肺部磨玻璃密度影MSCT征象分析与良恶性鉴别诊断研究
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摘要
目的：分析肺局灶性磨玻璃密度影(fGGO)的MSCT征象,旨在发现和进一步总结恶性与良性fGGO的CT表现异同,寻找其较为特异性征象,以进一步提高fGGO的临床诊断准确率。
方法：回顾性分析病理证实或临床影像证实的80例肺fGGO的基本临床资料,其中恶性者49例,细支气管肺泡癌(BAC)29例,腺癌20例(其中2例为BAC伴高或中分化腺癌)；良性者31例(34个病灶),挫伤6例(7个病灶),炎症17例(18个病灶),不典型腺瘤样增生(AAH)3例(4个病灶),机化性肺炎3例,结核1例、炎性假瘤1例。上述病例采用16排及64排多层螺旋CT扫描,层厚0.625-5.0mm,以常规肺窗及调整纵隔窗观察病灶大小、分布及MSCT征象(病灶形态、边缘征象、病灶-肺界面、内部结构及邻近结构改变),用X2检验进行统计学分析。
结果：良性者的男女比例(19：12)高于恶性者(23：26),男女发病率差异没有统计学意义(X2值1.356,P>0.05)。良性者病灶形态(圆形、类圆形、不规则形)、边缘征象(分叶征、毛刺征、棘状突起)、病灶-肺界面(清楚、模糊)、邻近结构(胸膜凹陷征、血管集束征)的分别为9、25、1、10、3、14、17、5、13个；恶性者相应分别为：43、6、30、26、28、43、6、25、42个(X2值依次为32.22、29.14、4.57、20.03、16.82、11.47、20.24,P值均<0.05),差异有统计学意义：良性者内部结构(空泡征、蜂窝征、细支气管充气征)分别为11、0、12个；恶性者相应分别为23、1、22个(X2值依次为1.77、0.07、0.77,P值均>0.05),差异没有统计学意义。依据病灶中是否含有实性成分将fGGO分为纯磨玻璃密度(pGGO)和混合性磨玻璃密度(mGGO),pGGO43个,恶性组17个,良性组26个；mGGO40个,恶性组32个,良性组8个,两组间比较有统计学意义(X2值15.42,P值<0.05)。
结论：肺内磨玻璃密度影良恶性病灶的影像学征象有一定特征性。病灶大小在fGGO良恶性病变诊断中价值有限；病灶圆形、边缘征象(分叶征、毛刺征、棘状突起)、病灶-肺界面清楚、邻近结构(胸膜凹陷征、血管集束征)对于fGGO良恶性鉴别有重要价值,·这与恶性病灶的病理学基础存在相应的关系；空泡征、细支气管充气征是fGGO恶性病灶的重要征象；fGGO病灶中磨玻璃密度成分所占比例的量化分型有助于良恶性的鉴别。
Objective:Analysis of lung with focal groud-glass opcity(fGGO)of MSCT signs,designed to identify and further sun of malignant and benign fGGO the CT show similarities and differences,look for the more specific signs,to further improve the accuracy of clinical diagnosis fGGO.
Method:80 cases with pathologically or cliniacal imaging data proved were reviewed.49 cases were maligant including 29 broncholoalveolar cell carcinoma(BAC)and 20 adenocarcinoma(of which 2 BAC cases with high or media differentiation).31 cases(341esions)were benign including 6 pulmonary contusion(71esions),17pneumonia(181esions),3atypical adeno-matous hyperplasia(AAH 4 lesions),3 organizing pneumonia,1 tuberculosis and 1 inflammatory pseudotumor。All cases were scaned by 16 or 64 multi-slice spiral CT with 0.625-5mm collimation. To analyze the size and distribution of lesion and the MSCT findings(shape,margin,interface, internal characteristics,adjacent strucure).The results were analysed with X2 test,p<0.05 were defined as threshold for statistical differences and p<0.05 were significant differences.
