CHINESE JOURNAL OF CT AND MRI,AUG.2019, Vol.17, No.8 Total No.118论 著
D O I:10.3969/j.i s s n.1672-5131.2019.08.018LUO Ji-yuan, WAN Qing-song, WANG Zhi-ming,et al., Department of Radiology, Panzhihua General Hospital, Panzhihua 617023, Sichuan Province, China
[Abstract] Objective To analyze the value of CT imaging features in the diagnosis of pulmonary pure ground glass nodule (pGGN) invasive adenocarcinoma. Methods 40 cases of invasive lung adenocarcinoma patients confirmed by surgical pathology and whose CT showed pGGN from 2015 to 2017 in our hospital were retrospectively analyzed, among them, there were 24 cases of micro invasive adenocarcinoma (MIA) and 16 cases of invasive adenocarcinoma (IAC), the imaging features such as lesion size, density, edge and adjacent structures of the lesions were observed by CT and the average CT value were calculated, receiver operational characteristic (ROC) curve was used to assess the values of lesions size and average CT value in the diagnosis of pGGN invasive lung adenocarcinoma. Results The presences of irregular shape, burr sign, lobulation sign, vascular cluster sign and air bronchial sign in IAC group were significantly higher than those in MIA group (P<0.05), the difference of pGGN lesion size and average CT value between the two groups was statistically significant (P<0.05). ROC curve analysis showed that the best limit value of lesion size for predicting IAC was 18.45mm, AUC was 0.808, sensitivity, specificity and Jordan index was 66.70%, 88.00% and 0.547, re
spectively; the best limit value of average CT value for predicting IAC was -534.05Hu, AUC was 0.856, sensitivity, specificity and Jordan index was 80.00%, 84.00% and 0.640, respectively, the diagnostic value of average CT value is higher than that of the lesion size. Conclusion CT imaging features can be used to identify MIA and IAC in the diagnosis of pulmonary pGGN invasive adenocarcinoma, the average CT value has higher diagnostic value, IAC is more likely when pGGGN is irregular, accompanied by burr sign, lobulation sign, vascular cluster sign and air bronchial sign, it can provide reference value for clinical diagnosis and treatment.播放影碟
[Key words] Pure Ground Glass Nodule; Invasiveness; Micro Invasive Adenocarcinoma; Invasive Adenocarcinoma
随着影像学技术不断发展，低剂量多层螺旋CT检出肺结节率明显提升，其中大部分为肺腺癌，临床对肺腺癌主要分为浸润前病变、微浸润性腺癌(micro invasive adenocarcinoma，MIA)和浸润性腺癌(invasive adenocarcinoma，IAC)等病理类型[1-2]。肺腺癌主要表现为磨玻璃结节(ground glass nodule，GGN)，并根据结节内是否存在实性成分或掩盖肺实质又可分为部分实性结节及纯磨玻璃结节(pure ground glass nodule，pGGN)，pGGN是多种病变所导致的非特异性表现，其不含实性成分，肺窗上密度轻度有所增高[3-4]。因不同病理类型GGN影像学表现存在差异性，根据其大小、体积、密度、质量等影像学特征可鉴别其侵袭性，目前临床关于CT诊断表现为pGGN侵袭性肺腺 癌分型相关报道甚少，基于此，本研究对肺部pGGN侵袭性肺腺癌的CT影像学特征进行讨论，以期对MIA、IAC进行鉴别，现报道如下。
孔府宴酒破产拍卖 1 资料与方法
1.1 一般资料 回顾性分析本院2015年-2017年40例经手术病理证实为侵袭性肺腺癌且CT表现为pGGN，男17例，女23例，纳入标准：
肺纯磨玻璃结节侵袭性肺腺癌CT影像学特征
1.攀钢总医院放射科
ccbot谭盾地图2.攀钢总医院肿瘤科
(四川 攀枝花 617023)
罗继元1 万青松1 王志明1
刘 威1 杨 科2
悲哀的玩具阅读答案【摘要】目的 分析肺部纯磨玻璃结节(pGGN)侵袭性肺腺癌诊断中CT影像学特征应用的价值。方法
回顾性分析本院2015年-2017年40例经手术病理证实为侵袭性肺腺癌且CT表现为pGGN，其中微浸润性腺癌(MIA)24例和浸润性腺癌(IAC)16例，应用CT观察患者病变大小、密度、边缘及临近结构等影像学特征并统计平均CT 值，采用受试者操作特征(ROC)曲线评估病灶大小及平均CT值在pGGN侵袭性肺腺癌中的诊断价值。结果 IAC组存在不规则形、毛刺征、分叶征、血管集束征、空气支气管征均显著高于MIA组(P＜0.05)；两组pGGN病变大小及平均CT值间比较差异具有统计学意义(P＜0.05)；经ROC曲线分析，病变大小预测IAC最佳界限值为18.45mm，诊断的AUC面积为0.808，灵敏度、特异度、约登指数分别为66.70％、88.00％、0.547；平均CT值预测IAC最佳界限值为-534.05Hu，诊断的AUC面积为0.856，灵敏度、特异度、约登指数分别为80.00％、84.00％、0.640，其中平均CT值诊断价值较病变大小高。结论 在肺部pGGN侵袭性肺腺癌诊断中应用CT影像学特征可有效鉴别MIA与IAC，其中平均CT值诊断价值较高，当pGGN表现为不规则形，并伴有毛刺征、分叶征、血管集束征、空气支气管征时，IAC可能性较大，可为临床诊治提供参考价值。
【关键词】纯磨玻璃结节；侵袭性；微浸 润性腺癌；浸润性腺癌
【中图分类号】R322.3+5
【文献标识码】A The Value of CT Imaging Features in the Diagnosis of Pulmonary Pure Ground Glass Nodule Invasive Adenocarcinoma
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