混合性磨玻璃结节样肺腺癌的多层螺旋CT表现及其诊断价值

Multislice spiral CT fmdings and its diagnostic value of mixed glandular glass nodular adenocarcinoma

目的 分析混合性磨玻璃结节样肺腺癌在多层螺旋CT（MSCT）中的特征,及MSCT对其的诊断价值.方法 采用前瞻性研究法,将2014年1月至2016年12月忻州市人民医院收治的120例混合性磨玻璃结节样肺腺癌患者作为肺腺癌组,178例混合性磨玻璃结节样肺炎性病变者作为肺炎性病变组.比较两组MSCT征象.将肺腺癌组患者根据病理类型分组,比较不同病理类型肺腺癌混合性磨玻璃样结节的影像特征.结果 肺腺癌组晕厚度不均率（61.67％）、分叶率（60.00％）、边界清晰率（80.83％）、血管聚集征率（64.17％）、胸膜凹陷率（61.67％）均高于肺炎性病变组（35.96％、35.39％、41.01％、44.94％、41.57％）,差异均有统计学意义（x2=8.69、12.47、33.64、7.62、7.97,均P＜0.01）.呈混合性磨玻璃结节的原位腺癌（AIS）、浸润性腺癌（IAC）、微浸润腺癌（MIA）在大小、数量、形状、部位、密度上差异均有统计学意义（均P＜0.05）.IAC型混合性磨玻璃结节是体积普遍≥5 mm的单发不规则结节,普遍偏离中心性生长,与同层面血管接近.AIS型混合性磨玻璃结节普遍≥5 mm的单发结节,多呈多边形或点状,普遍为中心性生长,与同层面血管密度接近.MIA型混合性磨玻璃样结节多数＜5 mm,普遍为多发,以椭圆或圆形最多,普遍为偏离中心性生长,密度较同层平面血管低.结论 MSCT有助于鉴别混合性磨玻璃结节样肺腺癌和混合性磨玻璃结节样肺炎性病变,且可以鉴别混合性磨玻璃结节样肺腺癌的病理类型,具有较高应用价值.

Objective To analyze the characteristics of mixed ground glass nodular adenocarcinoma in multi-slice spiral CT（MSCT） and its diagnostic value.Methods This study was prospective study,120 patients with mixed glass nodules lung adenocarcinoma were classified as lung adenocarcinoma in the People＇s Hospital of Xinzhou from January 2014 to December 2016.178 cases of mixed glass nodular pneumonitis were classified as pneumonia.The MSCT signs were compared between the two groups.The imaging features of medullographic nodules with different pathologic types of lung adenocarcinoma by grouping of patients with lung adenocarcinoma were compared.Results In the lung adenocarcinoma group,the dizzy uneven thickness rate （61.67%）,leaf rate （60.00%）,clear boundary rate （80.83 %）,blood vessels,gather tax rate （64.17 %）,pleural indentation rate （61.67 %） were significantly higher than those in the pneumonia group（35.96%,35.39%,41.01%,44.94%,41.57%,x2 =8.69,12.47,33.64,7.62,7.97,all P 〈 0.01）.The mixed grinding glass nodules of IAC,MIA and MIS in size,number,shape,position and density were significantly different（all P 〈 0.05）.The IAC type mixed grinding glass nodules was irregular single nodules （volume generally ≥5 mm）,common deviation centricity growth,and with blood vessels.The AIS type mixed grinding glass nodule was single nodule （volume generally ≥5 mm）,formed a polygon or dotted,common growth of centricity,vascular density was close to the same level.The volume of the MIA type mixed grinding hyaline nodules was most 〈 5 mm,common to multiple,with oval or round most,common to deviate from the centricity growth,lower density than plane tree blood vessels.Conclusion MSCT is helpful in the differential diagnosis of mixed ground glass nodules of lung adenocarcinoma and mixed ground glass nodular inflammatory lesions,and pathological types have leaded to the identification of mixed ground glass nodules of lung adenocarcinoma MSCT,which has higher application value.