ResuIt:The male and female ratio of benign GGO(19:12) were higher than that of maligant(23:26),but no difference were found(p>0.05).The incidence of round shape,irregular, lobulation,speculation,spine-like process,well-defined interface,ill-defined interface,pleural indentationsign and blood vesselclueter sign of benign cases (n=9,25,1,10,3,14,17,5,13)were different from those of maligant cases(n= 43,6,30,26,28,43,6,25,42),x2 vlaue(32.22,29.14,4.57,20.03,16.82,11.47,20.24,p<0.05).No differences were found in the incidence of vacuole sign,honey-combing and air bronchograms between benign and maligant cases.x2 value (1.77,0.07,0.77, p>0.05).fGGO were divided into pure ground-opacity (pGGO)and mixed ground-opacity(mGGO) by including solid ingredient.pGGO group were 43 including maligant 17 and begnign 26.mGGO group were 40 including maligant 32 and benign 8.There were defference between two group(x2 value15.42,p<0.05).
Conclusion:Ground glass opacity pulmonary lesions of benign and malignant imaging findings of certain features.Lesion size fGGO diagnosis of benign and malignant lesions of limited value;lesion round the edge of signs(lobulation,spicule sign, spine-like protrusions),lesion-lung interface clear, adjacent structures (pleural indentation, vascular convergence sign)for fGGO benign and malignant differentiation has important value, which is the basis of pathology of malignant lesions in the corresponding relationship exists;vacuole sign,thin air bronchogram is fGGO important signs of malignant lesions;fGGO lesions,the proportion of ground-glass density in the quantitative sub-components type contribute to the identify-cation of benign and malignant.
方法：回顾性分析病理证实或临床影像证实的80例肺fGGO的基本临床资料,其中恶性者49例,细支气管肺泡癌(BAC)29例,腺癌20例(其中2例为BAC伴高或中分化腺癌)；良性者31例(34个病灶),挫伤6例(7个病灶),炎症17例(18个病灶),不典型腺瘤样增生(AAH)3例(4个病灶),机化性肺炎3例,结核1例、炎性假瘤1例。上述病例采用16排及64排多层螺旋CT扫描,层厚0.625-5.0mm,以常规肺窗及调整纵隔窗观察病灶大小、分布及MSCT征象(病灶形态、边缘征象、病灶-肺界面、内部结构及邻近结构改变),用X2检验进行统计学分析。
结果：良性者的男女比例(19：12)高于恶性者(23：26),男女发病率差异没有统计学意义(X2值1.356,P>0.05)。良性者病灶形态(圆形、类圆形、不规则形)、边缘征象(分叶征、毛刺征、棘状突起)、病灶-肺界面(清楚、模糊)、邻近结构(胸膜凹陷征、血管集束征)的分别为9、25、1、10、3、14、17、5、13个；恶性者相应分别为：43、6、30、26、28、43、6、25、42个(X2值依次为32.22、29.14、4.57、20.03、16.82、11.47、20.24,P值均<0.05),差异有统计学意义：良性者内部结构(空泡征、蜂窝征、细支气管充气征)分别为11、0、12个；恶性者相应分别为23、1、22个(X2值依次为1.77、0.07、0.77,P值均>0.05),差异没有统计学意义。依据病灶中是否含有实性成分将fGGO分为纯磨玻璃密度(pGGO)和混合性磨玻璃密度(mGGO),pGGO43个,恶性组17个,良性组26个；mGGO40个,恶性组32个,良性组8个,两组间比较有统计学意义(X2值15.42,P值<0.05)。
结论：肺内磨玻璃密度影良恶性病灶的影像学征象有一定特征性。病灶大小在fGGO良恶性病变诊断中价值有限；病灶圆形、边缘征象(分叶征、毛刺征、棘状突起)、病灶-肺界面清楚、邻近结构(胸膜凹陷征、血管集束征)对于fGGO良恶性鉴别有重要价值,·这与恶性病灶的病理学基础存在相应的关系；空泡征、细支气管充气征是fGGO恶性病灶的重要征象；fGGO病灶中磨玻璃密度成分所占比例的量化分型有助于良恶性的鉴别。
Objective:Analysis of lung with focal groud-glass opcity(fGGO)of MSCT signs,designed to identify and further sun of malignant and benign fGGO the CT show similarities and differences,look for the more specific signs,to further improve the accuracy of clinical diagnosis fGGO.
