血管集束征在肺磨玻璃结节定性诊断中的价值研究

doi:10.16150/j.1671-2870.2018.05.008

摘要/Abstract

摘要： 目的：评价胸部增强CT图像中的血管集束征,在肺磨玻璃结节（ground-glass nodule,GGN）定性诊断中的价值。方法：回顾性分析经手术病理证实的,直径为5~20 mm的136个GGN的动态增强CT表现,包括良性结节20个、浸润前病变（pre-invasive lesions,PL）32个,微浸润腺癌（minimally invasive adenocarcinoma,MIA）31个,浸润性腺癌（invasive adenocarcinoma,IAC）53个。所有患者均采用双源CT行胸部增强CT扫描,观察、比较GGN血管集束征的出现率。根据扫描结果将血管集束征分为肺动脉异常（Ⅰ型）、肺静脉异常（Ⅱ型）两型,比较Ⅰ、Ⅱ型血管集束征在良、恶性结节及不同浸润程度结节中的差异。结果：在动态增强CT扫描上,GGN中血管集束征的显示率为53.68%（73/136）,而恶性结节中的血管集束征显示率（57.76%,67/116）高于良性结节（30.00%,6/20）（P=0.021)。良、恶性结节间的Ⅰ型血管集束征出现率差异无统计学意义[10.00% （2/20）比13.79% （16/116）,P=0.644];在不同病理亚型的恶性结节间,Ⅰ型血管集束征的出现率差异亦无统计学意义 [PL,12.50% （4/32）;MIA,25.81% （8/31）;IAC,7.55%（4/53）,P=0.062]。但Ⅱ型血管集束征在恶性结节中的出现率（43.97%,51/116）高于良性结节（20.00%,4/20）（P=0.044）,且随着恶性结节病变级别的增加,Ⅱ型血管集束征的出现率增高[PL,21.88%（7/32）;MIA,25.81%（8/31）;IAC,67.92% （36/53）,P<0.001],其在IAC中的出现率为最高,诊断灵敏度为67.92%,特异度为76.19%。IAC组与PL组、MIA组比较,Ⅱ型血管集束征出现率差异均有统计学意义（P均<0.001）,而PL组与MIA组间的Ⅱ型血管集束征出现率差异无统计学意义（P=0.714）。结论：肺静脉异常型（Ⅱ型）血管集束征的出现率对鉴别肺结节良恶性具有临床应用价值,当GGN为IAC时出现血管集束征的概率更高。

关键词: 双源CT, 血管集束征, 磨玻璃结节, 肺腺癌

Abstract: Objective: To study the qualitative diagnostic value of vessel convergence sign in ground glass nodules (GGNs) of lung in chest enhanced CT images. Methods: A retrospective analysis of 136 GGNs with 5-20 mm in diameter showed in dynamic enhanced CT image and confirmed by surgical pathology including 20 benign nodules, 32 pre-invasive lesions(PL), 31 minimally invasive adenocarcinoma(MIA) and 53 invasive adenocarcinoma(IAC) was performed. All patients were examined with dual-source CT for chest enhanced CT scan to observe and analyze the occurrence of GGN vessel convergence sign. Vessel convergence sign was classified into pulmonary artery abnormality (type Ⅰ) and pulmonary vein abnormality (type Ⅱ). Compared the occurrence of different types of vessel convergence sign in benign and malignant nodules. Results: Vessel convergence sign was found in 73 of the 136 GGNs (53.68%), the occurrence rate in benign GGNs(6/20, 30.00%) was significantly less than that in malignant GGNs (67/116, 57.76%) (P=0.021). For type Ⅰ vessel convergence sign, there was no significant difference between benign and malignant GGNs[10.00% (2/20) vs 13.79% (16/116), P=0.644], and between different pathological types of malignant GGNs [PL 12.50% (4/32), MIA25.81% (8/31), IAC7.55% (4/53), all P>0.05]. The occurrence rate of type Ⅱ vessel convergence sign in malignant GGNs (51/116, 43.97%) was significantly higher than that in benign GGNs(4/20, 20.00%) (P=0.044). With the increase in infiltration degree, the occurrence rate of type Ⅱ vessel convergence sign increased [PL21.88% (7/32), MIA25.81% (8/31)], IAC67.92% (36/53), P<0.001]. Significant differences in occurrence rate of type Ⅱ vessel convergence sign were found between IAC and MIA(P<0.001), as well as between PL and MIA (P<0.001), but not between PL and MIA (P=0.714). Conclusions: Vessel convergence sign showed potential value in the differentiation between benign and malignant GGNs. The presence of pulmonary vein vessel convergence sign in GGNs indicates the high risk of IAC.

