姜海波

基于螺旋CT影像的肺部毛玻璃結(jié)節(jié)的診斷價(jià)值

姜海波

目的探討基于螺旋CT影像的肺部毛玻璃結(jié)節(jié)(pulmonary ground glass opacity nodule，GGO)的診斷價(jià)值。方法采用回顧性研究方法，選擇肺部毛玻璃結(jié)節(jié)患者58例作為研究對(duì)象，根據(jù)良惡性分為2組。觀察2組的病灶界面、病灶邊緣、病灶的形態(tài)、病灶大小及GGO的鄰近結(jié)構(gòu)。結(jié)果2組中病灶大小、病灶邊緣、病灶形態(tài)、病灶界面例數(shù)對(duì)比，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)；良性病變組的胸膜凹陷者0例，胸膜增厚者27例；惡性病變組的胸膜凹陷者16例，胸膜增厚者15例，2組對(duì)比有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論多層螺旋螺旋CT可作為肺部毛玻璃結(jié)節(jié)良惡性的診斷方法。

螺旋CT影像；毛玻璃結(jié)節(jié)；良性；惡性；診斷價(jià)值

(ThePracticalJournalofCancer,2017,32:1657～1658)

肺部毛玻璃結(jié)節(jié)(pulmonary ground glass opacity nodules，GGO)是指CT圖像上表現(xiàn)為內(nèi)部有支氣管、血管紋理顯現(xiàn)的淡薄密度增高影的1種肺部影像學(xué)表現(xiàn)[1-2]。有研究表明，肺部CT持續(xù)時(shí)間較長(zhǎng)的磨玻璃結(jié)節(jié)提示惡性病變的可能性較大，如細(xì)支氣管肺泡癌、腺癌或不典型腺瘤樣增生等病理類型[3-4]；如果CT下的磨玻璃結(jié)節(jié)中發(fā)現(xiàn)實(shí)性成分，表明惡性病變可能性較大[2,5]。研究GGO患者的CT診斷對(duì)于早期肺癌的早發(fā)現(xiàn)、早治療，改善患者預(yù)后具有重要應(yīng)用。本文探討了基于螺旋CT影像的肺部毛玻璃結(jié)節(jié)(GGO)的診斷價(jià)值?，F(xiàn)報(bào)告如下。

1 資料與方法

1.1 研究對(duì)象

采用回顧性研究方法，2012年2月到2017年3月選擇在我院診治的肺部毛玻璃結(jié)節(jié)患者58例作為研究對(duì)象，納入標(biāo)準(zhǔn)：臨床資料詳細(xì)；年齡20～80歲；研究得到醫(yī)院倫理委員會(huì)的批準(zhǔn)。排除標(biāo)準(zhǔn)：臟器穿孔、腸梗阻及其他肺部疾病；妊娠與哺乳期婦女；精神疾病患者。58例GGO中經(jīng)病理診斷良性病變者27例(腺瘤樣增生者12例，炎性15例)；惡性病變者31例(原位腺癌12例，微浸潤(rùn)腺癌8例，浸潤(rùn)腺癌11例)。58例中男性33例，女性25例；年齡23～78歲，平均年齡(49.11±4.93)歲；平均體重指數(shù)為(24.55±2.11)kg/m2。

1.2 CT檢查方法

所有患者都給予多層螺旋CT進(jìn)行檢查，選擇GE64排128層螺旋CT掃描機(jī)，患者雙臂上舉，頭先進(jìn)，掃描范圍從肺尖到肺底，包括胸壁和腋窩等部位，原始圖像采用標(biāo)準(zhǔn)薄層重建。掃描參數(shù)：層厚5 mm，層間隔5 mm，管電壓120 KV，螺距0.938：1，管電流220～250 mA，矩陣512×512，縱隔窗：窗寬360 HU、窗位60 HU；肺窗：窗寬1500 HU、窗位-700 HU。將掃描原始數(shù)據(jù)傳送至工作站做橫斷面進(jìn)行薄層重組和冠狀面、矢狀面多平面重組，重組圖像的層間距為1.25 mm，層厚為1.25 mm。

1.3 圖像分析

觀察所有患者的多層螺旋CT圖像，包括病灶的界面(清晰或模糊)、病灶的邊緣(光滑形、棘狀突起、刺狀)、病灶的形態(tài)(近圓形、分葉狀、斑點(diǎn)狀、不規(guī)則狀)、病灶大小(<0.9 cm；1.0～2.9 cm；>2.9 cm)。觀察GGO的鄰近結(jié)構(gòu)，觀察胸膜凹陷征和胸膜增厚癥。

1.4 統(tǒng)計(jì)方法

所有數(shù)據(jù)均通過統(tǒng)計(jì)軟件SPSS 20.0進(jìn)行統(tǒng)計(jì)處理，計(jì)數(shù)數(shù)據(jù)采用百分比表示，對(duì)比采用卡方χ2檢驗(yàn)，P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

