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胸膜侵犯(viceral pleural invasion,VPI)是影响肺腺癌的预后的重要因素之一[1]。第8版肺癌TNM分期(2017)指南指出,肺癌发生脏层VPI,T分期由T1期提升至T2期[2]。无VPI的周围型非小细胞癌病人,可采用肺段切除代替肺叶切除,从而在不影响生存率的情况下尽可能保护肺功能[3]。因此,术前明确有无VPI,对病人术式选择和预后评估有重要意义。本研究收集162例经术后病理证实的肺腺癌资料,利用靶重建技术进行CT图像后处理,通过分析影像学特征与病理结果对照,旨在寻找判断VPI的可靠征象,为临床诊断治疗及预后判断提供依据。
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162例病人年龄(58.97±12.30)岁,其中左肺73例(上叶41例,下叶32例),右肺89例(上叶43例,中叶10例,下叶36例)。VPI阳性47例(PL1 28例,PL2 19例),阴性115例。
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VPI阳性组在年龄、性别及结节最大径与VPI阴性组间差异无统计学意义(P>0.05)。VPI阳性组DLP明显大于VPI阴性组(P < 0.01)。结节与胸膜关系分类在脏层VPI阳性组与VPI阴性组间差异有统计学意义(P < 0.01)(见表 1)。
分组 年龄/岁 男 女 结节与胸膜关系 结节最大径/mm DLP/mm 1型 2型 3型 4型 5型 VPI(-)组 58.74±11.6 46 69 41(100.0) 24(92.3) 22(59.5) 7(87.5) 21(42.0) 18.8±9.2 4.0±3.3 VPI(+)组 59.24±13.5 21 26 0(0.0) 2(7.7) 15(40.5) 1(12.5) 29(58.0) 21.2±7.9 6.0±3.7 t 0.24 0.30# 46.34* 1.57 3.38 P >0.05 >0.05 < 0.01 >0.05 < 0.01 *示矫正χ2值;#示χ2值 表 1 VPI(+)与VPI(-)组间临床及影像学特征分析(x±s)
CT靶重建技术在肺腺癌脏层胸膜侵犯诊断中的应用
Application value of CT target reconstruction technique in the diagnosis of visceral pleural invasion of lung adenocarcinoma
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摘要:
目的利用CT靶重建技术分析肺腺癌的图像特征与脏层胸膜侵犯(VPI)的关系。 方法收集162例经术后病理证实的最大径≤3 cm的肺腺癌资料,根据肺癌TNM国际分类新标准肿瘤对胸膜的侵犯程度分类,将PL1、PL2归为脏层VPI阳性组,PL0归为VPI阴性组。在CT靶重建图像下分析肺腺癌与毗邻脏层胸膜的关系。 结果结节与脏层胸膜关系分为下列五种类型:结节与胸膜无任何关系41例,结节与胸膜间1条或多条线样影相连,相应胸膜无凹陷征象26例,结节与胸膜间1条或多条线样影相连,伴有胸膜凹陷37例,结节与胸膜相贴,瘤胸贴面为磨玻璃密度8例,结节与胸膜相贴,瘤胸贴面为实性密度50例。VPI阳性组在年龄、性别及结节最大径与VPI阴性组间差异均无统计学意义(P>0.05)。VPI阳性组结节至胸膜的最短距离明显大于VPI阴性组(P < 0.01)。结节与胸膜关系分类在脏层VPI阳性组与VPI阴性组间差异有统计学意义(P < 0.01)。 结论伴有胸膜凹陷以及胸膜贴面为实性的肺腺癌更易发生VPI。 Abstract:ObjectiveTo analyze the relationship between the image features of lung adenocarcinoma and visceral pleural invasion(VPI) using CT target reconstruction. MethodsThe data of 162 lung adenocarcinoma patients with the maximum diameter less than or equal to 3 cm diagnosed by postoperative pathology were retrospectively analyzed.The PL1 and PL2 were classified as the positive VPI group, and the PL0 was classified as the negative VPI group according to the classification of pleural invasion degree of the new TNM international classification of lung cancer.The relationship between lung adenocarcinoma and adjacent visceral pleura was analyzed under CT target reconstruction. ResultsThe relationship between nodules and visceral pleura could be divided into the following five types: the nodules had nothing to do with pleura in 41 cases; there was one or more linear shadows between the nodules and pleura complicated without signs of depression in pleura in 26 cases; there was one or more linear shadows between the nodules and pleura complicated with signs of depression in pleura in 37 cases; the nodules were pasted to pleura with ground glass density in 8 cases; and the nodules were pasted to pleura with solid density in 50 cases.The differences of the age, gender and maximum nodule diameter between VPI positive group and VPI negative group were not statistically significant(P>0.05), and the minimum distance from the lesion to the pleura in VPI positive group was greater than that in VPI negative group(P < 0.01).The difference of the classification of the relationship between nodules and pleura between the VPI positive group and VPI negative group was statistically significant(P < 0.01). ConclusionsThe VPI is more likely to occur in lung adenocarcinoma with pleural depression and solid pleural veneer. -
Key words:
- lung neoplasms /
- viceral pleural invasion /
- CT target reconstruction
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表 1 VPI(+)与VPI(-)组间临床及影像学特征分析(x±s)
分组 年龄/岁 男 女 结节与胸膜关系 结节最大径/mm DLP/mm 1型 2型 3型 4型 5型 VPI(-)组 58.74±11.6 46 69 41(100.0) 24(92.3) 22(59.5) 7(87.5) 21(42.0) 18.8±9.2 4.0±3.3 VPI(+)组 59.24±13.5 21 26 0(0.0) 2(7.7) 15(40.5) 1(12.5) 29(58.0) 21.2±7.9 6.0±3.7 t 0.24 0.30# 46.34* 1.57 3.38 P >0.05 >0.05 < 0.01 >0.05 < 0.01 *示矫正χ2值;#示χ2值 -
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