Method:80 cases with pathologically or cliniacal imaging data proved were reviewed.49 cases were maligant including 29 broncholoalveolar cell carcinoma(BAC)and 20 adenocarcinoma(of which 2 BAC cases with high or media differentiation).31 cases(341esions)were benign including 6 pulmonary contusion(71esions),17pneumonia(181esions),3atypical adeno-matous hyperplasia(AAH 4 lesions),3 organizing pneumonia,1 tuberculosis and 1 inflammatory pseudotumor。All cases were scaned by 16 or 64 multi-slice spiral CT with 0.625-5mm collimation. To analyze the size and distribution of lesion and the MSCT findings(shape,margin,interface, internal characteristics,adjacent strucure).The results were analysed with X2 test,p<0.05 were defined as threshold for statistical differences and p<0.05 were significant differences.
ResuIt:The male and female ratio of benign GGO(19:12) were higher than that of maligant(23:26),but no difference were found(p>0.05).The incidence of round shape,irregular, lobulation,speculation,spine-like process,well-defined interface,ill-defined interface,pleural indentationsign and blood vesselclueter sign of benign cases (n=9,25,1,10,3,14,17,5,13)were different from those of maligant cases(n= 43,6,30,26,28,43,6,25,42),x2 vlaue(32.22,29.14,4.57,20.03,16.82,11.47,20.24,p<0.05).No differences were found in the incidence of vacuole sign,honey-combing and air bronchograms between benign and maligant cases.x2 value (1.77,0.07,0.77, p>0.05).fGGO were divided into pure ground-opacity (pGGO)and mixed ground-opacity(mGGO) by including solid ingredient.pGGO group were 43 including maligant 17 and begnign 26.mGGO group were 40 including maligant 32 and benign 8.There were defference between two group(x2 value15.42,p<0.05).
Conclusion:Ground glass opacity pulmonary lesions of benign and malignant imaging findings of certain features.Lesion size fGGO diagnosis of benign and malignant lesions of limited value;lesion round the edge of signs(lobulation,spicule sign, spine-like protrusions),lesion-lung interface clear, adjacent structures (pleural indentation, vascular convergence sign)for fGGO benign and malignant differentiation has important value, which is the basis of pathology of malignant lesions in the corresponding relationship exists;vacuole sign,thin air bronchogram is fGGO important signs of malignant lesions;fGGO lesions,the proportion of ground-glass density in the quantitative sub-components type contribute to the identify-cation of benign and malignant.
引文
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15.Kawakami S,Sone S,Takashima S,et al.A typical Adenomatous Hyperplasia of the Lung:Correlation between High-Resolution CT findings and Histopathologic Features[J].Eur Radio,2001,11(5):811-814.
16.Kushihashi T,Munechika H,Ri K,et al.Bronchioloalveolar Adenoma of the Lung: CT-pathologic Correlation[J].Radiology,1994,193(3),789-793.
17.Yang PS,Lee KS,Han J,et al.Focal organizing pneumonia:CT and pathologic findings[J].JK oreanMed Sci,2001,16(5):573-578.
18.Chang Min Park Jin Mo Goo,Hyun Ju Lee,et al.Nodular Ground-Glass Opacity at Thin-Section CT.Histologic Correlation and Evaluation of Change at Follow-up[J].Radio Graphics,2007,27(2):391-408
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15.Kawakami S,Sone S,Takashima S,et al.A typical Adenomatous Hyperplasia of the Lung:Correlation between High-Resolution CT findings and Histopathologic Features[J].Eur Radio,2001,11(5):811-814.
16.Kushihashi T,Munechika H,Ri K,et al.Bronchioloalveolar Adenoma of the Lung: CT-pathologic Correlation[J].Radiology,1994,193(3),789-793.
17.Yang PS,Lee KS,Han J,et al.Focal organizing pneumonia:CT and pathologic findings[J].JK oreanMed Sci,2001,16(5):573-578.
