CT支气管征在鉴别良恶性实性孤立性肺结节(≤2 cm)中的价值

张春; 李琦; 吕发金; 霍继文; 何小群

doi:10.16016/j.2097-0927.202204065

您当前的位置：

首页 >

文章列表页 >

CT支气管征在鉴别良恶性实性孤立性肺结节(≤2 cm)中的价值

临床医学 | 更新时间：2026-02-13

- CT支气管征在鉴别良恶性实性孤立性肺结节(≤2 cm)中的价值
- Value of bronchogram sign on CT images in differentiating benign and malignant solid pulmonary nodules with maximum diameter ≤2 cm
- 陆军军医大学学报 2022年44卷第21期页码：2206-2210
- 作者机构：
  
  400016 重庆，重庆医科大学附属第一医院放射科
- 作者简介：
  
  [李琦，E-mail: zhuoshui@sina.com LI Qi, E-mail: zhuoshui@sina.com
- 基金信息：
- DOI：10.16016/j.2097-0927.202204065
  中图分类号： R447;R734.2;R814.42
- 收稿：2022-04-10，
  
  修回：2022-06-19，
  
  纸质出版：2022-11-15
- 稿件说明：
移动端阅览
张春, 李琦, 吕发金, 等. CT支气管征在鉴别良恶性实性孤立性肺结节(≤2 cm)中的价值[J]. 陆军军医大学学报, 2022,44(21):2206-2210.

Chun ZHANG, Qi LI, Fajin LYU, et al. Value of bronchogram sign on CT images in differentiating benign and malignant solid pulmonary nodules with maximum diameter ≤2 cm[J]. Journal of Army Medical University, 2022, 44(21): 2206-2210.
张春, 李琦, 吕发金, 等. CT支气管征在鉴别良恶性实性孤立性肺结节(≤2 cm)中的价值[J]. 陆军军医大学学报, 2022,44(21):2206-2210. DOI： 10.16016/j.2097-0927.202204065.

Chun ZHANG, Qi LI, Fajin LYU, et al. Value of bronchogram sign on CT images in differentiating benign and malignant solid pulmonary nodules with maximum diameter ≤2 cm[J]. Journal of Army Medical University, 2022, 44(21): 2206-2210. DOI： 10.16016/j.2097-0927.202204065.

摘要

目的

探讨最大径≤ 2 cm的实性肺结节与支气管的关系，以期为良恶性肺结节的鉴别诊断提供线索。

方法

回顾性分析本院2014年1月至2021年1月经手术病理证实的776例最大径≤ 2 cm实性肺结节患者的临床及CT资料，根据病理结果分为恶性结节组(340例)和良性结节组(436例)，良性结节组又分为炎性结节组(299例)和良性肿瘤组(137例)。根据肺结节与支气管的关系将CT支气管征分为4型，分别比较恶性结节组和良性结节组、炎性结节组和良性肿瘤组CT支气管征的发生率及其分型的差异，评估CT支气管征对良、恶性实性肺结节的诊断效能。

结果

① 恶性结节组CT支气管征发生率为65.9%(224/340)，显著高于良性结节组(31.4%，

＜0.001)；良性结节组Ⅰ型、Ⅱ型CT支气管征发生率显著高于恶性结节组，而恶性结节组Ⅲ型、Ⅳ型CT支气管征发生率显著高于良性结节组，差异均有统计学意义(

＜0.01)；CT支气管征鉴别良恶性实性肺结节的灵敏度为82.1%，特异度为56.2%，准确率为72.3%。②炎性结节组CT支气管征发生率为39.1%(117/299)，显著高于良性肿瘤组(14.6%，

＜0.001)；炎性结节组Ⅳ型CT支气管征发生率显著高于良性肿瘤组(

＜0.05)，而两组Ⅰ型、Ⅱ型及Ⅲ型CT支气管征发生率差异均无统计学意义(

＞0.05)。

结论

CT支气管征对鉴别最大径≤ 2 cm实性孤立性肺结节的良恶性有一定价值，当肺结节内出现不规则充气支气管征或支气管走行至结节边缘截断时需高度警惕肺癌的可能。

Abstract

Objective

To investigate the relationship between solid pulmonary nodules with maximum diameter≤2 cm and the bronchi in order to provide more valuable clues to differentiate benign and malignant solid pulmonary nodules.

