CT各征象对肺磨玻璃结节浸润性及浸润程度的鉴别价值

Differential value of CT signs in the infiltration and degree of infiltration of pulmonary ground-glass nodules

目的 研究CT各征象在肺磨玻璃结节(GGN)浸润性及浸润程度中的鉴别价值。方法 回顾性收集320例GGN患者(335枚GGN结节),其中不典型腺瘤样增生(AAH)3例、原位腺癌(AIS)83例、微浸润腺癌(MIA)130例、浸润性腺癌(IAC)119例,分为腺体前驱性病变组(AAH+AIS)和浸润性肺腺癌组(MIA+IAC)。观察并记录两组结节的分布部位、形态、大小、密度、内部结构、边缘特征、周围血管集聚、胸膜受累情况及GGN与支气管的相互关系,并分析各征象的鉴别价值。结果 腺体前驱性病变组与浸润性肺腺癌组在大小、形态、密度、空气支气管征、分叶征、结节状突起、毛刺征、GGN血管征及胸膜凹陷征占比比较,差异均有统计学意义(χ^(2)分别=70.84、43.91、78.52、40.31、84.21、58.77、22.09、51.75、17.28,P均<0.05)。logistic回归分析显示:大小、密度、有分叶征、有结节状突起为鉴别腺体前驱性病变及浸润性病变的影响因素(OR分别=3.12、3.60、3.17、2.55,P均<0.05)。结论 CT各征象在预测肺GGN浸润性及浸润程度中具有一定价值,为临床早期诊断及治疗方案的选择提供有力依据。

Objective To study the discriminative value of various signs of CT in the infiltration and infiltration de⁃gree of pulmonary ground glass nodules(GGN).Methods Totally 320 patients with GGN(335 GGN nodules)are retro⁃spectively collected,including 3 cases of atypical adenomatous hyperplasia(AAH),83 cases of adenocarcinoma in situ(AIS),130 cases of minimally infiltrating adenocarcinoma(MIA),and 119 cases of invasive adenocarcinoma(IAC),which divided into adenoidal precursor lesions group(AAH+AIS)and invasive lung adenocarcinomas group(MIA+IAC).The distribution sites,morphology,size,density,internal structure,margin features,peripheral vascular collections,pleural involvement and the interrelationship between GGN and bronchus of the nodules in the two groups are observed and re⁃corded,and the discriminative value of each sign is analyzed.Results The differences in size,morphology,density,air bronchial sign,lobular sign,nodular protrusion,burr sign,GGN vascular sign and pleural depression sign are statistically significant when compared between the adenoidal precursor lesions group and invasive lung adenocarcinomas group(χ^(2)=70.84,43.91,78.52,40.31,84.21,58.77,22.09,51.75,17.28,P<0.05).Logistic regression analysis shows that size,densi⁃ty,presence of lobar sign,and presence of nodular protrusions are influential factors in identifying adenoidal precursor le⁃sions and infiltrative lesions(OR=3.12,3.60,3.17,2.55,P<0.05).Conclusion Various signs of CT are valuable in pre⁃dicting the infiltration and degree of infiltration of pulmonary GGN,which providing a strong basis for early clinical diag⁃nosis and choice of treatment plan.