CT 窗口技术在肺磨玻璃结节诊断中的临床意义

目的 探讨肺腺癌磨玻璃结节（GGN）术前薄层胸部CT 图像中，不同窗宽窗位下测得的GGN 大小对其病理浸润性的预测价值。方法 回顾性分析2015 年1 月—2018 年3 月复旦大学附属中山医院青浦 分院手术证实为肺腺癌的47 例患者，共49 个GGN 术前薄层胸部CT 图像及术后病理结果。测量GGN 在肺 窗（窗宽1 500 HU，窗位-400 HU）、纵隔窗（窗宽350 HU，窗位50 HU）及调整窗（窗宽1 300 HU，窗位 50 HU）的平均直径并结合术后病理分析。结果 49 个GGN 中浸润性腺癌（IAC）32 个，非浸润性腺癌17 个；后者含13 个微润浸腺癌（MIA），2 个原位癌（AIS），2 个不典型腺瘤样增生。肺窗上GGN 平均直径以 15 mm 为临界值，调整窗和纵隔窗上GGN 平均直径以5 mm 为临界值区分IAC 和非IAC ；GGN 平均直径≥ 临界值组的肺腺癌为浸润性腺癌的比例升高（P <0.05）。以肺窗上测得的GGN 平均直径≥ 15 mm 诊断的肺 腺癌为IAC 的敏感性为62.50%，特异性为88.24%。以调整窗和纵隔窗上测得的GGN 平均直径≥ 5 mm 诊断 的肺腺癌为IAC 的敏感性分别为75.00% 和31.25%、特异性分别为94.12%、100.0%。结论 不同窗宽窗位下 测得的GGN 大小与浸润性相关。综合考虑不同窗宽窗位测得的GGN 大小对GGN 肺腺癌是否浸润有预测 价值，为术前制定手术方案提供参考。

Clinical significance of CT window technique in the diagnosis and treatment of pulmonary ground-glass nodules

Objective To explore the predictive value of the size of lung adenocarcinoma presenting as ground-glass nodules (GGN) for invasiveness of lung adenocarcinoma, which measured by thin-slice chest CT in different window width and window level, and to increase awareness of GGN. Methods Retrospective analysis was performed on 47 patients with lung adenocarcinoma from January 2015 to March 2018. There were preoperative thinslice chest CT images and postoperative pathology of 49 GGN. The average diameter of GGN in the lung window (window wide: 1500HU, window level: -400HU), mediastinal window (window wide: 350HU, window level: 50HU), adjust window (window wide: 1300HU, window level: 50HU) was measured, which were analyzed with postoperative pathology. Results There were 32 invasive adenocarcinoma (IAC) in 49 GGN and 17 non-invasive adenocarcinoma: 13 microinvasive adenocarcinomas (MIA), 2 carcinomas in situ (AIS) and 2 atypical adenomatous hyperplasia. The GGNs according to 5mm diameter measured on the lung window and 5mm on adjust window and mediastinal window were differentiated as the IAC and non-IAC. The proportion of IAC was significantly increased in group with GGN average diameter greater than or equal to the boundary value. The sensitivity of the boundary value to IAC diagnosis was 62.5% (lung widow), 75% (adjust window) and 31.25%(mediastinal window), and the specificity was 88.24%, 94.12% and 100% respectively. Conclusions The size of GGN measured in different window wide and window level is associated with invasiveness of lung adenocarcinoma presenting as GGN. Comprehensive consideration of GGN size of lung adenocarcinoma presenting as GGN measured by chest thin-slice CT in different window width and window level has predictive value, which can provide a reference for operation scheme.