Key words: Dual-source CT, Vessel convergence sign, Ground glass nodule, Pulmonary adenocarcinoma

中图分类号:

R734.2

曹琪琪, 杨文洁, 严福华, 刘燕. 血管集束征在肺磨玻璃结节定性诊断中的价值研究[J]. 诊断学理论与实践, 2018, 17(05): 521-525.

CAO Qiqi, YANG Wenjie, YAN Fuhua, LIU Yan. The qualitative diagnostic value of vessel convergence sign inground glass nodules of lung[J]. Journal of Diagnostics Concepts & Practice, 2018, 17(05): 521-525.

参考文献

[1] de Hoop B, de Boo DW, Gietema HA, et al. Compute-raided detection of lung cancer on chest radiographs: effect on observer performance[J]. Radiology,2010,257(2):532-540.
[2] Yankelevitz DF, Yip R, Smith JP, et al.CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds[J]. Radiology,2015,277(2):555-564.
[3] Chang B, Hwang JH, Choi YH, et al.Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan[J]. Chest,2013,143(1):172-178.
[4] Henschke CI, Yankelevitz DF, Mirtcheva R, et al.CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules[J]. AJR Am J Roentgenol,2002,178(5):1053-1057.
[5] Gao F, Li M, Ge X, et al.Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels[J]. Eur Radio,2013,23(12):3271-3277.
[6] 范丽, 于红, 刘士远, 等. 3 cm以下肺恶性局灶性磨玻璃结节与实性结节螺旋CT征象对照[J]. 中华放射学杂志,2010,44(1):16-19.
[7] Lee SM, Park CM, Goo JM, et al.Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features[J]. Radiology,2013,268(1):265-273.
[8] Naidich DP, Bankier AA, MacMahon H, et al. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society[J]. Radiology,2013,266(1):304-317.
[9] 范丽, 刘士远, 李清楚, 等. 肺部局灶性磨玻璃密度结节的MSCT征象分析[J]. 临床放射学杂志,2010,29(6):760-764.
[10] Zwirewich CV, Vedal S, Miller RR, et al.Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation[J]. Radiology,1991,179(2):469-476.
[11] Travis WD, Rekhtman N.Pathological diagnosis and classification of lung cancer in small biopsies and cytology: strategic management of tissue for molecular testing[J]. Semin Respir Crit Care Med,2011,32(1):22-31.
[12] Zhang J, Wu J, Tan Q, et al.Why do pathological stage IA lung adenocarcinomas vary from prognosis?: a clinicopathologic study of 176 patients with pathological stage IA lung adenocarcinoma based on the IASLC/ATS/ERS classification[J]. J Thorac Oncol,2013,8(9):1196-1202.
[13] Noguchi M, Morikawa A, Kawasaki M, et al.Small adenocarcinoma of the lung. Histologic characteristics and prognosis[J]. Cancer,1995,75(12):2844-2852.
[14] Yang Z, Sone S, Takashima S, et al.Small peripheral carcinomas of the lung: thin-section CT and pathologic correlation[J]. Eur Radiol,1999,9(9):1819-1825.
[15] Kakinuma R, Ohmatsu H, Kaneko M, et al.Detection failures in spiral CT screening for lung cancer: analysis of CT findings[J]. Radiology,1999,212(1):61-66.
[16] 董伟华, 肖湘生, 李惠民, 等. 支气管动脉和肺动脉多层螺旋CT血管造影对肺癌血供的研究[J]. 中华放射学杂志,2003,37(7):612-614.
[17] Zhang Y, Qiang JW, Ye JD, et al.High resolution CT in differentiating minimally invasive component in early lung adenocarcinoma[J]. Lung Cancer,2014,84(3):236-241.
[18] Suzuki K, Yokose T, Yoshida J, et al.Prognostic significance of the size of central fibrosis in peripheral adenocarcinoma of the lung[J]. Ann Thorac Surg,2000,69(3):893-897.
[19] 滑炎卿, 张国桢, 丁其勇, 等. CT肿瘤血管成像对周围型肺癌的诊断价值[J]. 中华放射学杂志,2004,38(7):701-705.
[20] Rapp-Bernhardt U, Welte T, Doehring W, et al.Diagnostic potential of virtual bronchoscopy: advantages in comparison with axial CT slices, MPR and mIP?[J]. Eur Radiol,2000,10(6):981-988.
[21] Ko JP, Berman EJ, Kaur M, et al.Pulmonary Nodules: growth rate assessment in patients by using serial CT and three-dimensional volumetry[J]. Radiology,2012,262(2):662-671.
[22] Goldin JG, Brown MS, Petkovska I.Computer-aided diagnosis in lung nodule assessment[J]. J Thorac Imaging,2008,23(2):97-104.
[23] 王圣恩, 孙琼芳, 涂蓉, 等. 联合CT三维重建与Fisher判别在非典型良性或恶性肺结节中的作用[J]. 实用放射学杂志,2014,30(10):1638-1641,1645.