3 cm以下肺腺癌MDCT影像学特征与不典型病例分析  

Analysis of MDCT imaging characteristics and the atypical manifestations of early lung adenocarcinoma with diameter less than 3 cm

作　　者：徐寅生[1] 徐大林[2] 邓之亚 张子林[1] 张海青[1] 汪大武 XU Yin-sheng;XU Da-lin;DENG Zhi-ya;ZHANG Zi-lin;ZHANG Hai-qing;WANG Da-wu(Department of Radiology,People's Hospital of Lujiang County,Hefei,Anhui 231500,China;Department of Respiratory and Critical Care Medicine,People's Hospital of Lujiang County,Hefei,Anhui 231500,China)

机构地区：[1]庐江县人民医院影像科,安徽合肥231500 [2]庐江县人民医院呼吸与危重症科,安徽合肥231500

出　　处：《临床肺科杂志》2021年第11期1719-1723,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的分析早期肺腺癌的多层螺旋CT(multi-detector computed tomography, MDCT)影像学特征和不典型影像表现以提高对早期肺腺癌的认识。方法回顾性分析2016年1月至2020年12月在我院经CT检查首次发现病灶直径小于3cm疑似早期肺癌,并经手术病理证实为原位腺癌、微浸润及T1期浸润肺腺癌。分析病灶的大小、形状、内部质地、瘤肺界面、空泡、囊腔、牵拉性支气管扩张、胸膜牵拉线、胸膜凹陷征、血管穿行、实性部分强化等征象。结果本组68例患者共76个肺腺癌病灶(11例原位腺癌,25例微浸润腺癌,32例T1期浸润性腺癌)。单一的影像特征分析比较显示:质地、边缘和胸膜牵拉线在不同腺癌病灶之间发生率,差别有统计学意义(P<0.05),而空泡征、囊腔形成、牵拉性支扩、胸膜凹陷征、血管增粗征、月牙征和极度强化等发生率差别均无统计学意义(P>0.05)。结论早期肺腺癌病灶最大径与质地对于鉴别AIS、MIA、IAC价值较高;少见影像征象和征象陷阱的识别,对于提高不典型早期肺腺癌诊断准确性有着重要意义。Objective To analyze the multi-detector computed tomography(MDCT) imaging characteristics and the atypical manifestations of the early lung adenocarcinoma, and to enhance the understanding of early lung adenocarcinoma. Methods A retrospective analysis was performed on patients treated in our hospital from January 2016 to December 2020. All the patients were with suspected signs of early lung cancer(diameter <3 cm) under the first CT scanning examination and were pathologically confirmed as adenocarcinoma in situ, microinvasive adenocarcinoma, and T1 stage invasive lung adenocarcinoma. The size, shape, texture, and signs such as tumor-lung interface,vacuoles, cysts, traction bronchiectasis, pleural stretch lines, pleural depression, vascular penetration, and solidpart enhancement of the lesions were further analyzed.Results 76 lung adenocarcinoma lesions were found in 68 patients(11 cases with adenocarcinoma in situ, 25 cases with microinvasive adenocarcinoma, and 32 cases with T1 invasive adenocarcinoma). Analysis and comparison of single image features showed that: the incidence of texture,margin, and pleural stretch lines were statistically different between the different adenocarcinoma lesions(P<0. 05), while the incidence of vacuole sign, cyst formation, traction branch expansion, pleural depression, vascularthickening, crescent sign, and extreme enhancement bear showed no significant difference(P> 0. 05).Conclusion The maximum diameter and internal texture of early-stage lung adenocarcinoma lesions demonstrated a high value indifferentiating diagnosis of AIS, MIA, and IAC. In addition, the identification of rare signs and sign traps is of greatsignificance for improving the accuracy of the diagnosis of atypical early lung adenocarcinoma.

关 键 词：原位腺癌 微浸润腺癌 T1期浸润性腺癌 CT征象 

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