2.1 2組臨床征象對(duì)比

2組病灶大小、病灶邊緣、形態(tài)、界面對(duì)比，差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)，見表1。

表1 2組臨床征象對(duì)比/例

2.2 2組鄰近結(jié)構(gòu)對(duì)比

良性病變的胸膜凹陷者0例，胸膜增厚者11例；惡性病變者胸膜凹陷者9例，胸膜增厚者7例，2組對(duì)比有統(tǒng)計(jì)學(xué)意義，χ2=16.722，P<0.05。

3 討論

GGO為肺部局灶性密度局限性增高，但遮蓋肺部的血管束、支氣管等卻因?yàn)槊芏炔粔蚨诓蛔?，出現(xiàn)磨玻璃樣式的一種影像學(xué)變現(xiàn)[1,6-8]。腫瘤性GGO病理基礎(chǔ)是腫瘤細(xì)胞沿肺泡間隔生長(zhǎng)，肺泡壁增厚，密度較淡的毛玻璃影表示尚未完全被癌組織填充的充氣肺組織，密度較高的片狀實(shí)性成分、結(jié)節(jié)為癌組織實(shí)變區(qū)，可由多種病變?cè)斐桑ㄏ倭鰳釉錾⒀仔?、腺癌、肺泡癌等，其在多層螺旋CT中顯示時(shí)，需注意采用低于2 mm的薄層CT掃描重建或薄層、小視野及重疊三方面的重建；觀察中應(yīng)注意用寬的肺窗觀察或中間窗觀察及深吸氣末掃描[9-10]。胸部X線對(duì)GGO顯示不明顯，表現(xiàn)為邊緣不清的陰影或結(jié)節(jié)。由于良惡性病變的臨床治療及預(yù)后大不相同，研究其病灶形態(tài)與CT征象的相關(guān)性有重要作用，可為判斷病灶的良惡性提供支持[11]。

2組病灶大小、病灶邊緣、形態(tài)、界面對(duì)比，差異有統(tǒng)計(jì)學(xué)意義。良性病變中<0.9 cm及0.9～2.9 cm的患者例數(shù)明顯高于惡性病變者。病灶的形態(tài)輪廓，如近圓形、分葉狀、斑點(diǎn)狀、不規(guī)則狀對(duì)疾病的良惡性診斷有重要價(jià)值，本文結(jié)果表明，良性病變者多為光滑圓形，惡性病變者多為分葉狀[11]。邊緣的特征及鄰近結(jié)構(gòu)，如光滑形、棘狀突或刺狀；邊緣模糊或清晰；鄰近結(jié)構(gòu)呈現(xiàn)凹陷征或胸膜增厚癥對(duì)GGO的良惡性診斷有重要作用，本文結(jié)果表明，良性病變者病變邊緣多為光滑狀，惡性病變者邊緣多為刺狀；良性病變中界面多為模糊，惡性病變者多為清晰。良性病變者可有胸膜增厚，惡性病變者可伴有胸膜凹陷，P均<0.05。

GGO疾病在多層螺旋CT上表現(xiàn)有助于判斷疾病的良惡性，提高了GGO疾病的診斷速度，為其后期治療提供了依據(jù)。多層螺旋螺旋CT可作為肺部毛玻璃結(jié)節(jié)良惡性的診斷方法。

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StudyontheDiagnosisValueofPulmonaryGroundGlassOpacityNodulesBasedonMultisliceSpiralCT

JIANGHaibo.

JiangduPeople’sHospitalofYangzhou,Yangzhou,225200

ObjectiveTo evaluate the diagnostic value of pulmonary ground glass opacity nodules(GGO) based on spiral CT images.Methods58 patients with pulmonary ground glass opacity nodules were selected as retrospective study.They were divided into 2 groups according to benign and malignant.The lesions interface,edge of lesions and lesions form,and the size of the lesions,proximity structure of the 2 groups were observed.ResultsThere were significant differences in lesions interface,edge of lesions,lesions form,and the size of the lesions,proximity structure between the 2 groups(P<0.05).The pleural indentation of benign lesion was 0,the pleural thickening was 27 cases;the pleural indentation of malignant lesions was 16 cases,the pleural thickening was 15 cases,which had significant differences between the 2 groups(P<0.05).ConclusionMultislice spiral CT images can be used as a diagnosis method for pulmonary ground glass opacity nodules of benign and malignant.

Spiral CT image;Pulmonary ground glass opacity nodules;Benign lesion;Malignant lesions;Diagnostic value

225200 江蘇省揚(yáng)州市江都人民醫(yī)院

10.3969/j.issn.1001-5930.2017.10.027

R734.2

A

1001-5930(2017)10-1657-02

2017-05-24

2017-08-03)

(編輯甘艷)