浸润前病变与早期(ⅠA期)肺腺癌的影像学对比研究  

CT imaging of pre-invasive lesions and stageⅠA pulmonary adenocarcinoma:a comparative study

作　　者：何亚奇[1] 唐秉航[1] 全勇[1] 黄德成[1] 李芳云[1] HE Yaqi;TANG Binghang;QUAN Yong;HUANG Decheng;LI Fangyun(Department of Medical Imaging Center,Zhongshan City People’s Hospital,Zhongshan 528403,Guangdong Province,China)

机构地区：[1]中山市人民医院医学影像中心,广东中山528403

出　　处：《肿瘤影像学》2021年第1期50-55,共6页Oncoradiology

基　　金：广东省中山市社会公益科技研究项目(2019B1084)。

摘　　要：目的:分析肺腺癌浸润前病变与ⅠA期肺癌的计算机体层成像(computed tomography,CT)影像表现,提高鉴别诊断水平。方法:收集2011年12月—2020年1月经手术病理学检查证实为IA期以下肺腺癌的患者147例,其中不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)18例,原位腺癌(adenocarcinoma in situ,AIS)86例、微浸润性腺癌(minimally invasive adenocarcinoma,MIA)43例,统计分析病灶大小、密度、分叶征、空泡征、胸膜凹陷征、肿瘤微血管成像征,并进行组内和组间比较。结果:AAH、AIS、MIA病灶大小分别为(8.6±3.2)、(9.7±2.9)、(12.1±3.8)mm。AAH、AIS、MIA平均CT值为-(592.2±60.1)、-(510.5±135.5)、-(408.9±127.4)Hu。CT形态学征象中AAH全部为纯磨玻璃密度结节(pure ground-glass opacity,pGGO),部分实性磨玻璃密度结节(mixed ground-glass opacity,mGGO)在AIS和MIA中占比分别为20.9%、48.8%。胸膜凹陷征和肿瘤微血管成像征未出现在AAH中,在AIS和MIA中比例逐渐增高,在MIA中肿瘤微血管成像征占69.8%。结论:CT影像学上鉴别AAH和AIS较困难,MIA具有一定特征性,具体患者需综合影像学表现,不宜采用单一征象作为鉴别手段。Objective:To analyze the computed tomography(CT)features of pre-invasive lesions and stageⅠA pulmonary adenocarcinomas,in order to improve the differential diagnosis level.Methods:A total of 147 patients with 18 atypical adenomatous hyperplasia(AAH),86 adenocarcinoma in situ(AIS)and 43 minimally invasive adenocarcinoma(MIA)confirmed by surgery and pathology were selected from December 2011 to January 2020.CT imaging features were analyzed including lesion’s size,density,lobulation,bubble sign,pleural indentation and tumor microangiogram sign.The statistical differences among and in groups were analyzed.Results:The average size of AAH was(8.6±3.2)mm,AIS was(9.7±2.9)mm and which of MIA was(12.1±3.8)mm.The average CT value of AAH was–(592.2±60.1)Hu,AIS was–(510.5±135.5)Hu and which of MIA was–(408.9±127.4)Hu.Among CT morphology features,AAH showed pure ground-glass opacity(pGGO),the percentage of mixed ground-glass opacity(mGGO)in AIS and MIA was 20.9%and 48.8%respectively.The pleural indentation and tumor microangiogram sign was not showed in AAH.The percentage of them in AIS and MIA were rising gradually which was 69.8%in MIA.Conclusion:There is relatively difficult to distinguish AAH from AIS with CT morphology features.The MIA morphology appearances have some extent characteristics.The integrated imaging features should be considered as diagnosing of specific cases.The single feature which to be a differential diagnosis method is not advisable.

关 键 词：肺腺癌 诊断 回顾性分析 CT 

分 类 号：R734.5[医药卫生—肿瘤] R445.3[医药卫生—临床医学]