肺磨玻璃结节内血管征对良、恶性病变的诊断价值

The diagnostic values of vascular signs in differentiating benign and malignant pulmonary ground-glassnodules

目的:探讨HRCT图像上肺磨玻璃样结节(GGN)内血管征对良、恶性病变的诊断价值。方法:回顾性分析经病理证实或随诊显示病灶消失的109例肺磨玻璃结节患者的临床和CT资料(平扫、动脉期及静脉期)。其中良性结节44例,恶性结节65例。观察指标为结节的主要CT征象(大小、密度、分叶、毛刺、空气支气管征和胸膜凹陷征)、结节内出现血管的例数及各项血管征像[包括血管穿行、血管的数量、种类(肺动脉或肺静脉)及异常形态学征象(僵硬、增粗、扭曲、聚集或截断)]。对良、恶性GGN组各项观察指标的差异进行统计学分析。结果:良性和恶性GGN组的结节大小、密度、分叶、毛刺、空气支气管征和胸膜凹陷征这6个CT征象出现率的差异均有统计学意义(P<0.05)。恶性GGN组血管征出现率高于良性GGN组(66.15%vs.43.18%),且差异有统计学意义(P<0.05)。恶性GGN组出现血管征的43例与良性GGN组出现血管征的19例进行比较,GGN内血管数量的差异无统计学意义(P>0.05);恶性GGN内肺动脉与肺静脉同时出现率明显高于良性GGN(41.86%vs.21.05%);血管的异常形态学征象(血管僵硬、增粗、扭曲、聚集或截断)在恶性GGN中的出现率明显高于良性GGN(53.49%vs.26.32%),尤其形态异常的血管是肺静脉时在恶性与良性GGN组中的出现率分别为65.22%和40.00%;以上指标的组间差异均具有统计学意义(P<0.05)。43例恶性结节同时具有血管征象和异常CT征象(毛刺、分叶、支气管充气征及胸膜凹陷征)的比例分别为41.86%、65.12%、23.26%、69.77%,19例良性结节同时具有血管征象与毛刺、分叶、支气管充气征及胸膜凹陷征的比例分别为10.53%、15.79%、0%、10.53%,表明恶性GGN中结节的各项CT征象与各种血管征象同时出现的例数多于良性GGN。结论:CT图像上显示的肺GGN内血管征结合结节的形态学征象有助于良、恶性病变的鉴别诊断,当结节内血管出现僵硬、增粗、扭曲、聚集或截断等异常征象,尤其是出现异常形态的血管为肺静脉时,提示结节为恶性的可能性较大。

Objective:To investigate the values of nodule vascular sign in HRCT indiagnosis and differential diagnosis for benign and malignant pulmonary ground-glass nodules(GGN).Methods:One hundred and nine patients with pulmonary ground glass nodules were confirmed by pathology or followed-up disappearing,who had complete clinical and imaging data(CT findings of unenhancement and dynamic enhancement),including 44 cases of benign nodules and 65 cases of malignant nodules.The observed indicators were mainly CT signs of GGN(the size,density,lobulation,spicule sign,air bronchogram and pleural depression sign),the vascular signs in nodules including the cases of appearing vessel in benign and malignant GGN,vascular passing-through,number of vessel,type of vessel(pulmonary artery or pulmonary vein),forms of abnormal vascular signs(stiff,thickened,twisted,aggregated or truncated).Statistical analysis were performed to test the difference of the observed indicators between benign and malignant GGN.Results:There were significant differences in the appearing rate of six CT features of the nodules including size,density,lobulation,spicule signs,air bronchogram and pleural depression sign between benign and malignant GGNs(all P<0.05).Vessel in GGN was found in 19 cases(43.18%)and 43 cases(66.15%)in benign and malignant group,respectively,the incidence of vessel in malignant GGN group was higher than that of benign GGN group(P<0.05).The vascular signs were compared between 43 cases of malignant GGN and 19 case of benign GGN,the statistical results showed that there was no significant difference in the number of vessel between the two groups(P>0.05);the concurrently appearing rate of pulmonary artery and pulmonary vein in malignant GGNs was 41.86%which was markedly higher than that in benign GGNs(21.05%);the incidence of abnormal vascular signs(stiff,thickened,twisted,aggregated or truncated)in malignant GGNs was 53.49%,which was markedly higher than that in benign GGNs(26.32%),and especially,when the intra-nobular vessel was pulmonary vein,the rate was 65.22%and 40.00%in malignant and benign GGNs,respectively;And the difference of the indexes mentioned above between the two groups were all statistical significance(all P<0.05).The occurence rates which malignant GGN with vascular signs in 43 cases had spicule sign,lobular sign,air bronchogram and pleural depression sign were 41.86%,65.12%,23.26%and 69.77%respectively;but the percent rates of benign GGN in 19 cases was 10.53%,15.79%,0%and 10.53%,respectively.The cases of abnormal CT signs and vascular signs appearing concurrently in malignant GGN was more than benign GGN.Conclusion:It was helpful to observe the incidence of abnormal vascular signs in GGN combined their CT shape features for differential diagnosing of benign and pulmonary malignant GGN.When the vessels in nodules are stiff,thickened,twisted,aggregated or truncated,especially the abnormal vascular signs are in pulmonary veins,the possibility of malignancy is higher.