肺磨玻璃样病变高分辨率CT的质地分析及其对早期肺癌的诊断价值
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摘要
目的通过对CT表现出的肺磨玻璃样病变的支气管改变和纹理质地分析,认识早期肺癌的CT征象,提高对肺部磨玻璃样病变定性诊断的能力。方法回顾性分析肺部CT表现为磨玻璃样病变的89例患者资料,包括炎性病变28例,浸润前病变14例,肺癌47例,均经组织病理学或临床证实。在薄层高分辨率CT图像上对病变进行观察与分析,比较炎性病变、浸润前病变和肺癌的支气管改变、CT值的平均数及其差异性和纹理质地特点,数据经统计学处理。结果组织病理学证实本组磨玻璃样改变的肺癌均为早期阶段。28例炎性病变中,4例病变内表现为3型支气管改变、9例表现为4型、15例表现为5型;14例浸润前病变,1例表现为3型、3例表现为4型和10例表现为5型;47例肺癌中,35例表现为1~3型、5例表现为4型和7例表现为5型(χ~2=12,P=0.017<0.05)。在支气管表现为4型和5型的病变中,炎症的CT值平均数为-422.25 HU,浸润前病变为-558.36 HU,肺癌为-336.77 HU(F=30.25,P=0.00)。CT值的标准差,炎症为±112.54,浸润前病变为±78.80,肺癌为±155.85(F=24.92,P=0.00)。肺癌的CT值线性分布图中的相邻CT值排列明显不规则。病变内部纹理结构(质地):28例炎症病变,单一均质型和单一粗糙型分别为18例和9例,仅1例为混合质地型;14例浸润前病变,单一均质型、单一粗糙型和混合质地型依次为8例、2例和4例;47例肺癌中,40例为混合质地型,仅3例为单一均质型,4例为单一粗糙型(χ~2=12,P=0.018,<0.05)。结论不同类型病变的磨玻璃改变在CT上表现出明显的差异,肺癌内支气管中断、管壁密度增高和扭曲扩张明显多于炎症性病变和浸润前病变,且CT值较高,CT值标准差差异较大,相邻线性CT值分布紊乱,纹理质地也以混合性结构为主。故磨玻璃样病变内支气管改变与纹理结构的不同,能反映病变是否具有破坏性和异质性程度,认识这些征象对诊断早期肺癌和与良性病变进行鉴别具有重要的作用。
Objective To realize the CT manifestations of early stage lung cancer and improve qualitative ability tostage early lung cancer by analyzing the bronchial change and texture of lung ground-glass opacity. Methods CT manifestations of lung ground-glass opacity in 89 patients were retrospectively analyzed including 28 inflammatory lesions,14 precancerous and 47 lung cancers that were proved by histopathology and clinical data. Ground-glass opacities displayed with thin slice and high resolution CT imaging were observed and analyzed. Differences of CT signs such as bronchial change,mean of CT value and standard deviation of CT value,texture in inflammatory lesions,preinvasive lesions and lung cancer were compared. Obtained data was statistically analyzed. Results Histopathology showed that all the lung cancers were in the early stage. Bronchial change: 28 inflammation lesions had 3 type in 4 cases,4 type in 9 cases and 5 type in 15 cases. Fourteen pre-invasive lesions had cases of 3 type in 3 cases,4 type in 3 cases and 5 type in 10 cases. Forty-seven lung cancer lesions had 1-3 type in 35 cases,4 type in 5 cases and 5 type in 7 cases( χ~2= 12,P = 0. 017 < 0. 05). In patients whose lesions had normal bronchus or no bronchus displayed,the CT values means of inflammation,precancerous and lung cancers were -422. 25 HU,-558. 36 HU,-336. 77 HU respectively( F = 30. 25,P = 0. 00) and CT values standard deviation were ±112. 54 ± 78. 80,± 155. 85 respectively( F = 24. 92,P = 0. 00). Linear distribution figures of neighboring CT values of lung cancers arranged the most irregularly. Structure( texture) in lesion: inflammation had 18 pure homogeneity type and 9 pure crude type,just 1 case were mixed type. Pre-invasive lesions had 18 pure homogeneity type,2 pure crude type and 4 mixed type. Lung cancer had 40 mixed type,just 3 homogeneity type and 4 pure crude type respectively( χ~2= 12,P =0. 018 < 0. 05). Conclusion CT manifestations of lung ground-glass opacity of different diseases had marked difference.The bronchus was interrupted,thickened wall and bronchial deformation in the lung cancers were more common than in other diseases. CT values mean of lung cancer was higher and the standard deviation was signifcant. Linear distribution figures of neighboring CT values of lung cancers arranged more irregularly and the texture was mainly mixed type. So bronchial changes and different texture of lung ground-glass opacity could be indicated if the lesion had destruction and the degree of heterogeneity. Realizing these signs is important in diagnosing early stage lung cancer and differentiating benign and malignant lesions.
