本文選題：磨玻璃密度影　切入點(diǎn)：形態(tài)學(xué)　出處：《大連醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的： 探討肺局灶性磨玻璃密度影（focal ground glass opacity，fGGO）病變的CT形態(tài)學(xué)表現(xiàn)以及灌注曲線，評(píng)價(jià)CT灌注曲線在診斷肺局灶性磨玻璃密度病變的價(jià)值。 材料與方法： 24例病例，男性10例，女性14例，年齡31-77歲，平均年齡58歲；24例fGGO均經(jīng)過(guò)手術(shù)病理或抗炎治療后證實(shí)，對(duì)臨床資料、病灶大小及形態(tài)學(xué)表現(xiàn)（形態(tài)、邊緣、分葉、毛刺及胸膜凹陷征），用Fisher確切概率法分析良惡性fGGO中是否存在差異。通過(guò)對(duì)病灶靶層面進(jìn)行CT灌注成像應(yīng)用非離子型造影劑(優(yōu)維顯300mg/ml),總量50ml，靜脈注射速度4ml／s。用GE Perfusion4軟件得出fGGO病灶的時(shí)間一密度（Time-density Curves，TDC）曲線，結(jié)合病變形態(tài)學(xué)表現(xiàn)，評(píng)價(jià)灌注曲線在診斷中的價(jià)值。 結(jié)果： 24例fGGO中腺癌（adenocarcinoma）11例，細(xì)支氣管肺泡癌（bronchoalveolarcarcinoma，BAC）6例，不典型腺瘤樣增生（atypical adenomatous hyperplasia，AAH）2例，炎癥（inflammation）4例，局灶性肺間質(zhì)性纖維化（Focal interstitialfibrosis，F(xiàn)IF）1例。將腺癌、BAC和AAH歸為惡性病變，炎癥和FIF歸為良性病變進(jìn)行分析研究。 1肺局灶性磨玻璃病變的形態(tài)學(xué)特征 臨床一般資料、病灶大小及密度在良惡性fGGO中沒(méi)有統(tǒng)計(jì)學(xué)意義（P均0.05）。病灶形態(tài)、邊緣光整或毛糙、毛刺及胸膜凹陷征在良惡性fGGO中存在著統(tǒng)計(jì)學(xué)意義（P均0.05），分葉征在良惡性fGGO中沒(méi)有顯著差異（P0.05）。 2肺局灶性磨玻璃病變的灌注曲線 各種fGGO中CT灌注曲線的類(lèi)型： 腺癌的時(shí)間-密度曲線表現(xiàn)為兩種類(lèi)型，I型：曲線上升及下降緩慢，整個(gè)曲線較低平，末端仍高于增強(qiáng)前密度；II型：曲線升支較緩，幾乎沒(méi)有降支，持續(xù)緩慢上升。 細(xì)支氣管肺泡癌的增強(qiáng)曲線表現(xiàn)為三種類(lèi)型：I型：曲線上升支較陡，達(dá)峰值后，曲線緩慢下降，末端仍高于增強(qiáng)前密度，增強(qiáng)幅度大； II型：曲線上升及下降緩慢，整個(gè)曲線較低平，，末端仍高于增強(qiáng)前密度；III型：曲線升支較緩，幾乎沒(méi)有降支，持續(xù)緩慢上升。 不典型腺瘤樣增生的增強(qiáng)曲線：曲線上升及下降緩慢，整個(gè)曲線較低平，末端仍高于增強(qiáng)前密度。 炎癥的增強(qiáng)曲線表現(xiàn)為兩種：I型曲線上升支較緩，下降支較陡，呈緩升速降；II型：曲線上升及下降緩慢，整個(gè)曲線較低平，末端仍高于增強(qiáng)前密度。 局灶性肺間質(zhì)纖維化的增強(qiáng)曲線：曲線上升及下降緩慢，整個(gè)曲線較低平，末端仍高于增強(qiáng)前密度。 結(jié)論： 肺局灶性磨玻璃病灶影像學(xué)表現(xiàn)（病灶形態(tài)、邊緣光整或毛糙、分葉及胸膜凹陷癥等）在鑒別fGGO的良惡性診斷中有統(tǒng)計(jì)學(xué)意義； CT灌注曲線在良惡性fGGO的鑒別診斷中有其共性以及特征性改變。結(jié)合fGGO的CT影像形態(tài)學(xué)征象和CT灌注曲線特征，對(duì)表現(xiàn)為fGGO的良惡性病變的診斷與鑒別診斷有一定的實(shí)際應(yīng)用價(jià)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類(lèi)號(hào)】：R816.41

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