摘要：
目的 分析≤1 cm肺纯磨玻璃结节(pGGN)病灶的CT影像特点,探讨多层螺旋CT(MSCT)在≤1 cm肺pGGN浸润性腺癌与浸润前病变鉴别诊断中的价值.方法 选择邯郸市第一医院2012年1月至2016年8月收治的103例≤1 cm肺pGGN患者,手术后确认103例pGGN病灶中浸润前病变67例(浸润前组),包括不典型腺瘤样增生28例、原位腺癌39例;浸润性病变36例(浸润组)包括微浸润腺癌21例、浸润性腺癌15例.对所有患者进行MSCT扫描,比较不同病理类型病灶的部位、大小、CT值、内部密度、病灶边缘、周围血管情况和瘤肺界面,并绘制浸润性病变和浸润前病变大小的受试者工作特征曲线,分析鉴别两种性质pGGN大小的界值.结果 浸润前组与浸润组的病变部位(x2=0.529,P=0.746)、空泡征(x2=1.581,P=0.209)、支气管充气征(x2=1.639,P=0.201)、病灶边缘(x2=0.614,P=0.722)差异均无统计学意义;而浸润组肺瘤界面清楚所占比例高于浸润前组(86.11％∶44.78％,x2=16.568,P＜0.001).在病灶与肺内血管的关系分类中,浸润组Ⅰ型所占百分比低于浸润前组(5.56％∶41.79％,x2=14.894,P ＜0.001),Ⅲ型所占百分比高于浸润前组(38.89％∶1.49％,x2=26.320,P＜0.001).浸润组病灶平均最大径[(0.85 ±0.17)cm]大于浸润前组[(0.76 ±0.16) cm],差异有统计学意义(t =2.663,P=0.009).鉴别浸润前和浸润性病变大小的最大径界值为0.81 cm,其敏感性和特异性分别为62.1％和63.5％,曲线下面积为0.622.结论 在≤1 cm肺pGGN中,浸润性病变病灶较大,肺瘤界面更为清楚,与周围血管的关系分型Ⅲ型所占比例较大,MSCT可呈现病灶的上述影像学特点在≤1 cm肺pGGN浸润性腺癌与浸润前病变鉴别诊断中具有重要价值.%Objective To analyze CT imaging features of lung pure ground-glass nodule (pGGN) of 1 cm or less,and to discuss the differential diagnosis value of multi-slice spiral CT (MSCT) of lung pGGN of 1 cm or less in lung infiltrating adenocarcinoma and before infiltration.Methods A total of 103 patients with lung pGGN≤ 1 cm admitted to the First Hospital of Handan from January 2012 to August 2016 were selected.Of the 103 lung pGGN lesions,there were 67 preinvasive lesions (the preinvasive lesion group) confirmed by operation,including 28 atypical adenomatous hyperplasia and 39 adenocarcinoma in situ.There were 36 invasive lesions (the infiltration group),including 21 minimally invasive adenocarcinoma and 15 invasive adenocarcinoma.All the patients underwent MSCT scanning,and the lesion location,size,CT value,internal density,edge,peripheral vessel and lung-tumor interface were compared between the two pathological types.The receiver operating characteristic curves of the size of the infiltrating lesion and before infiltration were drawn,and the boundary values of the size of the two kinds of pGGN were analyzed and identified.Results The differences of the lesion location (x2 =0.529,P =0.746),vacuole sign (x2 =1.581,P =0.209),aerated bronchus sign (x2 =1.639,P =0.201),edge of the lesion (x2 =0.614,P =0.722) between the two groups were not statistically significant.The proportion of clear lung-tumor interface in infiltration group was higher than that in preinvasive lesion group (86.11％ vs.44.78％;x2 =16.568,P ＜0.001).The proportion of type Ⅰ in the classification of pulmonary vascular relationships in infiltration group was lower than that in preinvasive lesion group (5.56％ vs.41.79％;/x2 =14.894,P ＜0.001),and the proportion of type Ⅲ in infiltration group was higher than that in preinvasive lesion group (38.89％ vs.1.49％;x2 =26.320,P ＜ 0.001) The average maximum diameter of the infiltration group [(0.85 ± 0.17) cm] was greater than that of the preinvasive lesion group [(0.76 ± 0.16) cm],and the difference was statiscally significant (t =2.663,P =0.009).The boundary value to identify the size of the preinvasive and invasive lesions was 0.81 cm,and its sensitivity and specificity rates were 62.1％ and 63.5 ％,and the area under the curve was 0.622.Conclusion Of lung pGGN ≤ 1 cm,invasive lesions are larger,lung-tumor interface is more clear,and the proportion of type Ⅲ in the classification of pulmonary vascular relationships is bigger.MSCT can present the above imaging characteristics of lesions,and it has the important value in differential diagnosis of lung pGGN ≤ 1 cm in infiltrating adenocarcinoma and before infiltration.
