CT形态学特征在多原发性肺癌及腺体前驱病变不同病理学分型中的价值  

The Significance of CT Morphological Features Across Various Pathological Classifications of Multiple Primary Lung Cancer and Precursor Glandular Lesions

作　　者：徐文北 邱慎满 王梓又 鲍毓 孙潇楠 唐鑫 张磊 丁涛 孟闫凯 徐凯 XU Wenbei;QIU Shenman;WANG Ziyou;BAO Yu;SUN Xiaonan;TANG Xin;ZHANG Lei;DING Tao;MENG Yankai;XU Kai(Department of Radiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221004,China;School of Imaging,Xuzhou Medical University,Xuzhou 221004,China;Jiangsu Medical Imaging and Digital Medical Engineering Research Center)

机构地区：[1]徐州医科大学附属医院医学影像科,徐州221004 [2]徐州医科大学医学影像学院,徐州221004 [3]江苏省医学影像与数字医学工程研究中心

出　　处：《中国医学计算机成像杂志》2024年第2期161-167,共7页Chinese Computed Medical Imaging

基　　金：江苏省医学会伦琴影像科研专项资金项目(SYH-3201150-0013);徐州市科学技术局重点研发计划(社会发展)(KC20159);江苏省中医药科技发展计划项目(MS2021100);江苏省卫生健康委老年健康科研项目(LKM2022018)。

摘　　要：目的:分析多原发性肺癌(MPLC)及腺体前驱病变的临床影像学特征,探讨CT形态学特征在不同病理学分型中的差异。方法:回顾性分析83枚结节经手术病理证实的患者临床及影像学资料。结节的影像学特征由人工智能肺结节分析软件自动获得,并由影像科医生再次进行人工评估。评估的内容包括结节在肺内的分布、最大径、密度、边缘(毛刺、分叶)、内部有无空腔、胸膜牵拉及肿瘤的T分期和N分期。采用SPSS 22.0软件对数据进行统计分析。采用单因素方差分析比较不同病理学类型病灶最大径的差异,卡方检验比较不同病理类型CT形态学特征(结节类型、毛刺征、分叶征、胸膜牵拉、空腔)的差异。结果:37例患者中,女性占70.27%;仅有3例(8.11%)有吸烟史,所有患者均不合并肺气肿。29例(78.38%)患者具有2枚结节,8例(21.62%)患者同时检出2枚以上结节。所有病灶均为T1N0期。仅有4例(20.00%)患者癌胚抗原(CEA)水平升高。不典型腺瘤样增生(AAH)、原位腺癌(AIS)、微浸润腺癌(MIA)、浸润性腺癌(IAC)这四种不同病理学类型中,病灶最大径分别为(4.83±0.98)mm、(6.72±2.35)mm、(9.46±4.04)mm和(17.06±5.65)mm,差异有统计学意义(P=0.000)。纯磨玻璃结节(pGGN)、混合磨玻璃结节(mGGN)在不同病理类型间差异均有统计学意义(P值分别为0.000、0.006)。形态学特征中病灶毛刺征、分叶征、胸膜牵拉、空腔在四种不同病理类型组间差异均有统计学意义(P值均为0.000)。结论:MPLC及腺体前驱病变具有一定的临床影像学特征,利用病灶内是否含有磨玻璃密度及其形态学特征能够对病灶的病理学类型进行初步判断。Purpose:To analyze the clinical and imaging characteristics of multiple primary lung cancer(MPLC)and precursor glandular lesions,and to explore the variances in CT morphological features across different pathological classifications.Methods:A retrospective analysis was conducted on the clinical and imaging data of 83 nodules confirmed by surgical pathology.The imaging characteristics of the nodules were initially determined using artificial intelligence(AI)pulmonary nodule analysis software and subsequently reassessed by a radiologist.Evaluated parameters included the nodules'distribution across lung lobes,maximum diameter,density,margin(spiculation and lobulation),presence of airspaces,pleural retraction,and T and N staging.Data analysis was performed using SPSS 22.0 software.Univariate analysis of variance was used to assesse the differences in maximum diameters across different pathological types,while the χ^(2) test was used to evaluate the disparities in CT morphological features(nodule type,spiculation,lobulation,pleural retraction,airspace)among these types.Results:Females comprised 70.27% of the patient cohort.Only 3 out of 37 patients(8.11%)had a smoking history,and none had emphysema.Twenty-nine(78.38%)presented with two nodules,while eight(21.62%)exhibited more than two.All lesions were classified as T1N0 stage.Serum carcinoembryonic antigen(CEA)levels were elevated in only 4(20.00%)patients.The maximum lesion diameters for atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),minimally invasive adenocarcinoma(MIA),and invasive adenocarcinoma(IAC)were(4.83±0.98)mm,(6.72±2.35)mm,(9.46±4.04)mm,and(17.06±5.65)mm,respectively,with a statistically significant difference(P=0.000).Significant differences were noted in pure ground-glass nodule(pGGN)and mixed ground-glass nodule(mGGN)across the pathological types(P=0.000 and P=0.006,respectively).Morphological features like spiculation,lobulation,pleural retraction,and airspace varied significantly across the pathological groups(P=0.000).Conclu

关 键 词：多原发肺癌 腺癌 计算机体层成像 分层 

分 类 号：R816.41[医药卫生—放射医学]