Methods

The clinical and CT data of 776 patients with solid pulmonary nodule at a maximum diameter of not larger than 2 cm confirmed by pathology in our hospital from January 2014 to January 2021 were analyzed retrospectively. According to pathological types

the patients were divided into malignant nodule group(

=340) and benign nodule group(

=436)

and those with benign nodules were further assigned into inflammatory nodule subgroup(

=299) and benign tumor subgroup(

=137). Bronchogram sign on CT images were classified into 4 types according to the relationship between pulmonary nodules and bronchi. The incidence and types of different bronchogram sign on CT images were compared between malignant nodule group and benign nodule group

and between inflammatory nodule subgroup and benign tumor subgroup. The diagnostic performance of bronchogram sign on CT images to differentiate benign and malignant solid pulmonary nodules was evaluated.

Results

① The incidence of bronchogram sign on CT images was higher in the malignant nodule group than the benign nodule group(65.9%

31.4%

0.001). Types Ⅰ and Ⅱ signs were more common in the benign nodule group

while Types Ⅲ and Ⅳ signs were more common in the malignant nodule group(all

0.01). The sensitivity

specificity

and accuracy of bronchogram sign on CT images was 82.1%

56.2%

and 72.3%

respectively in differentiation of benign and malignant solid pulmonary nodules. ②The incidence of bronchogram sign on CT images was statistically higher in the inflammatory nodule subgroup than the benign tumor subgroup(39.1%

14.6%

0.001). Type Ⅳ was more common in inflammatory nodule subgroup(

0.05). However

no significant differences were observed in the other

3 types between the 2 subgroups (all

0.05).

Conclusion

Bronchogram sign on CT images is valuable in differentiation of benign and malignant solid pulmonary nodules measuring ≤2 cm in diameter. Irregular air bronchogram sign or truncation of bronchus in the margin of nodule is highly suggestive of malignancy.

关键词

Keywords

references

NAIDICH D P, BANKIER A A, MACMAHON H, et al . Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society[J ] . Radiology, 2013, 266(1): 304-317. DOI: 10.1148/radiol.12120628.

GODOY M C B, NAIDICH D P. Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management[J]. Radiology, 2009, 253(3): 606-622. DOI: 10.1148/radiol.2533090179.

CHU Z G, ZHANG Y, LI W J, et al . Primary solid lung cancerous nodules with different sizes: computed tomography features and their variations[J ] . BMC Cancer, 2019, 19(1): 1060. DOI: 10.1186/s12885-019-6274-0.

LIU X, LIANG M, WANG Y, et al . The outcome differences of CT screening for lung cancer pre and post following an algorithm in Zhuhai, China[J ] . Lung Cancer, 2011, 73(2): 230-236. DOI: 10.1016/j.lungcan.2010.11.012.

高益萍, 黎良山, 沈志炜, 等. 肺结节CT靶扫描及重建技术对肺腺癌支气管改变的诊断价值分析[J]. 中国医学计算机成像杂志, 2019, 25(2): 129-132. DOI: 10.19627/j.cnki.cn31-1700/th.2019.02.007.

GAO Y P, LI L S, SHEN Z W, et al . Application of CT target scanning and reconstruction technique in evaluating bronchial changes of pulmonary nodules[J ] . Chin Comput Med Imaging, 2019, 25(2): 129-132. DOI: 10.19627/j.cnki.cn31-1700/th.2019.02.007.

胡星, 刘含秋, 张家文, 等. 孤立性肺结节与血管和支气管关系: 多层螺旋CT与病理对照初步研究[J]. 中国医学计算机成像杂志, 2015, 21(2): 105-110. DOI: 10.19627/j.cnki.cn31-1700/th.2015.02.005.

HU X, LIU H Q, ZHANG J W, et al . Study of the relationship between solitary pulmonary nodule, blood vessels and Bronchus by multi-slice spiral CT[J ] . Chin Comput Med Imaging, 2015, 21(2): 105-110. DOI: 10.19627/j.cnki.cn31-1700/th.2015.02.005..

李凤, 沈晶, 薛昌辉, 等. 肺磨玻璃结节与邻近血管及支气管的关系与分型对其良恶性鉴别诊断的价值[J]. 大连医科大学学报, 2017, 39(5): 446-451. DOI: 10.11724/jdmu.2017.05.07.

