肺部单发微小磨玻璃结节(<10mm)MSCT特征对肺腺癌病理亚型的诊断价值  

Diagnostic value of MSCT imaging features of solitary pulmonary ground-glass micronodules(<10mm) to lung adenocarcinoma

作　　者：陈琦[1,2] 朱全新[1] 郁义星[2] 郑梦龙 杨井 胡春洪 CHEN Qi;ZHU Qua-xin;YU Yi-xing(Department of Radiology,Kunshan Third People's Hospital,Jiangsu 215300,China)

机构地区：[1]昆山市第三人民医院放射科,江苏215300 [2]苏州大学附属第一人民医院影像科,江苏215006 [3]吴中人民医院放射科,苏州221000

出　　处：《放射学实践》2019年第7期778-783,共6页Radiologic Practice

基　　金：国家重点研发计划项目(2017YFC0114300);苏州市临床重点病种诊疗技术专项项目(lczx201501)

摘　　要：目的:探讨肺部单发微小磨玻璃结节(GGN,<10mm)的MSCT影像特征对于浸润前病变(不典型腺瘤样增生AAH+原位腺癌AIS)、微浸润腺癌(MIA)和浸润性腺癌(IAC)的诊断价值。方法:回顾性分析272例肺部单发微小GGN的MSCT图像特征,按照肺腺癌病理分类标准分为3组,包括AAH+AIS:95(31+64)例,MIA153例和IAC24例。对三组患者的临床资料及GGN的CT特征进行分析,包括患者性别、年龄、GGN最大径、CT值及MSCT图像的影像特征(边缘、瘤肺界面、内部结构及邻近结构)。采用受试者操作特征曲线(ROC)分析三组病变最大径及CT值的鉴别诊断价值。结果:病灶位置、密度、边缘分叶征、边缘毛刺征、边缘棘突征、瘤肺界面、血管集束征、支气管充气征、空泡征、血管穿入、病变最大径及CT值等特征指标在三组中的差异有统计学意义(P<0.05);而性别、年龄及胸膜凹陷征在三组中差异无统计学意义(P>0.05)。病变最大径诊断AAH+AIS和IAC、AAH+AIS和MIA及AAH+AIS和MIA+IAC的诊断阈值分别为7.70mm(敏感度91.7%,特异度30.5%),7.15mm(敏感度49.7%,特异度37.9%)及7.15mm(敏感度55.4%,特异度37.9%)。CT值诊断AAH+AIS和IAC、AAH+AIS和MIA及AAH+AIS和MIA+IAC的诊断阈值分别为-539.5HU(敏感度100%,特异度33.7%),-562.5HU(敏感度77.8%,特异度45.3%)及-547.5HU(敏感度74.6%,特异度38.9%)。结论:MSCT的影像特征对表现为微小GGN(<10mm)的AAH+AIS、MIA及IAC具有重要的诊断价值。GGN的最大径及CT值对于AAH+AIS、MIA及IAC具有较好的诊断效能。Objective: To investigate the diagnostic value of multi-slice computed tomography (MSCT) imaging features of solitary pulmonary ground-glass micro-nodules (dimension<10mm;GGN) among pre-invasive atypical adenomatous hyperplasia (AAH),adenocarcinoma in situ (AIS),minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). Methods: A retrospective analysis of thin-slice thoracic MSCT examination was performed in a total of 272 pathological confirmed solitary pulmonary GGNs,including 95AAH+ AIS(31+ 64),153 MIA and 24 IAC.The clinical data from these 3 groups of patients and the CT features of the GGNs were analyzed,including gender,age,GGN's maximum diameter,CT density value and imaging features of the MSCT images (edge,tumor-lung interface,internal structure and adjacent structure).The diagnostic value of maximal lesion diameter and CT density of GGN were analyzed by receiver operator characteristic curve (ROC). Results: Significant differences were found on the characteristics of lesion location,density,marginal lobulation sign,marginal burr,lung tumor interface,vascular bundle,bronchial aeration sign,vacuole sign,non-inflation sign and vacuole sign,and vascular penetration among the 3 groups (all P <0.05);whereas no difference was found on the gender,age and the characteristics of pleural sag (all P > 0.05).The optimal cut-off value of maximal transverse diameter of lesions in diagnosis of AAH+AIS and IAC,AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively 7.70mm (Sensitivity: 0.917,Specificity:0.305),7.15mm (Sensitivity:0.497,Specificity:0.379) and 7.15mm (Sensitivity:0.554,Specificity:0.305).The optimal cut-off value of CT density of lesions in diagnosis of AAH+AIS and IAC,pre-invasion AAH+AIS and MIA,and AAH+AIS and MIA+IAC was respectively -539.5HU (Sensitivity:1.00,Specificity:0.337),-562.5HU (Sensitivity:0.778,Specificity:0.453) and -547.5HU (Sensitivity:0.746,Specificity:0.389). Conclusion: The MSCT imaging features of solitary pulmonary GGN (dimension<10mm) has important diagnosis valu

关 键 词：肺肿瘤 肺磨玻璃结节 肺腺癌 病理亚型 

分 类 号：R814.42[医药卫生—影像医学与核医学] R734.2[医药卫生—放射医学]