18.Chang Min Park Jin Mo Goo,Hyun Ju Lee,et al.Nodular Ground-Glass Opacity at Thin-Section CT.Histologic Correlation and Evaluation of Change at Follow-up[J].Radio Graphics,2007,27(2):391-408
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22.姜华伟,于中海,刘永江.CT值直方图鉴别肺不典型腺瘤样增生和细支气管肺泡癌[J].放射学实践,2006,21(9)：959-961
23.Seitaro Oda,Kazuo Awai,Duo Liu,et al.Ground-Glass Opacities on Thin-Section Helical CT:Differentiation Between Bronchioloalveolar Carcinoma and Atypical Adenomatous Hyperplasia[J].AIR2008,190,1363-1368.
24.Park CM,Coo JM,Lee HJ.CT findins of atypical adenomatous hyperplasia in the Lung[J].Korean J Radiol,2006,7:80-86.
25.Ha Young Kim,Young Mog Shim,Kyung Soo Lee,et al.Persistent Pulmonary Nodular Ground-Glass Opcity at Thin-Section CT:Histopathologic Comparisons. Radiology:Volume 245:Number 1-October 2007,267-275.
26.林均海,姜华伟,王文虎.肺局灶性磨玻璃样病变的放射学与组织学特性相关性 研究.放射学实践,2006,21(7)：667-669
27.Lingning E.Daqing M.Volumetric measuremeat pulmonary ground-Glass opacity nodules with multi-detectorCT:effect of various tube current on measuremeat accuracy-a chest CT phantom study,Acad Radiol,2009 Aug:16(8):934-939
28.Yoon H E,Fukuhara K,Michiura T,et al.Pulmonary nodules 10mm or less in diameter with Ground-Glass opacity component detected by high-resolution computed tomorgraphy have a high possibility of malignancy{J}.Br J Radiol, 2000,73(12):1252～1259
29.Li F,Sone S,Abe H,et al.Malignant Versus Benign Nodules at CT Screening for Lung Cancer:Comparison of Thin-Section CT Findings [J].Radiology,2004, 233(10):793-798.
30.Hollings N, Shaw P. Diagnostic imaging of lung cancer, Eur Respir J 2002 Apr; 19(4):722-42
31.Erasmus JJ,Connolly JE,Mcadams P, et al. Solitary pulmonary nodules:part I.morphologic evaluation for differentiation of benign and malignant lesions, RadioGraphics 2000 Jan-Feb;20(1):43-58
32.Zwirewich CV, Vedal S, Miller RR, et al.Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation,Radiology 1991 May; 179(2):469-76
33.Kim H,Kang SJ,Suh GY,et al.Predictors for benign solitary pulmonary nodule in tuberculosis-endemic area,Korean J Intern Med 2001 Dec;16(4):236-41
34.Nambu A,Araki T,TaguchiY,et al.Focalarea of ground-glass opacity and ground-glass opacity pred(minance on thin-section CT:discrim ination between neoplastic and non-neoplastic lesions[J] ClinRadiol,2005,60(9):1006-1017
35.Seitaro Oda,Kazuo Awai,Duo Liu,et al.Ground-Glass Opacities on Thin-Section Helical CT:Differentiation Between Bronchioloalveolar Carcinoma and Atypical Adenomatous Hyperplasia[J].AIR2008,190,1363-1368
36.Jung JI, Kim H,Park SH, et al.CT Differentiation of Pneumonictype Bronchioloalveolar Cell Carcinoma and Infectious Pneumonia[J].Br J of Radiol,2001,74(882):490-494
37.韩玉成,程绍玲,初建国等.周围型肺癌的支气管血管集束征—病理表现及其形成机制.中国临床医学影像杂志,2001；12(2)：93-7
38.肖湘生,吴华伟,李惠民等.周围型肺癌胸膜凹陷的CT和MR表现与病理对照.临床放射学杂志,2002,24(5)：344-347
39.张开华,张志勇,唐建华等.良性胸膜凹陷的CT诊断[J].中华现代影像学杂志,2006,3(7)：586 588
40.Henschke CI,Yankelevetz DF, Mirtcheva R, et al.CT screening for lung cancer: frequency and significance fo part solid and nonsolid nodules AJR,2002, 178(5):1053～1057