1 绵阳市第三人民医院(四川省精神卫生中心)放射科，四川 绵阳 621000
2 四川射洪中医院脑外科，四川 遂宁 629000
目的：探讨高分辨率CT对早期肺腺癌的诊断价值，分析CT征象在评价其浸润性中的意义。方法：选取2019年6月至2020年6月医院诊治的早期肺腺癌患者600例为研究对象，其中非浸润组370例，浸润组230例。均对病灶进行高分辨率靶扫描，比较两组病灶大小、密度及分布特征，分析其CT征象，并分析亚厘米级纯磨玻璃密度肺腺癌浸润性的影响因素。结果：与非浸润组(8.1±1.8) mm比较，浸润组病灶最大径(8.7±1.2) mm更大，差异有统计学意义(P<0.05)。与非浸润组比较，浸润组病灶毛刺征(23.9% vs 16.2%)、胸膜凹陷征(21.7% vs 13.5%)及血管集束征(16.5% vs 10.5%)发生率更高，差异有统计学意义(P<0.05)。多因素logistics分析显示：最大径(>8.51 mm)、存在毛刺征及血管集束征为亚厘米级纯磨玻璃密度肺腺癌存在浸润性的危险因素。ROC分析显示肿瘤最大径>8.51 mm诊断肺腺癌存在浸润性的线下面积0.886，95%CI：0.791~0.941，敏感度83.8%，特异度77.9%，约登指数为0.617。结论：高分辨率CT能够更加清晰的显示早期肺腺癌的各种征象，在表现为亚厘米级纯磨玻璃密度结节的肺腺癌病灶中，当病灶径线>8.51 mm或存在毛刺征或存在血管集束征时则应高度怀疑其存在浸润性。关键词： 高分辨CT；肺结节；计算机体层成像；肺肿瘤；肺癌；磨玻璃结节；亚厘米
Application value of high-resolution thin slice CT in diagnosis and screening of early lung adenocarcinoma
CorrespondingAuthor: Yanju WANG Email: firstname.lastname@example.org
Foundation: This work was supported by Project of Mianyang health and Family Planning Commission, China (201622).
Objective: To explore the value of high-resolution CT in the diagnosis of early lung adenocarcinoma and analyze the significance of CT signs in the evaluation of its infiltration. Methods: A total of 600 patients with early lung adenocarcinoma admitted to our hospital from June 2019 to June 2020 were selected as the study object, including 370 cases in a non invasive group and 230 cases in an invasive group. All the lesions were scanned with high-resolution target. The size, density, and distribution of the lesions in the two groups were compared, and their CT signs were analyzed. The influencing factors of infiltration of lung adenocarcinoma were analyzed. Results: Compared with the non invasive group (8.1±1.8) mm, the maximum diameter of lesions in the invasive group (8.7±1.2) mm was larger, the difference was significant (P<0.05). The incidence of burr sign (23.9% vs 16.2%), pleural indentation sign (21.7% vs 13.5%), and vascular fasciculation sign (16.5% vs 10.5%) were higher in the invasive group than those in the non invasive group (P<0.05). Multivariate logistic analysis showed that the largest diameter (>8.51 mm), presence of burr sign and presence of vascular cluster sign were the risk factors for infiltration of sub-centimeter pure ground-glass opacity lung adenocarcinoma. ROC analysis showed that the area of infiltration was 0.886, 95%CI: 0.791 to 0.941, the sensitivity was 83.8%, the specificity was 77.9%, and the Youden index was 0.617. Conclusion: High-resolution CT can show all kinds of signs of early lung adenocarcinoma more clearly. In the lung adenocarcinoma lesions appearing as sub-centimeter pure ground-glass opacity nodules, when the diameter of the lesions is more than 8.51 mm, or spicule sign or vessel convergence sign is presented, its infiltration should be highly suspected.Keywords： high-resolution CT; pulmonary nodule; computed tomography; lung tumor; lung cancer; ground-glass nodule; sub-centimeter