HRCT多征象及其联合应用在表现为GGNs的同时性多原发肺癌中的诊断价值  

The Value of HRCT Imaging Features in Diagnosing Multiple Primary Lung Cancer Presenting with GGNs

作　　者：于喜红[1] 杨瑞[1] 刘继伟[1] YU Xihong;YANG Rui;LIU Jiwei(Department of Radiology,Henan Provincial Chest Hospital,Zhengzhou University,Zhengzhou 45000,China)

机构地区：[1]河南省胸科医院(郑州大学附属胸科医院)医学影像科,郑州450000

出　　处：《中国医学计算机成像杂志》2023年第4期367-373,共7页Chinese Computed Medical Imaging

摘　　要：目的:探讨高分辨CT(HRCT)不同征象及其联合应用在表现为磨玻璃结节(GGNs)的同时性多原发肺癌(SMPLC)中的诊断价值。方法:收集我院行HRCT检查、影像表现为GGNs且可疑SMPLC患者资料共114例261枚结节,对每枚结节的HRCT征象和部位进行分析,并与病理进行对照,计算结节的HRCT征象及联合应用诊断肺癌结节的灵敏度、特异度、阴性预测值、阳性预测值、准确度,并与炎性结节的HRCT征象进行比较。结果:114例中确诊SMPLC 94例(肺癌结节208枚,炎性结节51枚,转移瘤2枚);肺癌结节的单一HRCT征象中,边缘清晰完整征的阳性预测值、准确度、阴性预测值最高(分别为93.3%、89.6%、74.0%),胸膜凹陷征、毛刺征的特异度最高(均为98.4%),胸膜凹陷征阳性预测值最高(96.8%);2个征象联合中,血管造影征+边缘完整清晰征的阳性预测值、特异度、准确度均最高(分别为97.3%、90.2%、86.1%),3个及以上征象联合中血管造影征+边缘完整清晰征+其他任何一项的阳性预测值、特异度均最高(分别为98.6%、96.1%);且与51枚炎性结节单一征象或多征象联合具有统计学差异(P<0.05);SMPLC女性发病率明显高于男性,且50~59年龄段女性为发病高峰期。结论:HRCT表现为GGNs,其中2枚及以上结节均具有原发肺癌的征象是诊断SMPLC的基础;结节的血管造影征、边缘完整清晰征单一征象应用在原发肺癌结节诊断中具有较高的灵敏度,但仍具有误诊风险;血管造影征+边缘完整清晰征或+其他征象(空泡征、分叶征、胸膜凹陷征、毛刺征)中的任何一项或多项可提高肺癌结节诊断的特异度,减少误诊的发生;50~59岁女性为高危人群,对其应提高警惕及加强筛查。Purpose:To explore the value of high resolution(HRCT)features in diagnosing simultaneous multiple primary lung cancer(SMPLC)presenting with ground-glass nodules(GGNs).Methods:The HRCT features and the distribution of 261 nodules presenting as GGNs in 114 patients suspected with multiple primary lung cancer were retrospectively analyzed.The features included the angiogram sign,the well-defined margin sign,the vacuole sign,the marginal lobulation sign,the pleural indentation sign and the marginal spicule sign.According to the pathological results,the sensitivity,specificity,negative predictive value,positive predictive value,and accuracy with different CT features pattern were evaluated and compared with the HRCT signs of the inflammatory nodule.Results:Of the 114 cases,94 cases of confirmed SMPLC were identified(of which 16 cases were removed≥3 nodules);Among the 261 nodules,107 were invasive adenocarcinomas,95 were microinvasive adenocarcinomas,3 were carcinoma in situ,3 were atypical adenomatoid hyperplasia,51 were inflammatory nodules and 2 were metastases.For the single HRCT sign of 208 lung cancer nodules,the positive predictive value,accuracy and negative predictive value of the well-defined margin sign were the highest(93.3%,89.6%,and 74.0%,respectively),the specificity of the pleural indentation sign and the spicule sign were the highest(both 98.4%),and the positive predictive value of the pleural indentation sign was the highest(96.8%).For the combination of two signs,the positive predictive value,specificity,and accuracy of the angiographic sign and the well-defined margin sign were the highest(97.3%,90.2%,and 86.1%,respectively),and the positive predictive value and specificity of the combination of three or more signs with the angiography sign,well-defined margin sign with any other signs were the highest(98.6%and 96.1%,respectively).The morbidity of female in SMPLC was significantly higher than that of male,accounting for 84.0%,and women in the 50-59 age group were the peak,accounting for 43.6%.Conc

关 键 词：肺肿瘤 高分辨CT 磨玻璃结节 同时性 多发性 原发性 

分 类 号：R445.3[医药卫生—影像医学与核医学]