Objective To realize the CT manifestations of early stage lung cancer and improve qualitative ability tostage early lung cancer by analyzing the bronchial change and texture of lung ground-glass opacity. Methods CT manifestations of lung ground-glass opacity in 89 patients were retrospectively analyzed including 28 inflammatory lesions,14 precancerous and 47 lung cancers that were proved by histopathology and clinical data. Ground-glass opacities displayed with thin slice and high resolution CT imaging were observed and analyzed. Differences of CT signs such as bronchial change,mean of CT value and standard deviation of CT value,texture in inflammatory lesions,preinvasive lesions and lung cancer were compared. Obtained data was statistically analyzed. Results Histopathology showed that all the lung cancers were in the early stage. Bronchial change: 28 inflammation lesions had 3 type in 4 cases,4 type in 9 cases and 5 type in 15 cases. Fourteen pre-invasive lesions had cases of 3 type in 3 cases,4 type in 3 cases and 5 type in 10 cases. Forty-seven lung cancer lesions had 1-3 type in 35 cases,4 type in 5 cases and 5 type in 7 cases( χ~2= 12,P = 0. 017 < 0. 05). In patients whose lesions had normal bronchus or no bronchus displayed,the CT values means of inflammation,precancerous and lung cancers were -422. 25 HU,-558. 36 HU,-336. 77 HU respectively( F = 30. 25,P = 0. 00) and CT values standard deviation were ±112. 54 ± 78. 80,± 155. 85 respectively( F = 24. 92,P = 0. 00). Linear distribution figures of neighboring CT values of lung cancers arranged the most irregularly. Structure( texture) in lesion: inflammation had 18 pure homogeneity type and 9 pure crude type,just 1 case were mixed type. Pre-invasive lesions had 18 pure homogeneity type,2 pure crude type and 4 mixed type. Lung cancer had 40 mixed type,just 3 homogeneity type and 4 pure crude type respectively( χ~2= 12,P =0. 018 < 0. 05). Conclusion CT manifestations of lung ground-glass opacity of different diseases had marked difference.The bronchus was interrupted,thickened wall and bronchial deformation in the lung cancers were more common than in other diseases. CT values mean of lung cancer was higher and the standard deviation was signifcant. Linear distribution figures of neighboring CT values of lung cancers arranged more irregularly and the texture was mainly mixed type. So bronchial changes and different texture of lung ground-glass opacity could be indicated if the lesion had destruction and the degree of heterogeneity. Realizing these signs is important in diagnosing early stage lung cancer and differentiating benign and malignant lesions.
引文
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11 Ganeshan B,Abaleke S,Young RCD,Texture analysis of nonsmall cell lung cáncer on unenhanced computed tomography:initial evidence for a relationship with tumour glucose metabolism and stage[J].Cancer imaging,2010,10:137-143.
2 Swanton C,Govindan R.Clinical implications of genomic discoveries in lung cancer[J].The New England Journal of Medicine,2016,374:1864-1873.
3 Travis WD,Brambilla E,Noguchi M,et al.International association for the study of lung Cancer/American thoracic society/European respiratory society international muhidisciplinary classification of lung adenocarcinoma[J].Journal of Thoracic Oncology,2011,6:244-285.
4 高丰,葛虓俊,李铭,等.经多层螺旋CT探讨肺磨玻璃结节与支气管的关系[J].中华放射学杂志,2013,47:157-161.
5 Sergiacomi G,CicciòC,Boi L,et al.Ground-glass opacity:High-resolution computed tomography and 64-multi-slice computed tomography findings comparison[J].European Journal of Radiology,2010,74:479-483.
6 Yoon SH,Park CM,Park SJ,et al.Tumor heterogeneity in lung cancer:Assessment with Dynamic Contrast-enhanced MR Imaging[J].Radiology,September,2016,280:940-948.
7 陈天忠,韦乐心,余绍立,等.多层螺旋CT对肺磨玻璃结节与支气管关系的初探[J].临床放射学杂志,2014,33:711-715.
8 Bedard PL,Hansen AR,Ratain MJ,et al.Tumour heterogeneity in the clinic[J].Nature,2013,501:355-364.
9 Chae HD,Park CM,Park SJ,et al.Computerized texture analysis of persistent part-solid ground-glass nodules:differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas[J].Radiology,2014,273:285-293.
10 Ganeshan B,Panayiotou E,Burnond K,et al.Tumour heterogeneity in non-small cell lung carcinoma assessed by CT texture analysis a potential marker of survival,[J].European Radiology,2012,22:796-802.
11 Ganeshan B,Abaleke S,Young RCD,Texture analysis of nonsmall cell lung cáncer on unenhanced computed tomography:initial evidence for a relationship with tumour glucose metabolism and stage[J].Cancer imaging,2010,10:137-143.