本文關(guān)鍵詞：2cm以下肺部磨玻璃影HRCT特征及其病理基礎(chǔ)的研究　出處：《蚌埠醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

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【摘要】：【目的】探討2公分以下肺部磨玻璃影(GGO)HRCT特征與病理分類的聯(lián)系。【材料和方法】回顧性分析2012年1月至2015年12月直徑2cm以下的肺部磨玻璃影152例病灶,男性56例,女96例,年齡范圍20~80歲,平均年齡53.3±12.9歲,病灶大小范圍從4.9mm~20.0mm,平均大小15.13±4.18mm,所用病灶均是手術(shù)切除后經(jīng)病理證實(shí)的。圖像評(píng)價(jià)分析內(nèi)容包括:病灶位置、病灶的大小和密度、病灶實(shí)性成分的大小和密度、實(shí)性成分所占的比例(大小、密度)、病灶邊緣(分葉、短毛刺、長(zhǎng)毛刺)、病灶內(nèi)部(空泡征、細(xì)支氣管造影征)、胸膜凹陷征、病灶與血管的關(guān)系。采用單因素方差分析(One-Way ANOVA)對(duì)病灶及實(shí)性成分的大小、密度與不同病理分類之間的差異性進(jìn)行分析,P0.05表明差異有統(tǒng)計(jì)學(xué)意義;采用卡方檢驗(yàn)或Fisher精確概率法檢驗(yàn)對(duì)性別、病灶的分布、病灶的邊緣、內(nèi)部及胸膜牽拉同與病理分類之間差異分析;采用秩和檢驗(yàn)對(duì)病灶與肺血管的關(guān)系同病理分類之間的差異分析。使用ROC曲線對(duì)炎癥病變和腺癌類病變、浸潤(rùn)前病變和浸潤(rùn)性病變的病灶及實(shí)性成分的大小、密度、實(shí)性成分大小及密度所占比例進(jìn)行評(píng)價(jià)�！窘Y(jié)果】性別、年齡、病變位置在不同病理類型中無(wú)明顯統(tǒng)計(jì)學(xué)差異,不同病理組的病灶的大小有統(tǒng)計(jì)學(xué)差別(P0.001),病灶大小浸潤(rùn)組(MIA+IAC)浸潤(rùn)前組(AAH+AIS)炎性病變組(INF)(P0.001)。不同病理組的實(shí)性出現(xiàn)率有統(tǒng)計(jì)學(xué)差異,AIS、MIA、IAC組較INF、AAH組更易出現(xiàn)實(shí)性成分(P0.001),實(shí)性成分大小中,浸潤(rùn)性病灶組(MIA+IAC)較浸潤(rùn)前病變組(AAH+AIS)更大(P0.001)。不同病理組病灶的密度、實(shí)性成分的密度有統(tǒng)計(jì)學(xué)差異,病灶密度IAC、MIA組最高,INF、AAH病灶密度最低。INF、IAC的實(shí)性密度最高。應(yīng)用ROC曲線評(píng)價(jià)病灶大小、病灶密度對(duì)診斷為腺癌病變組的意義及診斷最佳臨界值,ROC曲線下面積分別為0.855、0.706,臨界值分別為病灶大小=12.80mm、病灶密度=-638HU。應(yīng)用ROC曲線評(píng)價(jià)病灶大小、病灶密度、實(shí)性成分的大小、實(shí)性成分的密度、實(shí)性成分所占比例對(duì)診斷病灶浸潤(rùn)性的意義及診斷最佳臨界值,ROC曲線下面積分別為0.757、0.722、0.780、0.683、0.697,臨界值分別為病灶大小=13.50mm、病灶密度=-464HU、實(shí)性大小=8.05mm、實(shí)性密度=284HU、實(shí)性所占比例=51.99%。不同病理組病灶的邊緣(分葉、短毛刺、長(zhǎng)毛刺)有統(tǒng)計(jì)學(xué)差異(P0.001),其中MIA、IAC組中的分葉征象較INF組更常見(jiàn)(P0.005);MIA、IAC組中的短毛刺征象較AIS組更常見(jiàn),AIS組短毛刺征象較INF、AAH組更為常見(jiàn)(P0.001);IAC、AIS組的長(zhǎng)毛刺征象較INF、AAH組更為常見(jiàn)(P0.005)。不同病理組病灶內(nèi)部(空泡征、細(xì)支氣管造影征)有統(tǒng)計(jì)學(xué)差異(P0.001),MIA組中的空泡征較AIS組中更常見(jiàn);IAC組出現(xiàn)細(xì)支氣管造影征的可能性最大(P0.005)。AIS、MIA、IAC組較INF、AAH組出現(xiàn)胸膜牽拉征的可能性更大(P0.005)。五組病理類型中,病灶與血管關(guān)系類型是有差異的(P0.001),INF、AAH組以Ⅰ、Ⅱ型與血管關(guān)系為主,AIS、MIA組以Ⅲ、Ⅳ型與血管關(guān)系為主,IAC組則以Ⅳ、Ⅴ型與血管關(guān)系為主。各個(gè)影像征象中的分葉、毛刺在鑒別腺癌和炎性病變中有著較高的的準(zhǔn)確率。各個(gè)影像征象中的分葉、短毛刺征象在鑒別肺腺癌浸潤(rùn)性中有著較高的的準(zhǔn)確率。【結(jié)論】病灶位置、病灶的大小和密度、病灶實(shí)性成分的大小和密度、實(shí)性成分所占的比例(大小、密度)、病灶邊緣(分葉、短毛刺、長(zhǎng)毛刺)、病灶內(nèi)部(空泡征、細(xì)支氣管造影征)、胸膜凹陷征、病灶與血管的關(guān)系類型對(duì)病理分類有預(yù)測(cè)價(jià)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負(fù)鐥呯伓澶у皬=13.50mm,鐥呯伓瀵嗗害=-464HU,瀹炴，

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