2cm以下肺部磨玻璃影HRCT特征及其病理基础的研究

发布时间：2017-12-31 14:02

  本文关键词：2cm以下肺部磨玻璃影HRCT特征及其病理基础的研究　出处：《蚌埠医学院》2016年硕士论文　论文类型：学位论文

  更多相关文章： 以下 肺部 玻璃 HRCT 特征 及其 病理 基础 研究

【摘要】：【目的】探讨2公分以下肺部磨玻璃影(GGO)HRCT特征与病理分类的联系。【材料和方法】回顾性分析2012年1月至2015年12月直径2cm以下的肺部磨玻璃影152例病灶,男性56例,女96例,年龄范围20~80岁,平均年龄53.3±12.9岁,病灶大小范围从4.9mm~20.0mm,平均大小15.13±4.18mm,所用病灶均是手术切除后经病理证实的。图像评价分析内容包括:病灶位置、病灶的大小和密度、病灶实性成分的大小和密度、实性成分所占的比例(大小、密度)、病灶边缘(分叶、短毛刺、长毛刺)、病灶内部(空泡征、细支气管造影征)、胸膜凹陷征、病灶与血管的关系。采用单因素方差分析(One-Way ANOVA)对病灶及实性成分的大小、密度与不同病理分类之间的差异性进行分析,P0.05表明差异有统计学意义;采用卡方检验或Fisher精确概率法检验对性别、病灶的分布、病灶的边缘、内部及胸膜牵拉同与病理分类之间差异分析;采用秩和检验对病灶与肺血管的关系同病理分类之间的差异分析。使用ROC曲线对炎症病变和腺癌类病变、浸润前病变和浸润性病变的病灶及实性成分的大小、密度、实性成分大小及密度所占比例进行评价。【结果】性别、年龄、病变位置在不同病理类型中无明显统计学差异,不同病理组的病灶的大小有统计学差别(P0.001),病灶大小浸润组(MIA+IAC)浸润前组(AAH+AIS)炎性病变组(INF)(P0.001)。不同病理组的实性出现率有统计学差异,AIS、MIA、IAC组较INF、AAH组更易出现实性成分(P0.001),实性成分大小中,浸润性病灶组(MIA+IAC)较浸润前病变组(AAH+AIS)更大(P0.001)。不同病理组病灶的密度、实性成分的密度有统计学差异,病灶密度IAC、MIA组最高,INF、AAH病灶密度最低。INF、IAC的实性密度最高。应用ROC曲线评价病灶大小、病灶密度对诊断为腺癌病变组的意义及诊断最佳临界值,ROC曲线下面积分别为0.855、0.706,临界值分别为病灶大小=12.80mm、病灶密度=-638HU。应用ROC曲线评价病灶大小、病灶密度、实性成分的大小、实性成分的密度、实性成分所占比例对诊断病灶浸润性的意义及诊断最佳临界值,ROC曲线下面积分别为0.757、0.722、0.780、0.683、0.697,临界值分别为病灶大小=13.50mm、病灶密度=-464HU、实性大小=8.05mm、实性密度=284HU、实性所占比例=51.99%。不同病理组病灶的边缘(分叶、短毛刺、长毛刺)有统计学差异(P0.001),其中MIA、IAC组中的分叶征象较INF组更常见(P0.005);MIA、IAC组中的短毛刺征象较AIS组更常见,AIS组短毛刺征象较INF、AAH组更为常见(P0.001);IAC、AIS组的长毛刺征象较INF、AAH组更为常见(P0.005)。不同病理组病灶内部(空泡征、细支气管造影征)有统计学差异(P0.001),MIA组中的空泡征较AIS组中更常见;IAC组出现细支气管造影征的可能性最大(P0.005)。AIS、MIA、IAC组较INF、AAH组出现胸膜牵拉征的可能性更大(P0.005)。五组病理类型中,病灶与血管关系类型是有差异的(P0.001),INF、AAH组以Ⅰ、Ⅱ型与血管关系为主,AIS、MIA组以Ⅲ、Ⅳ型与血管关系为主,IAC组则以Ⅳ、Ⅴ型与血管关系为主。各个影像征象中的分叶、毛刺在鉴别腺癌和炎性病变中有着较高的的准确率。各个影像征象中的分叶、短毛刺征象在鉴别肺腺癌浸润性中有着较高的的准确率。【结论】病灶位置、病灶的大小和密度、病灶实性成分的大小和密度、实性成分所占的比例(大小、密度)、病灶边缘(分叶、短毛刺、长毛刺)、病灶内部(空泡征、细支气管造影征)、胸膜凹陷征、病灶与血管的关系类型对病理分类有预测价值。
[Abstract]:[Objective] to investigate the 2 cm below the pulmonary ground glass opacity (GGO) HRCT features and pathological classification. [materials and methods] a retrospective analysis from January 2012 to December 2015 2cm below diameter of pulmonary ground glass opacity lesions of 152 cases, 56 cases were male, 96 were female, age range 20~80 years, mean age 53.3 + 12.9 years old the size of the lesions, ranging from 4.9mm~20.0mm, the average size of 15.13 + 4.18mm, the lesions were confirmed by pathology after surgery. The evaluation of image analysis including: lesion location, size and density of lesions, lesion size and density of the solid component, accounting for the proportion of solid components (size, density), lesion the edge (leaf, short burr, long thorn), internal lesions (vacuole sign, bronchial angiography syndrome), pleural indentation, vascular lesions and the relationship. The single factor analysis of variance (One-Way ANOVA) of the lesions and solid component size, density and different Analyze the differences between pathological classification, P0.05 showed a statistically significant difference; using chi square test or Fisher test for gender exact probability, distribution of lesions, lesions of the edge, internal and pleural retraction between pathologic classification and difference analysis; analysis of the difference between the rank and inspection on the relationship between the lesion and pulmonary vascular the same pathological classification. Using the ROC curve of inflammation lesions and adenocarcinoma, preinvasive lesions and invasive lesions and solid component size, density, size and density of the solid component proportion was evaluated. [results] gender, age, location of lesions in different pathological types and no obvious statistical differences, there are significant differences in different pathological lesions group size (P0.001), tumor size (MIA+IAC) infiltration group before the infiltration group (AAH+AIS) inflammatory disease group (INF) (P0.001). Unfruitfulness with pathological group occurrence rate There is significant difference, AIS, MIA, IAC compared with group INF, group AAH is more prone to the solid component (P0.001), the solid component size, infiltrating lesions group (MIA+IAC) than the preinvasive lesion group (AAH+AIS) (P0.001). Larger lesions with different pathologic group density, solid component density there were significant differences in lesion density, IAC, MIA, INF, AAH group was the highest, the lowest density lesions.INF, IAC of the highest density. The application of ROC curve to evaluate the lesion size, lesion density in the diagnosis of adenocarcinoma lesions and diagnosis significance of optimal threshold, the area under the ROC curve were 0.855,0.706, respectively, were critical value the size of =12.80mm, =-638HU. using ROC curve to evaluate the lesion density lesion size, lesion density, solid component size, solid component density, solid component proportion for the diagnosis of invasive lesions and the significance of the best diagnostic critical value, the area under the ROC curve was 0.757,0.722,0.78 0,0.683,0.697,涓寸晫鍊煎垎鍒�涓虹梾鐏跺ぇ灏�=13.50mm,鐥呯伓瀵嗗害=-464HU,瀹炴，

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