摘要
目的探讨同表现为磨玻璃密度结节（GGO）的微浸润型肺腺癌的高分辨率CT（HRCT）影像特点及与原位腺癌的鉴别诊断，以应对肺小结节的临床处置。方法经病理证实的肺原位腺癌或微浸润型肺腺癌患者72例（均为周围型、直径〈2．5cm），术前均行常规HRCT扫描，经多方位薄层重建，观察病灶的HRCT表现。结果72例患者中68例均为单发结节，4例为多发（两个）。其中纯磨玻璃结节47个，混杂磨玻璃样结节29个，病灶直径为0．6—2．4cm，平均（1．5±0．9）cm；量化分型中Ⅰ型0例、Ⅱ型3例、Ⅲ型10例，Ⅳ型16例，V型47例；混杂GGO边缘清晰24个，分叶4个，毛刺征2个；胸膜凹陷征3个；空气．细支气管扩张征1个；支气管狭窄、截断征0个，血管集束征1个。结论HRCT检查发现GGO影时，特别是纯GGO，大小在0．6～1．0cm之间，实性成份小于25％（量化分型较高），病灶边缘清晰，不伴有分叶征、胸膜凹陷及毛刺征时，应考虑原位腺癌，可以随访复查，余均要高度怀疑恶性病变（微浸润型肺腺癌），建议尽早择期手术切除后病理检查。
Objective To investigate the differentiation of the high-resolution CT （HRCT） manifestation between the minimally invasive adenocarcinom which exhibited the ground-glass opacity （GGO） and the adenocarcinoma in situ （AIS）. Methods Seventy-two adenocarcinoma （ peripheral type, diameter below 2.5 cm） patients confirmed by pathology received high-resolution CT scan before surgery, then the lesions underwent MPR reconstruction and the manifestation of HRCT was evaluated. Results Single nodule was demonstrated for 72 patients, multiple for 4 patients （2 nodules）, including pure ground-glass opacity nodule in 47 cases and mixed ground-glass nodule in 29 cases with the diameter of the lesion 1.5 ± 0.9 （0.6 -2.4 cm）, in which 53 lesions were between 1.0 - 2.4 cm. The types I of the quantification grouping harbored 0 cases, the Ⅱ types had 3 cases, the Ⅲ types had 10 cases, the Ⅳ types had 16 cases, th types had 47 cases. In the mixed ground-glass nodule in 29 cases, the other imaging characteristics included 24 cases with clear margin, 4 cases with lobulate, 2 cases with spur sign, 3 cases with pleural indentation, 1 case with bronchiolectasis sign, 0 case with bronchial stenosis and truncated sign, 1 case with vessel convergence sign. Conclusion The pure ground-glass nodules with the diameter of the lesions between 0.6 - 1.0 cm, clear margin, the less solid component （the higher quantification types）, without the lobulate sign, pleural indentation, spur sign and bronchiolectasis sign on HRCT images, should be thought the adenocarcinoma in situ, the others should be highly suspected as minimal invasive adenocarcinoma, which is better to be surgery.
出处
《医学影像学杂志》
2016年第8期1413-1416,共4页
Journal of Medical Imaging
基金
浙江省宁波市领军和拔尖人才项目(编号:2012-131)
关键词
肺肿瘤
原位腺癌
微浸润型肺腺癌
体层摄影术
x线计算机
Lung neoplasms
Adenocarcinoma in situ
Minimal invasive adenocarcinoma
Tomography, X-ray computed