LI F, SHEN J, XUE C H, et al . Clinical study on the differential diagnosis of benign and malignant bronchial nodules based on vessels and bronchial signs[J ] . J Dalian Med Univ, 2017, 39(5): 446-451. DOI: 10.11724/jdmu.2017.05.07.

陈天忠, 韦乐心, 余绍立, 等. 多层螺旋CT对肺磨玻璃结节与支气管关系的初探[J]. 临床放射学杂志, 2014, 33(5): 711-715. DOI: 10.13437/j.cnki.jcr.2014.05.017.

CHEN T Z, WEI L X, YU S L, et al . Application of multislice spiral CT scanning in evaluating the relationship between pulmonary ground glass nodule and bronchiole[J ] . J Clin Radiol, 2014, 33(5): 711-715. DOI: 10.13437/j.cnki.jcr.2014.05.017.

QU H F, ZHANG W C, YANG J S, et al . The value of the air bronchogram sign on CT image in the identification of different solitary pulmonary consolidation lesions[J ] . Medicine, 2018, 97(35): e11985. DOI: 10.1097/MD.0000000000011985.

吴顺, 李琦, 何小群, 等. 实性孤立性肺浸润性黏液腺癌与非黏液腺癌的CT表现差异[J]. 第三军医大学学报, 2021, 43(19): 1919-1924. DOI: 10.16016/j.1000-5404.202104020.

WU S, LI Q, HE X Q, et al . Differences in CT findings between solid solitary mucinous lung invasive adenocarcinoma and non-mucinous lung invasive adenocarcinoma[J ] . J Third Mil Med Univ, 2021, 43(19): 1919-1924. DOI: 10.16016/j.1000-5404.202104020.

何小群, 罗天友, 李琦, 等. 浸润性肺腺癌不同病理亚型的临床病理及CT特征分析[J]. 第三军医大学学报, 2020, 42(19): 1950-1956. DOI: 10.16016/j.1000-5404.202004321.

HE X Q, LUO T Y, LI Q, et al . Clinicopathological characteristics and CT features of invasive adenocarcinoma of the lung with different pathological subtypes[J ] . J Third Mil Med Univ, 2020, 42(19): 1950-1956. DOI: 10.16016/j.1000-5404.202004321.

方金忠, 张文奇, 王和平, 等. 螺旋CT薄层靶扫描对孤立性肺结节与支气管关系的诊断价值与病理对照[J]. 医学影像学杂志, 2016, 26(2): 234-238.

FANG J Z, ZHANG W Q, WANG H P, et al . Spiral CT thin layer target scan in the diagnosis of solitary pulmonary nodule and Bronchus relationship value and pathology[J ] . Chin J Med Imaging, 2016, 26(2): 234-238..

朱丽, 段庆红. 孤立性肺结节与支气管及血管关系的MSCT研究[J]. 医学影像学杂志, 2019, 29(3): 403-406.

ZHU L, DUAN Q H. The study of the relationship between solitary pulmonary nodules and Bronchus and blood vessels with MSCT[J ] . Chin J Med Imaging, 2019, 29(3): 403-406.

郑恒, 彭昌勇, 张昊, 等. 64排CT支气管动脉双期扫描技术对肺结节的良、恶性诊断价值[J]. 分子影像学杂志, 2021, 44(2): 314-320. DOI: 10.12122/j.issn.1674-4500.2021.02.20.

ZHENG H, PENG C Y, ZHANG H, et al . Value of dual-phase bronchial artery 64-slice CT in the diagnosis of benign and malignant pulmonary nodules[J ] . J Mol Imaging, 2021, 44(2): 314-320. DOI: 10.12122/j.issn.1674-4500.2021.02.20.

李琦, 黄兴涛, 罗天友, 等. Ⅰ期中央型肺癌与支气管播散性肺结核CT树芽征的比较分析[J]. 中国医学影像学杂志, 2016, 24(12): 930-933. DOI: 10.3969/j.issn.1005-5185.2016.12.014.

LI Q, HUANG X T, LUO T Y, et al . Stage Ⅰ central lung cancer and bronchial disseminated pulmonary tuberculosis: a comparative analysis of tree-in-bud sign at CT[J ] . Chin J Med Imaging, 2016, 24(12): 930-933. DOI:10.3969/j.issn.1005-5185.2016.12.014.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

实性孤立性肺浸润性黏液腺癌与非黏液腺癌的CT表现差异

CT影像组学分层鉴别三种常见孤立性肺结节的价值