目的 回顾分析最大径≤2cm小 结节肺癌的多层螺旋CT(multi spiral computed tomography, MSCT)表现与病理 亚型间的相关性，试从影像学角度来评估 其侵袭性，指导治疗与随访。方法 收集 整理2014年1月-2016年12月我院经手术 病理证实、有完整MSCT资料的肺癌(非小 细胞癌)患者95例共97个肺结节(最大径 ≤2cm)，按病理亚型将不典型腺瘤样增生 和原位腺癌计38个结节归为低侵袭性组， 将微浸润腺癌、浸润性腺癌、鳞癌、大细 胞癌计59个结节归为高侵袭性组，归类分 析两组病灶的MSCT特征，进行统计学分 析。结果 高侵袭性组中病灶最大径、实 性成分比例、分叶征、血管集束征、胸膜 凹陷征出现率高于低侵袭性组，两组间 的差异存在统计学差异(P<0.05)，而病 灶形状、病灶边界、空泡征、支气管充 气征和毛刺征在两组间差异无统计学意 义(P>0.05)。ROC曲线分析病灶最大径分 割值为10.2mm，灵敏度和特异度分别为 72.9%和81.6%。实性成分比例的分割值为 37.4%，灵敏度和特异度分别为84.7%和 81.5%。结论 小结节肺癌的一些MSCT征象 有助于鉴别其不同侵袭性，当病灶最大径 >10.2mm，实性成分比例>37.4%时，提示 其可能已具有较高侵袭性。

Objective To evaluate the predicted value of low-invasive pulmonary nodules and high-invasive lesions(≤2cm in maximal diameter) by analyzing the correlations between MSCT signs and its histopathologic subtypes. Methods The MSCT signs and pathology data of 95 patients (97 lesions) were enrolled in this study. Among which 33 nodules were low-invasive lesions and 58 nodules were high-invasive lesions. The relationships between MSCT signs and histopathologic subtypes were analyzed by using fisher's exact test and receiver operating characteristic curve. Results The analysis of 97 lesions showed that there were statistically significant difference between low-invasive lesions and high-invasive lesions, among tumor maximal diameter, the proportion of solid lesions, lobulation, vascular convergence, pleura indentation(P<0.05). ROC analysis showed that the threshold was 10.2mm in maximal diameter, and the sensitivity and specificity of differential diagnosis was 72.9% and 81.6%.The proportion of solid lesions was 37.4%, and the sensitivity and specificity of differential diagnosis was 84.7% and 81.5%. Conclusion The tumor maximal diameter, the proportion of solid lesions, lobulation, vascular convergence and pleura indentation may help to differentiate the invasiveness of lung cancer presenting as small nodules.