肺局灶性磨玻璃病变的CT形态学表现与灌注曲线的相关性研究

发布时间：2018-03-26 18:52

本文选题：磨玻璃密度影　切入点：形态学　出处：《大连医科大学》2012年硕士论文

【摘要】：目的：探讨肺局灶性磨玻璃密度影（focal ground glass opacity，fGGO）病变的CT形态学表现以及灌注曲线，评价CT灌注曲线在诊断肺局灶性磨玻璃密度病变的价值。材料与方法： 24例病例，男性10例，女性14例，年龄31-77岁，平均年龄58岁；24例fGGO均经过手术病理或抗炎治疗后证实，对临床资料、病灶大小及形态学表现（形态、边缘、分叶、毛刺及胸膜凹陷征），用Fisher确切概率法分析良恶性fGGO中是否存在差异。通过对病灶靶层面进行CT灌注成像应用非离子型造影剂(优维显300mg/ml),总量50ml，静脉注射速度4ml／s。用GE Perfusion4软件得出fGGO病灶的时间一密度（Time-density Curves，TDC）曲线，结合病变形态学表现，评价灌注曲线在诊断中的价值。结果： 24例fGGO中腺癌（adenocarcinoma）11例，细支气管肺泡癌（bronchoalveolarcarcinoma，BAC）6例，不典型腺瘤样增生（atypical adenomatous hyperplasia，AAH）2例，炎症（inflammation）4例，局灶性肺间质性纤维化（Focal interstitialfibrosis，FIF）1例。将腺癌、BAC和AAH归为恶性病变，炎症和FIF归为良性病变进行分析研究。 1肺局灶性磨玻璃病变的形态学特征临床一般资料、病灶大小及密度在良恶性fGGO中没有统计学意义（P均0.05）。病灶形态、边缘光整或毛糙、毛刺及胸膜凹陷征在良恶性fGGO中存在着统计学意义（P均0.05），分叶征在良恶性fGGO中没有显著差异（P0.05）。 2肺局灶性磨玻璃病变的灌注曲线各种fGGO中CT灌注曲线的类型：腺癌的时间-密度曲线表现为两种类型，I型：曲线上升及下降缓慢，整个曲线较低平，末端仍高于增强前密度；II型：曲线升支较缓，几乎没有降支，持续缓慢上升。细支气管肺泡癌的增强曲线表现为三种类型：I型：曲线上升支较陡，达峰值后，曲线缓慢下降，末端仍高于增强前密度，增强幅度大； II型：曲线上升及下降缓慢，整个曲线较低平，，末端仍高于增强前密度；III型：曲线升支较缓，几乎没有降支，持续缓慢上升。不典型腺瘤样增生的增强曲线：曲线上升及下降缓慢，整个曲线较低平，末端仍高于增强前密度。炎症的增强曲线表现为两种：I型曲线上升支较缓，下降支较陡，呈缓升速降；II型：曲线上升及下降缓慢，整个曲线较低平，末端仍高于增强前密度。局灶性肺间质纤维化的增强曲线：曲线上升及下降缓慢，整个曲线较低平，末端仍高于增强前密度。结论：肺局灶性磨玻璃病灶影像学表现（病灶形态、边缘光整或毛糙、分叶及胸膜凹陷症等）在鉴别fGGO的良恶性诊断中有统计学意义； CT灌注曲线在良恶性fGGO的鉴别诊断中有其共性以及特征性改变。结合fGGO的CT影像形态学征象和CT灌注曲线特征，对表现为fGGO的良恶性病变的诊断与鉴别诊断有一定的实际应用价值。
[Abstract]:Objective:. To investigate the CT morphological features and perfusion curves of focal ground glass opacities of lung lesions, and to evaluate the value of CT perfusion curve in the diagnosis of focal ground-glass density lesions of the lung. Materials and methods:. 24 cases (male 10, female 14, age 31-77 years old, mean age 58 years) were confirmed by operation and pathology or anti-inflammatory therapy. The clinical data, lesion size and morphology (morphology, margin, lobulation) were analyzed. Fisher exact probability method was used to analyze the difference between benign and malignant fGGO. Non-ionic contrast agent (UVX 300 mg / ml, total 50 ml, intravenous injection rate 4 ml / s) was used to perform CT perfusion imaging on the target plane of the lesion, using Nonionic contrast medium (UVX 300 mg / ml, total 50 ml, iv injection rate 4 ml / s). The time-density curves of fGGO lesions were obtained by GE Perfusion4 software. To evaluate the value of perfusion curve in the diagnosis of pathological changes. Results:. There were 11 cases of adenocarcinoma, 6 cases of bronchoalveolar carcinoma, 2 cases of atypical adenomatous adenomatous hyperplasia, 4 cases of inflammation, 1 case of focal pulmonary interstitial fibrosis. Inflammation and FIF were classified as benign lesions. 1. Morphologic features of focal hyaluronic lesions of the lung. In general clinical data, the size and density of lesions were not statistically significant in benign and malignant fGGO (P < 0.05). There was significant difference between benign and malignant fGGO (P < 0.05), but there was no significant difference in lobulation sign in benign and malignant fGGO (P 0.05). 2Perfusion curve of focal ground-glass lesion of lung. Types of CT perfusion curves in various fGGO:. The time-density curve of adenocarcinoma showed two types: the curve rose slowly and decreased slowly, the whole curve was low and flat, and the end of the curve was still higher than that of pre-enhancement density type II. The ascending branch of the curve was slower, almost no descending branch, and the curve continued to rise slowly. The enhancement curve of bronchioloalveolar carcinoma shows three types: the ascending branch of the curve is steeper, after reaching the peak, the curve decreases slowly, the end of the curve is still higher than the pre-enhancement density, and the enhancement amplitude is large, type II: the curve rises and declines slowly. The whole curve is low and flat, and the end of the curve is still higher than that of the pre-enhancement density type III: the ascending branch of the curve is slow, almost no descending branch, and rising slowly. The enhancement curve of atypical adenomatous hyperplasia: the curve rose slowly and decreased slowly, the whole curve was low and flat, and the end of the curve was still higher than that of preenhancement density. The enhancement curve of inflammation showed two types of curve: the ascending branch was slower, the descending branch was steeper, the curve was slowly ascending and falling slowly, the whole curve was lower and the end was still higher than the density before enhancement. The enhancement curve of focal pulmonary interstitial fibrosis: the curve rose and decreased slowly, the whole curve was low and flat, and the end of the curve was still higher than that of preenhancement density. Conclusion:. Imaging findings of focal ground-glass lesions of the lung (shape of focus, smooth or rough margin, Lobulation and pleural depression) have statistical significance in differential diagnosis of benign and malignant fGGO, CT perfusion curve has its common and characteristic changes in differential diagnosis of benign and malignant fGGO. It has some practical value in the diagnosis and differential diagnosis of benign and malignant lesions with fGGO.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R816.41

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