2 eases showed an inerease of CT values. In the pre-invasive group and the MIA group, the increase of CT values after contrast administration was （45.88±15.97） HU and （66.47±44.54） HU, respectively, showing statistically significant difference （P= 0.001 ）. The increase of solid portions in the MIA group and IAC group was （1.55±0.73） mm and （1.88±0.75） ram, respectively, also showing significant difference （P=0.032）. Conclusion Contrast-enhanced CT scans were more useful than unenhanced CT scans for the diagnosis of lung adenocarcinomas manifesting as GGNs.