结节肿块型原发肺黏液腺癌与非黏液腺癌CT征象比较

Comparison of CT signs between primary pulmonary mucinous adenocarcinomaand non-mucinous adenocarcinoma of nodular mass type

目的探讨结节肿块型原发肺黏液腺癌(PPMA)与非黏液腺癌(PPNMA)CT征象的差异,找出鉴别两者的影像学征象。方法回顾性分析经手术病理证实的24例PPMA、72例PPNMA患者的临床资料及CT影像学资料,对比分析两者的临床资料、CT征象。结果PPMA组与PPNMA组在性别、年龄、吸烟史、肿瘤家族史、肿瘤标志物(CEA、NSE、CyFra21-1)组间差异均无统计学意义(P>0.05);PPNMA发生在右肺上叶构成比大于PPMA,PPMA发生在右肺下叶构成比大于PPNMA,差异有统计学意义(P<0.05);PPMA边缘出现毛刺或棘突、胸膜凹陷征构成比低于PPNMA,差异有统计学意义(P<0.05);分叶、支气管征、空泡或空腔、慧星尾征组间差异均无统计学意义(P>0.05);肿瘤的CT值、直径、体积、CT值/体积比值、长短比、Z/F比值组间差异均无统计学意义(P>0.05);PPMA组在液性无强化区、血管造影征的构成比大于PPNMA,PPMA组强化程度低于PPNMA组,组间差异均有统计学意义(P<0.05)。结论PPMA与PPNMA的CT影像表现(瘤内特征、边缘征象)具有一定交叉重叠,与PPNMA比较,PPMA好发于右肺下叶,毛刺、胸膜凹陷征出现的比例较低,当病灶内部出现液性无强化区、血管造影征、强化较轻时更倾向于PPMA诊断。

Objective To investigate the difference of CT signs between nodular mass primary pulmonary mucinous adenocarcinoma(PPMA)and primary pulmonary non-mucinous adenocarcinoma(PPNMA)of nodular mass type,and to identify the imaging signs of the two.Methods This study retrospectively analyzed the clinical data and CT imaging data of 24 patients with PPMA and 72 patients with PPNMA confirmed by surgery and pathology,and compared the clinical data and CT signs of the two groups.Results There were no significant differences in gender,age,smoking history,family tumor history and tumor markers(CEA,NSE,CyFra21-1)between the two groups(P>0.05).The proportion of PPNMA in the upper lobe of the right lung was greater than that of PPMA,and the proportion of PPMA in the lower lobe of the right lung was greater than that of PPNMA,the difference was statistically significant(P<0.05).The proportion of burrs or spines and pleural indentation at the edge of PPMA was lower than that of PPNMA,and the difference was statistically significant(P<0.05).There were no significant differences in lobular sign,bronchial sign,vacuole or cavity sign and comet tail sign among groups(P>0.05).There were no significant differences in CT value,diameter,volume,ratio of CT value to volume,ratio of length to length and ratio of Z/F among groups(P>0.05).In the PPMA group,the proportion of liquid non-enhancement area and angiographic signs was greater than that in PPNMA group,and the degree of enhancement in PPMA group was lower than that in PPNMA group,with statistical significances(P<0.05).Conclusion The CT signs of PPMA and PPNMA(intratumoral features,marginal signs)overlap to some extent.Compared with PPNMA,PPMA is more likely to occur in the lower lobe of the right lung,and the proportion of occurrence of burrs and pleural indentation are relatively low.PPMA is more likely to be diagnosed when there are liquid non-enhanced areas,angiographic signs and light enhancement in the lesions.