多层螺旋CT对肺磨玻璃结节与支气管关系的初探  

Application of Multislice Spiral CT Scanning in Evaluating the Relationship Between Pulmonary Ground Glass Nodule and Bronchiole

作　　者：陈天忠[1] 韦乐心 余绍立[1] 程旭坚 

机构地区：[1]广西柳州医学高等专科学校第一附属医院放射科,柳州545002

出　　处：《临床放射学杂志》2014年第5期711-715,共5页Journal of Clinical Radiology

摘　　要：目的研究肺磨玻璃结节（GGN）与支气管的关系及其分型，并探讨其诊断价值。方法选择行MSCT检查所检出的最大直径≤3．0cm的GGN患者68例，共68个GGN（分为肺浸润性肺癌组35个，浸润前病变组10个，良性组23个）作为观察对象，在横断位和薄层重组（MPR）图像上观察GGN实性成分的含量及其与支气管的关系。按照CT图像上病灶内实性成分所占比例，GGO比例=[（GGO成分最大径一实性成分最大径）／GGO成分最大径l×100％将GGN分为三类，A类为纯GGN；B类为磨玻璃成分占76％-99％的混合GGN；C类为磨玻璃成分占50％～75％的混合GGN。将GGN与支气管的关系分为5型：Ⅰ型：支气管在GGN中被实性成分截断；Ⅱ型：支气管在GGN实性成分中扭曲、扩张；Ⅲ型：支气管GGN的磨玻璃区扭曲、扩张；Ⅳ型：支气管在磨玻璃区走行正常；Ⅴ型：支气管在病灶旁边绕行，未进入病灶内部。结果（1）3组GGN与支气管存在关系的比率分别为88．6％（31／35）、10％（1／10）及60．9％（14／23），3组之间的差异有明显统计学意义（X^2=18．432，P〈0．000）。（2）GGN与支气管类型显示为Ⅰ型时，浸润性腺癌组、浸润前病变组及良性组分别为11、0、0个；Ⅱ型在3组中分别为12、0、1个；Ⅲ型在3组中分别为5、0、1；Ⅳ型在3组中分别为3、1、6个；Ⅴ型在3组中分别为0、0、6个，差异有统计学意义（P〈0．01）。浸润型腺癌以Ⅰ、Ⅱ型多见，浸润前病变组多与支气管无关系；良性病变组多以Ⅳ、Ⅴ型多见。（3）按CT图像上病灶内磨玻璃成分比例，A类26个；B类13个；C类29个，病灶内磨玻璃成分含量与支气管分型间存在相关性（r=-4．262，P〈0．000）。结论不同类型的GGN与支气管所显示的关系不同，综合分析病灶内磨玻璃成分含量，对GGN的诊断及鉴别诊断有重要价值。Objective to investigate the classification of pulmonary ground glass nodule （GGN） and its relationship with the bronchiole, and to discuss its diagnostic value. Methods A total of 68 patients who had ≤3.0 cm GGN that was detected on multislice spiral CT （MSCT） scan were enrolled in this study. The 68 lesions were divided into pulmonary invasive lung cancer group （n = 35 ）, pre-invasive lung cancer group （n = 10） and benign lesion group （n = 23）. The solid component proportion of GGN and its relationship with bronchiole were determined on the cross sectional plane and MPR images. According to the proportion of solid component which was measured on CT images, GGN lesions were divided into class A （pure GGN）, class B （76 -99% ground glass） and class C （50 -75% ground glass）. The relationships of GGN with bronchiole were divided into five types： type Ⅰ （the bronchiole was obstructed） ; type Ⅱ （the bronchiole within GGN shadow was tortuous and dilated） ; type Ⅲ （within ground glass area the bronchiole was tortuous and dilated） ; type Ⅳ（the bronchial course was normal within ground glass area） ; and type Ⅴ （the bronchiole ran its way by the side of the lesion and did not enter GGN）. Results （ 1 ） The presence rate of certain relationship between GGN and bronchiole in the three groups was 88.6% （31/35）, 10% （1/10） and 60.9 （ 14/23 ） respectively, the statistically significant difference existed between each other of the three groups （ X^2 = 18. 432,P 〈0. 000）. （2） In type I , the lesion number of the invasive group, pre-invasive group and benign lesion group was 11,0 and 0 respectively, which was 12, 0 and Ⅰ respectively in type Ⅱ , 5, 0 and 1 respectively in type Ⅲ. 3.1 and 6 respectively in type Ⅳ. and 0.0 and 6 resnectivelv in tvne Ⅴ.The differences were statistically significant （ P 〈 0.01 ）. In infiltrative adenocarcinomas type Ⅰ and Ⅱ were commonly seen, while in benign lesion group type Ⅳ and Ⅴwere

关 键 词：支气管 肺磨玻璃结节 体层摄影术 X线计算机 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]