论著-头颈部
MSCT探讨肺局灶性 磨玻璃结节与其微 小血管的关系*
作者:毛伍兵1 李水连1 张英俊2
所属单位:1.广东省中山市中医院CT室 (广东 中山 528400) 2.湖南医药学院医学影像系 (湖南 怀化 418000)
PDF摘要
目 的 研究肺内磨玻璃结节 (ground-glass opacity,GGN)与微小血管 的关系及类型,探讨多层螺旋CT(MSCT)对 其诊断价值。方法 回顾性分析经病理或 临床证实的45例GGN的CT图像。将GGN与微 小血管的关系分为5型:Ⅰ型,血管从旁 绕行未进入GGN内部;Ⅱ型血管走行于病 灶内,无增粗、扭曲、僵直及分出微小血 管;Ⅲ型,单支血管伸入病灶,且病灶内 血管增粗、扭曲及僵直;Ⅳ型,一支血管 进入病灶且发出微小血管;Ⅴ型,2支或 以上血管进入病灶形成的微小血管,且相 与联通。对GGN的病理类型进行统计学分 析。结果 45例GGN炎症2例;非典型腺瘤 样增生4例;原位腺癌7例;微浸润腺癌11 例;浸润性腺癌21例。45例GGN 与微小 血管的关系5种类型(Ⅰ-Ⅴ)分别为3、3、 12、11、16例,其中Ⅴ型最多。16例Ⅴ型 的均为浸润性腺癌;11例Ⅳ型中浸润性腺 癌8例。Ⅳ型+Ⅴ型为浸润性腺癌的可能性 较大。三组GGN病理(炎症组、浸润前病变 组、浸润性腺癌组)与微血管关系比较有 统计学意义(P<0.001)。结论 不同病理 类型的GGN与微小血管的关系不同,对GGN 的性质判定有一定帮助。
Objective To investigate the relationships and types between pulmonary ground glass nodules (GGNs) and microvessel, and explore its value in diagnosis. Methods To study retrospectively the MSCT images of 45 cases proved by operation, pathology or clinical materials. The relationships between GGN and microvessel were divided into five types. Type I: The vessel were circumvent GGN lesions.Type lI: the ovessel were normal course in the GGO. TypeⅢ: The ovessel was distortion and extension in the GGN. TypeⅣ: the vessel reached into and gived off branches in the GGO. TypeⅤ: 2 or more than 2 ovessels gived off branches and communicated with each other in the GGNs. The relationship type and pathologic of GGN were statistically analyzed. Results Of 45 GGNs ,2 were inflammation, 4 were atypical adenomatous hyperplasia (AAH), 7 were adenocarcinoma in situ (AIS), 11 were mininally invasive adenocarcinoma (MIS), 21 were invasive adenocarcinoma (IAC).Types Ⅰ-Ⅴmicrovessel relationships were observe in 3,3,12,11 and 16 GGNs.Type Ⅴ relationship was obvious one. All 16 cases of typeⅤwere IAC. There were 8 IAC, when the relationship between GGNs and microvessel. There was significant association between IAC and type ⅣandⅤof GGNs, according to statistical analysis. Statistical significance were found between 3 groups of pathology result(inflammation group, precancerosis ground, IAC ground) and microvessel(P <0.001). Conclusion There were different relationships between GGNs and microvessel. It is helpful for differential diagnosis by analyzing the relationships between GGNs and microvessel.
【关键词】局灶性磨玻璃结节;微小血 管;计算机体层成像
【中图分类号】R445.3;R734.2
【文献标识码】A
【DOI】 10.3969/j.issn.1672- 5131.2018.04.021
前言
在临床工作中越来越多的无症状肺结节被发现,其中部分为GGN。 GGN可见于良性和恶性病变,因此对它的定性诊断与鉴别诊断非常 重要。Henschke等[1]研究发现,GGN尤其肺混合性磨玻璃结节(mixde ground-glass nodule,mGGN)的恶性发生比率高于肺实性结节。国内 外有关GGN与支气管及血管关系的研究,但对于GGN内部微小血管研究 较少。本研究拟通过分析肺局灶性GGN与其内≤2mm微小血管的关系, 探讨其诊断价值。
中国CT和MRI杂志
第16卷, 第 4 期
2018年04月
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