肺部局灶性磨玻璃影的CT诊断

目的探讨肺部良恶性局灶性磨玻璃影的CT表现,以期减少误诊和早期诊断周围型小肺癌。方法搜集资料完整的良性GGO结节43个(AAH6个,炎性37个)、恶性GGO结节77个(其中BAC62个、腺癌或混合性腺癌15个),对其CT表现作回顾分析。结果①大小:AAH≤1cm,6/6;炎性≥2cm,32/37;恶性1～2cm,44/77;②形态:球形,AAH6/6、炎性4/37、BAC43/32、腺癌10/15;③密度:纯GGO,AAH6/6、炎性33/37、BAC36/62;混杂GGO,炎性4/37、BAC26/62、腺癌15/15;④边缘:光滑,AAH6/6、炎性4/37、恶性73/77;⑤其它倾向肺癌征象(分叶、细毛刺、空泡、空气支气管征、血管集束、胸膜凹陷):AAH无;炎性极少;恶性常见;⑥.随访:10～45天抗炎后复查,无明显变化AAH6/6、炎性3/37、恶性70/77,缩小或吸收炎性34/37。结论①球形、边界清楚局灶性纯GGO影多为AAH或BAC,并且AAH多≤1cm;②混杂密度GGO,恶性可能大;③较大边界模糊斑片、不规则形纯GGO傾向炎性;④短期随访是重要鉴别手段。

CT diagnosis of pulmonary focal ground glass opacity

Objective To Analyze the CT signs of pulmonary focal ground glass opacity （GGO） so as to improve the accuracy of clinical diagnosis of small peripheral lung cancer. Methods 120 cases were reviewed, in which 77 cases were malignant, including 62 cases of bronchioloalveolar cell carcinoma （BAC）, 15 cases of adenocarcinoma and, 43 cases were benign, including 6 cases of atypical adenomatous hyperplasia （AAH）, 37 cases of pneumonia. CT findings were analyzed retrospectively. Results In size, AAH 〈= 1 cm （6/6）, pneumonia 〉=2 cm （32/37）, malignant were between 1 to 2 cm （44/77）. Malignant cases were round shaped, （BAC 43/62, adenocarcinoma 10/15）. Cases of AAH and pneumonia were pure GGO （6/6, 33/37）. In contrast, malignant were Farrago GGO （,BAC 26/62, adenoearcinoma 15/15）. AAH and malignant cases had clear boundary （AAH 6/6, malignant 73/77）. Malignant cases had other malignant signs, including the signs of lobulation, burr, vacuole, air bronehogram, vascular convergence, pleural indentation, AAH had none, sel- dom seen in inflammation. Following up for 10-45 days after anti inflammatory, pneumonia cases decreased in size or ab sorption, which were not common in AAH and malignant cases. Conclusion （1） Pure focal GGO with round shape and clear boundary was likely to be AAH or BAC, and AAH has size 41 cm;（2） Farrago GGO was likely to be malignant nod- ule; （3） Large size with vague boundary plaque and irregular GGO was likely to be inflammation; （4） Follow up with short term was important.