周围型肺腺癌胸膜CT表现分析

Pleural Signs Analysis of Peripheral Lung Adenocarcinoma on CT

目的探究周围型肺腺癌的胸膜CT表现与肿瘤侵犯脏层胸膜（VPI）的相关性。方法回顾性分析41例肺腺癌的胸膜表现并将其分为非叶间裂胸膜（A组）及叶间裂胸膜（B组）,根据肿瘤与胸膜关系将A组分为5型,B组分为4型,统计分析各型胸膜与VPI的相关性。结果共75处胸膜,A组共46处,B组共29处。VPI发生率为A组Ⅰ型0、Ⅱ型66.7%、Ⅲ型87.5%、Ⅳ型80%、Ⅴ型10%;B组Ⅰ型84.2%和Ⅱ型40%,Ⅲ型及Ⅳ型VPI所占比为2/2和0/3。4处A组Ⅳ型瘤-壁脂肪间隙不清晰均伴VPI。6处纵隔胸膜异常伴VPI。结论 A组Ⅲ、Ⅳ型及B组Ⅰ、Ⅲ型高度提示VPI,A组Ⅳ型伴不清晰瘤-壁脂肪间隙或累及纵隔胸膜,可增加VPI发生的可能。

Objective To evaluate the correlation between the pleural signs and visceral pleural invasion（ VPI） of peripheral lung adenocarcinoma. Methods Pleural signs of 41 lung adenocarcinoma were retrospective analyzed and classified. The correlation between pleural signs and VPI were statistically evaluated. Results There were 75 involved pleurae in the study,while 46 involved pleurae were in group A（ non-interlobar fissure,classified into 5 types） and 29 were in group B（ interlobar fissure,into 4 types）. The incidence of VPI in group A were 0（ type Ⅰ）,66. 7%（ type Ⅱ）,87. 5%（ type Ⅲ）,80%（ type Ⅳ） and 10%（ type Ⅴ）,which in group B were 84. 2%（ type I） and 40%（ type Ⅱ）. The rate of VPI in group B type Ⅲ and Ⅳ were 2/2 and 0/3,respectively. In group A type Ⅳ,4 involved pleurae with infiltrated fat space of chest wall were confirmed with VPI. 6 which involved mediastinal pleurae with morphological abnormalities were also confirmed with VPI. Conclusion Type Ⅲ-and Ⅳ in group A and type I and Ⅲ in group B are predictors to VPI.The involved pleurae with infiltrated fat space and mediastinal pleural abnormalities may increase the incidence of VPI.