發(fā)布時(shí)間：2018-02-23 23:00

  本文關(guān)鍵詞： 肺腺癌 純磨玻璃密度結(jié)節(jié) 計(jì)算機(jī)斷層成像 均勻度　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討肺部純磨玻璃密度結(jié)節(jié)(pure groung-glass opacity nodule,p GGN)的CT影像特征及臨床特點(diǎn)對(duì)于浸潤(rùn)前病變(preinvasive lesion,PIL)[包括不典型腺瘤樣增生(atypical adenomatous hyperplasia,AAH)、原位腺癌(adenoeareinoma in situ,AIS)]及浸潤(rùn)性病變[包括微浸潤(rùn)腺癌(minimally invasive adenocarcinoma,MIA)、浸潤(rùn)性肺腺癌(invasive lung adenocarcinomas,ILA)]的診斷價(jià)值,嘗試定量分析p GGN均勻度對(duì)浸潤(rùn)前與浸潤(rùn)性病變的鑒別診斷價(jià)值。材料與方法:回顧性分析2014年9月至2016年12月期間被吉林大學(xué)第一醫(yī)院收治并行胸部CT(computed tomography)檢查,經(jīng)術(shù)后病理證實(shí)的80例p GGN的CT影像特征及臨床特點(diǎn),包括病變的位置、大小、密度、邊緣(光滑、分葉征、毛刺征)、瘤-肺界面(清晰、不清晰)、內(nèi)部征象(空氣支氣管征、空泡征、囊腔)、均勻度、胸膜凹陷征、患者性別、年齡、吸煙史。選取p GGN內(nèi)任意三點(diǎn)感興趣區(qū)(region of interest,ROI),測(cè)量平均CT值及標(biāo)準(zhǔn)差,需避開血管及支氣管,取三個(gè)ROI變異系數(shù)[(標(biāo)準(zhǔn)差SD/平均值Mean)×100%),C·V]平均值的相對(duì)值代表病灶均勻度。病灶大小、均勻度、密度及患者年齡在病理分組之間的比較采用獨(dú)立樣本t檢驗(yàn);患者性別、病變部位及CT影像特征的比較采用卡方檢驗(yàn);以P0.05為差異具有統(tǒng)計(jì)學(xué)意義,并通過受試者工作曲線(receive operating characteristic,ROC)分析浸潤(rùn)前與浸潤(rùn)性病變大小及均勻度的最佳臨界值。結(jié)果:80例p GGNs中浸潤(rùn)前病變16例(AAH 6例,AIS 10例);浸潤(rùn)性病變64例(MIA 29例,ILA 35例)。在浸潤(rùn)前病變與浸潤(rùn)性病變之間,患者性別、年齡、病灶部位及空泡征的差異無統(tǒng)計(jì)學(xué)意義。病灶大小、均勻度、密度、分葉征、毛刺征、瘤-肺界面、空氣支氣管征及胸膜凹陷征在鑒別浸潤(rùn)前與浸潤(rùn)性病變之間差異具有統(tǒng)計(jì)學(xué)意義(各組P值分別為0.001、0.001、0.01、0.033、0.034、0.029、0.041、0.042,P0.05)。ROC曲線顯示以直徑10.5mm為鑒別浸潤(rùn)前病變與浸潤(rùn)性病變的臨界值時(shí),敏感度為81.3%,特異性為71.9%,ROC曲線下面積(AUC)為0.770;以0.085作為鑒別浸潤(rùn)前與浸潤(rùn)性病變密度均勻度的最佳臨界值,敏感度為81.3%,特異性為75.0%,AUC為0.785。結(jié)論:病灶的大小、CT影像特征(均勻度、密度、分葉征、毛刺征、瘤-肺界面、空氣支氣管征、胸膜凹陷征)對(duì)p GGN浸潤(rùn)前與浸潤(rùn)性病變具有鑒別診斷價(jià)值;定量分析p GGN均勻度,為評(píng)價(jià)病灶均勻度提供一種新的客觀分析方法。
[Abstract]:Objective: to investigate the CT features and clinical features of pure groung-glass opacity noduleus (GGNN) for preinvasive lesions (including atypical adenomatous hyperplasia, adenoeareinoma in situ) and invasive lesions [including microinvasive lesions]. The diagnostic value of minimally invasive invasive adenocarcinoma A and invasive lung adenocarcinomassus (ILA). Materials and methods: from September 2014 to December 2016, we retrospectively analyzed the value of p GGN evenness in the differential diagnosis of preinvasive and invasive lesions by CT(computed CT(computed examination in the first Hospital of Jilin University, which was admitted to the first Hospital of Jilin University from September 2014 to December 2016. Ct features and clinical features of 80 cases of p GGN confirmed by postoperative pathology, including location, size, density, margin (smooth, lobular sign, burr sign, tumor-lung interface (clear, unclear), internal sign (air bronchus sign) of the lesion, were analyzed. Vacuole sign, cystic cavity, uniformity, pleural indentation, patient sex, age, smoking history. Select any three regions of interest in p GGN to measure average CT value and standard deviation, avoid blood vessels and bronchi, The relative values of the mean values of the three ROI coefficients of variation [(standard deviation mean / mean) 脳 100C 路V] were taken to represent the lesion evenness. The size, evenness, density and age of the lesions were compared between pathological groups by independent sample t test. The location of lesion and CT imaging features were compared by chi-square test, with P0.05 as the difference was statistically significant, The optimal critical value of the size and evenness of the infiltrating lesions before infiltration and with the invasive lesions was analyzed by the operating curve of the subjects. Results in the 80 cases of p GGNs, 16 cases had preinvasive lesions, 6 cases had AIS, and 64 cases had infiltrative lesions with MIA in 29 cases. Between preinvasive lesions and invasive lesions, There was no significant difference in sex, age, location of lesion and vacuole sign. Lesion size, uniformity, density, lobulation, burr sign, tumor-lung interface, There were significant differences between air bronchus sign and pleural depression sign in differentiating preinvasive lesions from invasive lesions (P = 0.001 / 0. 001 / 0. 01 / 0. 031 / 0. 033 / 0. 034 / 0. 029 / 0. 041 / 0. 042) P 0.05 / ROC curve indicating that the diameter of 10. 5mm was taken as the critical value for differentiating preinvasive lesions from invasive lesions. The sensitivity is 81.3, the specificity is 71.9 and the area under the ROC curve is 0.770; the best critical value for distinguishing the density uniformity between the pre-invasive and the invasive lesions is 0.085, the sensitivity is 81.3 and the specificity is 75.0 and the AUC is 0.785.Conclusion: the size of the lesion is uniform. Density, lobulation sign, burr sign, tumor-lung interface, air bronchus sign, pleural indentation sign) are valuable for differential diagnosis of preinvasive and invasive lesions of p GGN, quantitative analysis of p GGN uniformity, It provides a new objective analysis method for evaluating the evenness of lesions.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R734.2;R730.44

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