摘要
目的研究磨玻璃结节（GGN）与支气管的关系及其类型，并探讨其诊断价值。方法采用MSCT对117例，共127个GGN（分为肺浸润性腺癌组68个、浸润前病变组15个、良性组44个）进行扫描，在横断面和MPR图像上观察GGN的分布、实性成分的含量及其与支气管的关系。按照CT图像上病灶内实性成分所占比例将GGN分为3类，A类为纯GGN；B类为磨玻璃成分76％～99％的混合GGN；C类为磨玻璃成分50％～75％的混合GGN。将GGN与支气管的关系分为5型：Ⅰ型：支气管在GGN中被实性成分截断；Ⅱ型：支气管在GGN实性成分扭曲、扩张；Ⅲ型：支气管在GGN的磨玻璃区扭曲、扩张；Ⅳ型：支气管在磨玻璃区走形正常；Ⅴ型：支气管在病灶旁边绕行，未进入病灶内部。采用SPSS16．0进行统计学分析，计量资料采用独立样本t检验；计数资料采用Pearson X^2检验，当有理论数〈1或所得概率接近检验水平时，采用Fisher确切概率算法检验；对GGN中磨玻璃成分及其与支气管类型用Spearman检验进行相关性分析，以P〈0．05为差异有统计学意义。结果（1）GGN与支气管关系的类型与其所在肺野无关，差异无统计学意义（浸润性腺癌组、浸润前病变组及良性组P值均〉0．05）。（2）3组GGN与支气管是否存在关系之间的差异有明显统计学意义（X^2=36．32，P〈0．01）。（3）GGN与支气管关系显示为Ⅰ型时，浸润性腺癌组、浸润前病变组及良性组分别为14、0、0个；Ⅱ型在3组中分别为25、0、3个；Ⅲ型在3组中分别为10、0、2个；Ⅳ型在3组中分别为8、1、12个；Ⅴ型在3组中分别为1、0、9个，差异有统计学意义（P〈0．01）。浸润性腺癌组以Ⅰ、Ⅱ型多见；浸润前病变组多与支气管无关系；良性组以Ⅳ、Ⅴ型多见。（4）CT图像上病灶内实性成分比例，A-C类分别为17、19、49个，病灶内磨玻璃成分含量与支气管分型间存在相关性（r=-0．546，P〈0．01）。结论不同类型GGN与支气管所显示的关系不同，综合分析病灶内磨玻璃成分的含量，对GGN的定性诊断有一定帮助。
Objective To investigate the relationships and types between pulmonary ground glass nodules（GGN） and bronchi and explore its value in diagnosis. Methods One hundred and twenty-seven GGN lesions were reviewed after （include 68 lesions of pulmonary adenocareinoma, 15 lesions were preinvasive lesions and 44 benign lesions） with MSCT. It was observed that lesion distribution, content of solid components and relationships between GGNs and bronchi both in axial images and muhi-planar reformation （ MPR ） images. The lesions were divided to three types according to the ratio of ground glass opacity. Type A was pure GGN. Type B was mixed GGN which contain 76% to 99% of ground glass opacity content. Type C was mixed GGN which contain 50% to 75% ground glass opacity content. The relationships between GGN and bronchi were divided into five types. Type Ⅰ： The bronchi were ＂cutoff＂ in the solid part of GGN. Type Ⅱ ： The bronchi were distortion and extension in the solid parts of GGN. Type Ⅲ ： The bronchi were distortion and extension in the GGO parts of GGN. Type Ⅳ ： The bronchi were normal course in the GGO parts of GGN. Type Ⅴ ： The bronchi were circumvent GGN lesions. SPSS16. 0 software was used for statistical analysis, measurement data using independent t test, measurement data using Pearson X^2 test; when there was a theory number 〈 1 or income probability close to test level, then using Fisher＇s exact test, Spearman rank correlation were used for analyze the content of ground glass in GGN and its relationship with the bronchial type. It was considered to be statistically significant when P value less than 0. 05. Results （ 1 ） There was no significant statistic significance about lesion＇ s location among 3 groups. The P value of group of invasive adenocarcinoma, preinvasive group and benign group were 1.000, 1.000, 0. 817 respectively. （2） The incidence of having relationships between GGN and bronchi were significant statistic significance among 3 groups（X^2 = 36.32 ,P 〈 0. 01 ）. （ 3 ） There were 14 cases of group of invasive adenocarcinoma,0 case of preinvasive group ,0 case of benign group when the relationship between GGN and bronchi were type Ⅰ. There were 25 cases of group of invasive adenocarcinoma ,0 case of preinvasive group, 3 cases of benign group when the relationship between GGN and bronchi were type Ⅱ. There were 10 cases of group of invasive adenocarcinoma,0 case of preinvasive group,2 case of benign group when the relationship between GGN and bronchi were type Ⅲ. There were 8 cases of group of invasive adenocarcinoma, 1 case of preinvasive group, 12 cases of benign group when the relationship between GGN and bronchi were type Ⅳ . There was l case of group of invasive adenocarcinoma,0 case of preinvasive group,9 case of benign group when the relationship between GGN and bronchi were type Ⅴ. There was significant statistic significance among 3 groups of relationships between GGN bronchi （ P 〈 0. 01 ） . The relationships between GGN and bronchi of adenocarcinomas most manifest as type I and type Ⅱ. There were no relationships with bronchi of most preinvasive lesions. The relationships between GGN and bronchi of benign lesions most manifest as type IV and type Ⅴ. （4） It was divided into 3 categories according to different proportion of solid components in CT images. There were 17,19 and 49 cases in Category A, B, C respectively, and the difference of GGO percentage among different categories with the relationships between GGN and bronchi were correlation statistic significance （ r = - 0. 546, P 〈 0. 01 ） . Conclusions There were different manifestations of relationships between GGN and bronchi in different kind of lesions. It may help to differential diagnosis through comprehensive evaluate the content of GGO area of lesions.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2013年第2期157-161,共5页
Chinese Journal of Radiology
基金
上海市科委重点基金资助项目（10411952600）
