不同病理类型的肺磨玻璃结节CT影像表现及相关性研究

Correlation study of CT imaging manifestations with different pathological types of ground-glass lung nodules

目的 总结不同病理类型肺磨玻璃结节(GGN)的CT影像表现特点,探讨肺内GGN的CT影像表现与病理类型之间的相关性。方法 回顾性分析37例患者的43个肺GGN的临床、病理和CT影像资料,分析不同病理类型肺GGN的CT影像表现,探讨不同类型GGN的CT影像表现与病理类型之间的相关性。结果 37例患者手术切除共43个GGN,病理证实腺癌或腺体前驱病变(PGL)41个(腺癌24个,PGL17个),病理证实炎性病变2例。41个肿瘤性GGN的CT影像表现为:形态不规则8个、边缘分叶16个、结节内及邻近血管异常改变22个、胸膜凹陷征4个。肺GGN密度、形态、边缘及邻近结构在腺体前驱病变PGL组、微浸润腺癌MIA组、浸润性腺癌IAC组间的差异具有统计学意义(P<0.05);肺GGN直径和内部结构在各组间的差异无统计学意义(P>0.05)。结论 当肺GGN的CT影像出现形态不规则、边缘分叶、结节内及邻近血管异常改变、胸膜凹陷征等征象时,提示结节可能恶变,结合肺GGN患者的一般情况、临床资料、高危因素等综合考虑,可以提高肺GGN诊断的准确性。

Objective To summarize the CT imaging features of different pathological types of ground glass nodules(GGN), and to study the relationship between CT imaging findings and pathological types. Methods The clinical, pathological, and CT imaging data of 43 lung GGNs from 37 patients were retrospectively analyzed. The CT imaging findings of different pathological types of lung GGN were analyzed, and the correlation between CT imaging findings of different types of GGN and pathological types was discussed. Results A total of 43 GGNs were surgically removed from 37 patients, 41 cases were pathologically confirmed as adenocarcinoma or glandular prodromal lesions(PGL)(24 adenocarcinomas and 17 PGL), and 2 cases were pathologically confirmed as inflammatory lesions. The CT imaging findings of neoplastic GGN included irregular shape in 8 cases, lobulated edges in 16 cases, abnormal changes of vessels in and around nodules in 22 cases, and pleural depression in 4 cases. The density, morphology, margin, and adjacent structure of lung GGN were significantly different among the PGL group, MIA group, and IAC group( P < 0. 05). There were no significant differences in the diameter and internal structure of lung GGN among all groups( P > 0. 05). Conclusion When the CT images of lung GGN show signs such as irregular shape,lobulated edge,abnormal changes of blood vessels in and near the nodules,and pleural depression,it is suggested that the nodules may be malignant. Combined with the general situation of lung GGN patients,clinical data,high-risk factors,and other comprehensive considerations,the accuracy of diagnosis of lung GGN can be improved.