肺多发肿瘤性局灶性磨玻璃结节CT征象与病理结果的对照分析

目的 分析肺部多发肿瘤性局灶性磨玻璃结节（fGGN） CT征象与病理结果，探讨CT征象对肺内多发fGGN的诊断价值。方法 回顾性分析29例经病理证实的肺内多发肿瘤性局灶性磨玻璃结节患者的CT及病理资料，每例至少包括2个fGGN，根据结节内是否含有实性成分将其分为纯磨玻璃密度结节（pGGN）和混合磨玻璃密度结节（mGGN），分析结节的形状、大小、内部特征（空气支气管征、空泡征、血管改变）、外部特征（分叶征、毛刺征、胸膜凹陷征），并与病理结果对照。结果 29例患者共64个结节，其中pGGN 36个，mGGN 28个。两种结节间形状差异无统计学意义（P=0.059）；mGGN最大径大于pGGN （P < 0.05）。各种征象中，分叶征、毛刺征、胸膜凹陷征、血管改变差异有统计学意义（P均 < 0.05），空气支气管征和空泡征差异无统计学意义（P均 > 0.05）。pGGN以不典型腺瘤样增生多见（12/36，33.33%）；mGGN以浸润性腺癌多见（15/28，53.57%）。结论 观察肺内多发性局灶性磨玻璃结节大小以及分叶、毛刺、胸膜凹陷征及血管改变征象，可判断结节是否具有侵袭性，有助于帮助临床制定合理的治疗方案。

CT characteristics of pulmonary multiple focal ground glass nodules: Compared with pathology

Objective To analyze CT features and histopathological findings of multiple tumorous focal ground-glass nodules (fGGN) in lung and to explore the diagnostic value of CT. Methods CT and pathological data of 29 patients with pathologically proved multiple tumorous fGGN were collected, including at least 2 fGGNs in each case. According to solid component within nodules, the nodules were divided into pure ground glass nodule (pGGN) and mixed ground glass nodule (mGGN). The shape, size, inside feature (air bronchogram, vacuole sign, blood vessel), outside feature (lobulation sign, spiculation sign, chest depression) were anlyzed respectively, and compared with pathological findings. Results Totally there were 64 nodules in 29 patients, including 36 pGGNs and 28 mGGNs. There was no significant difference in the shape between pGGNs and mGGNs (P=0.059). The diameters of mGGNs were larger than that of pGGNs (P<0.05). Among the various signs, there were significant differences in lobulation sign, spiculation sign, chest depression and vascular changes (all P<0.05), and there were no significant differences in air bronchogram and vacuole sign (both P>0.05).pGGNs were more common in atypical adenomatous hyperplasia (12/36, 33.33%), and mGGNs were common in invasive pulmonary adenocarcinoma (15/28, 53.57%). Conclusion Lobulation sign, spiculation sign, chest depression and vascular changes of fGGN can determine invasive nodules and help to develop a reasonable treatment plan.