CT影像对肺部磨玻璃结节良恶性的诊断与分析-现代医学

CT影像对肺部磨玻璃结节良恶性的诊断与分析

单位：1. 南京市雨花医院/南京市第一医院雨花分院放射科, 江苏南京 210039;
2. 东南大学医院外科, 江苏南京 210008

分类号：R655.3;R814.42

出版年·卷·期（页码）：2022·50·第七期（810-815）

摘要：

目的：分析肺部良恶性磨玻璃结节的CT表现，探讨可用于鉴别诊断良恶性磨玻璃结节的影像特点。方法：收集2019年1月至2021年5月南京市雨花医院收治的80例肺部磨玻璃结节患者并进行回顾性分析。所有病例经术后病理、穿刺活检、支气管镜取活检或诊断性治疗而确诊，其中良性组为炎性肺部磨玻璃结节30例，恶性组为肺腺癌磨玻璃结节50例。结果：良性组结节直径较小，平均CT值为（-629.23±71.34） HU，结节多为纯磨玻璃结节；恶性组结节直径较大，平均CT值为（-434.64±104.39） HU，结节多为混杂磨玻璃结节。两组结节在大小、CT值、CT影像表现上差异有统计学意义。对良恶性磨玻璃结节的不同影像特征进行多因素Logistic回归分析显示，结节大小、结节支气管征、结节血管征及结节边缘毛刺征为恶性磨玻璃结节的危险因素（P<0.05）。结论：对肺部磨玻璃结节进行CT影像分析可鉴别诊断肺部磨玻璃结节的良恶性，磨玻璃结节大小、结节支气管征、结节血管征、结节边缘毛刺征在恶性磨玻璃结节诊断中具有重要意义。

Objective: To acquire imaging characteristics of benign and malignant ground glass density nodules in the lungs for the differential diagnosis, and to compare and study CT results of benign and malignant ground glass density nodules in the lungs. Methods: A total of 80 cases with ground-glass density nodules in the lungs were collected and retrospectively examined from January 2019 to May 2021 at Nanjing Yuhua Hospital. Postoperative pathology, needle biopsy, bronchoscopy, or diagnostic treatment were used to confirm all the cases.In the benign group, 30 were inflammatory pulmonary ground-glass nodules, while the malignant group had 50 cases of pulmonary adenocarcinoma ground glass nodules. Results: The diameter of the nodules was smaller in the benign group, the average CT value was (-629.23±71.34) HU, and the majority of the nodules were pure ground-glass nodules.In the malignant group, the nodules in diameter were larger, the mean CT value was (-434.64±104.39) HU, and the nodules were mostly intermixed ground glass nodules.The size and CT value of the two groups of nodules were significantly different.Between the benign and malignant groups, there were statistical disparities in CT imaging performance. The varied imaging characteristics of benign and malignant ground glass nodules were subjected to multivariate logistic regression analysis:nodule size, nodule bronchial sign, nodule vascular sign, and nodule edge burr sign were all risk factors for malignant ground glass nodules(P<0.05). Conclusion: Ground-glass pulmonary nodules can be distinguished from benign and malignant pulmonary ground-glass nodules using CT imaging.When it comes to diagnosing malignant ground-glass nodules, the size of the nodules, nodular bronchial symptoms, nodular vascular indications, and nodular edge burr signs are all important.

参考文献：

[1] 张晓菊, 白莉, 金发光, 等.肺结节诊治中国专家共识(2018年版)[J].中华结核和呼吸杂志, 2018, 41(10):763-771.
[2] 张海宽, 贾宁, 冷艾泠.高分辨CT、胸部平片及病理学诊断肺磨玻璃结节临床分析[J].中华肺部疾病杂志(电子版), 2020, 13(3):360-364.
[3] EGUCHI T, YOSHIZAWA A, KAWAKAMI S, et al.Computed tomography attenuation predicts the growth of pure ground-glass nodules[J].Lung Cancer, 2014, 84(3):242-247.
[4] SWENSEN S J, JETT J R, HARTMAN T E, et al. Lung cancer screening with CT:Mayo clinic experience1[J].Radiology, 2003, 226(3):756-761.
[5] ERASMUS J.Solitary pulmonary nodules:part I.Morphologic evaluation for differentiation of benign and malignant lesions[J].Radiographics, 2000, 20(1):43-58.
[6] 陈相猛, 张嘉瑜, 段晓蓓, 等.基于HRCT影像学表现对磨玻璃肺结节腺癌浸润程度的鉴别诊断[J].中国CT和MRI杂志, 2021, 19(6):71-74.
[7] 陈颖, 胡春洪, 林盪, 等.多排螺旋CT薄层重组和高分辨率CT靶扫对肺微小结节的价值比较[J].临床放射学杂志, 2017, 36(11):1617-1622.
[8] 张国桢, 郑向鹏, 李铭.微小肺癌:影像诊断与应对策略[M].北京:人民军医出版社, 2015:86-88.
[9] 游小风, 徐伟华.肺内孤立性磨玻璃密度结节良恶性病灶的MSCT鉴别征象及其病理学基础[J].中国CT和MRI杂志, 2017, 15(12):57-59.
[10] LU J, TANG H, YANG X, et al.Diagnostic value and imaging features of multi-detector CT in lung adenocarcinoma with ground glass nodule patients[J].Oncol Lett, 2020, 20(1):693-698.
[11] ZHANG P, LI T, TAO X, et al. HRCT features between lepidic-predominant type and other pathological subtypes in early-stage invasive pulmonary adenocarcinoma appearing as a ground-glass nodule[J].BMC Cancer, 2021, 21(1):1124.
[12] 何慧, 孙鹏飞, 曹向荣, 等.肺局灶性磨玻璃密度结节的多层螺旋CT诊断[J].中国医学影像学杂志, 2014, 22(2):121-123.
[13] 杨海, 陈盈, 李欣, 等.CT值鉴别纯磨玻璃密度的肺原位腺癌与微浸润腺癌的价值[J].肿瘤学杂志, 2017, 23(2):121-124.
[14] 杨培金, 田卫兵, 邱娟, 等.肺磨玻璃结节CT影像特征及在病灶性质判断中的应用[J].临床肺科杂志, 2021, 26(9):1347-1351.
[15] 庞勃, 吕剑剑, 葛孝忠, 等.Swensen模型在肺结节临床诊断中的应用研究(附115例报告)[J].东南大学学报(医学版), 2019, 38(3):424-427.
[16] 陈山, 左敏, 刘长华.高分辨率CT靶扫描技术对肺磨玻璃密度结节的诊断价值分析[J].解放军预防医学杂志, 2019, 37(2):120-121, 150.
[17] 陈婧, 叶晓丹, 叶剑定, 等.孤立性肺结节良恶性判断的数学预测模型建立与验证[J].中国医学计算机成像杂志, 2016(6):573-577.

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