CAJ | 학술논문

目的探讨CT影像学表现为肺部磨玻璃结节中浸润前病变[不典型腺瘤样增生(AAH)和原位腺癌(AIS)]、微浸润腺癌(MIA)和浸润性腺癌(IAC)的CT表现特征.方法对97例CT影像学表现为肺部磨玻璃结节患者的术前CT图像进行回顾性分析,将病灶分为浸润前病变组(24例)、MIA组(39例)和IAC组(34例),对3组病灶的大小、三维比率、二维比率、实性成分大小、病灶密度、形状、边缘毛刺、边缘分叶、边界情况、内部空泡以及胸膜凹陷进行对比分析.结果浸润前病变均表现为纯磨玻璃结节,多为圆形或类圆形,边界多较清晰;MIA可表现为纯磨玻璃结节或混合密度的磨玻璃结节,也多为圆形或类圆形,边界多较清晰;IAC多为混合密度的磨玻璃结节,不规则形多见.从浸润前病变、MIA至IAC,病灶边缘毛刺、分叶,内部空泡及胸膜凹陷征的比率逐渐增高.MIA组与IAC组的病灶大小、实性成分大小、病灶密度、形状、边缘毛刺、内部空泡和胸膜凹陷的差异均有统计学意义(均P ＜0.05).浸润前病变组与MIA组的实性成分大小和病变密度的差异均有统计学意义(均P ＜0.05).浸润前病变和MIA、MIA和IAC组实性成分的曲线下面积分别为0.705和0.814.结论综合分析磨玻璃结节的CT影像学形态特征,特别是病灶内的实性成分,可对术前诊断和鉴别诊断肺部浸润前病变、MIA和IAC提供帮助.
목적 탐토CT영상학표현위폐부마파리결절중침윤전병변[불전형선류양증생(AAH)화원위선암(AIS)]、미침윤선암(MIA)화침윤성선암(IAC)적CT표현특정.방법 대97례CT영상학표현위폐부마파리결절환자적술전CT도상진행회고성분석,장병조분위침윤전병변조(24례)、MIA조(39례)화IAC조(34례),대3조병조적대소、삼유비솔、이유비솔、실성성분대소、병조밀도、형상、변연모자、변연분협、변계정황、내부공포이급흉막요함진행대비분석.결과 침윤전병변균표현위순마파리결절,다위원형혹류원형,변계다교청석;MIA가표현위순마파리결절혹혼합밀도적마파리결절,야다위원형혹류원형,변계다교청석;IAC다위혼합밀도적마파리결절,불규칙형다견.종침윤전병변、MIA지IAC,병조변연모자、분협,내부공포급흉막요함정적비솔축점증고.MIA조여IAC조적병조대소、실성성분대소、병조밀도、형상、변연모자、내부공포화흉막요함적차이균유통계학의의(균P ＜0.05).침윤전병변조여MIA조적실성성분대소화병변밀도적차이균유통계학의의(균P ＜0.05).침윤전병변화MIA、MIA화IAC조실성성분적곡선하면적분별위0.705화0.814.결론 종합분석마파리결절적CT영상학형태특정,특별시병조내적실성성분,가대술전진단화감별진단폐부침윤전병변、MIA화IAC제공방조.
Objective To explore the CT features of ground-glass nodules (GGN) including preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)],minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC).Methods Ninety-seven GGN lesions confirmed by operation pathology were included in this study.The lesions were divided into three groups:preinvasive lesion group (24 cases),MIA group (39 cases),IAC group (34 cases).The lesion size,3-dimensional ratio,2-dimensional ratio in axial images,lesion density,shape,speculation,lobulation,air-containing space and pleural indentation on the preoperative CT images in the three groups were analyzed and compared with pathological results.The data were statistically analyzed using SPSS 17.0.Results All preinvasive lesions presented as pure GGN on CT image,most showed round-like shape,clear and smooth border.MIA presented as pure GGN or mixed GGN on CT image,most showed round-like shape,with a clear and smooth border.IAC most presented as mixed GGN on CT image,often showed irregular shape.Speculation,lobulation,air-containing space and pleural indentation displayed gradually increasing from preinvasive lesions to MIA and IAC.There were statistically significant differences in lesion size,CT density,shape,air-containing space,speculation,pleural indentation and long diameter of solid component between the MIA and IAC groups (P ＜ 0.05 for all).There were statistically significant differences in CT density values and long diameters of solid component of the lesions between the preinvasive lesion group and MIA group (P ＜ 0.05).The AUC of solid component of the preinvasive lesion group and MIA group was 0.705,and that of the MIA and IAC groups was 0.814.Conclusion Comprehensive analysis of the CT image features of GGNs,especially the solid component in the lesions,may help to the preoperative and differential diagnosis of preinvasive lesions,MIA and IAC.