同时多原发肺腺癌与肺腺癌伴肺内转移CT鉴别诊断及临床预后评估  

CT Differential Diagnosis and Clinical Prognosis Evaluation of Synchronous Multiple Primary Lung Adenocarcinomas and Lung Adenocarcinoma with Intrapulmonary Metastases

作　　者：寇介丽 刘娜 杨枫 刘桃桃 李丹萍 韩君蕊 杨立洲 KOU Jie-li;LIU Na;YANG Feng;LIU Tao-tao;LI Dan-ping;HAN Jun-rui;YANG Li-zhou(Department of CT Radiology,Cangzhou People's Hospital,Cangzhou 061000,Hebei Province,China)

机构地区：[1]沧州市人民医院CT放射科,河北沧州061000

出　　处：《中国CT和MRI杂志》2025年第4期61-64,共4页Chinese Journal of CT and MRI

基　　金：沧州市重点研发计划指导项目(222106039)。

摘　　要：目的分析CT对同时多原发肺腺癌(MPLAs)与肺腺癌伴肺内转移(IPMs)鉴别诊断及临床预后评估价值。方法选取2010年1月至2018年12月本院收治的103例行外科手术治疗的多发性肺腺癌患者,根据组织学评估标准将入组患者分为原发组(MPLAs患者,n=64)和转移组(IPMs患者,n=39),比较两组影像配对类型,分析两组主病灶和伴随病灶的CT表现(大小、磨玻璃成分、形态、分叶、边界、毛刺、空泡征、胸膜牵拉和胸膜贴邻),分析不同磨玻璃结节和实性结节数量与多发性肺腺癌患者生存预后的相关性。结果结合组织病理学结果分为MPLAs和IPMs,分别纳入原发组(n=64)和转移组(n=39),两组间纯磨玻璃结节(pGGN+pGGN)、纯磨玻璃结节+混合磨玻璃结节(pGGN+mGGN)、混合磨玻璃结节(mGGN+mGGN)、混合磨玻璃结节+实性结节(mGGN+SN)、均为实性结节(SN+SN)类型比较差异具有统计学意义(P<0.05),原发组病灶多数含有磨玻璃成分,转移组均含有SN;转移组主病灶总体长径、实性成分长径大于原发组主病灶(P<0.05),两组主病灶磨玻璃成分、贴邻胸膜情况比较差异具有统计学意义(P<0.05),见表2;原发组伴随病灶70个,转移组伴随病灶43个,转移组伴随病灶总体长径小于原发组,实性成分长径大于原发组主病灶(P<0.05),两组伴随病灶磨玻璃成分、形态、分叶、边界、空泡、胸膜牵拉、贴邻胸膜情况比较差异具有统计学意义(P<0.05);经COX回归分析显示,实性病灶、主病灶贴邻胸膜、肺腺癌伴肺内转移为多发性肺腺癌生存预后的独立危险因素(P<0.05)。结论CT的影像学特征可用于鉴别MPLAs和I P M s,M P L As以含磨玻璃成分的病灶多见,IPMs以实性成分病灶为主,实性成分、主病灶贴邻胸膜、肺腺癌伴肺内转移为多发性肺腺癌生存预后的独立危险因素。Objective To analyze the evaluated value of CT in the differential diagnosis and clinical prognosis evaluation of simultaneous multiple primary lung adenocarcinomas(MPLAs)and lung adenocarcinoma with intrapulmonary metastases(IPMs).Methods A total of 103 patients with multifocal lung adenocarcinomas(MLAs)who underwent surgical treatment in the hospital were selected from January 2010 to December 2018 as the study subjects.According to the comprehensive histological evaluation criteria,the enrolled patients were divided into primary group(MPLAs patients,n=64)and metastatic group(IPMs patients,n=39).The image matching types of the two groups were compared,and the CT manifestations of the main lesions and accompanying lesions(size,ground glass composition,morphology,lobulation,boundary,spicule sign,vacuole sign,pleural traction and pleural attachment)were analyzed.The correlation between the number of different ground glass nodules and solid nodules and the survival prognosis of patients with MLAs was analyzed.Results Combined with histopathological results,MPLAs and IPMs were divided into primary group(n=64)and metastatic group(n=39).There were statistically significant differences in the types of pure ground glass nodules(pGGN+pGGN),pure ground glass nodules+mixed ground glass nodules(pGGN+mGGN),mixed ground glass nodules(mGGN+mGGN),mixed ground glass nodules+solid nodules(mGGN+SN),and all solid nodules(SN+SN)between the two groups(P<0.05).Most of the lesions in the primary group contained ground glass composition,and the metastatic group contained SN.The overall long diameter of the main lesion and the long diameter of the solid component in metastatic group were larger than those in primary group(P<0.05).There were statistical differences in the ground glass composition and adjacent pleural conditions of the main lesions between the two groups(P<0.05),as shown in table 2.There were 70 accompanying lesions in the primary group and 43 accompanying lesions in the metastatic group.The overall long diameter of the ac

关 键 词：肺腺癌 同时多原发 肺转移 CT 鉴别诊断 

分 类 号：R563[医药卫生—呼吸系统]