肺部GGO病理解读 及HRCT评价,GGO(ground-glass opacity,GGO)，肺毛玻璃样病变，是周围型肺癌最早期的CT表现 容易被我们忽视或者被认为是正常的CT图像 随着CT技术的发展及人们健康意识的增强，我们将面临越来越多这种的病人,一、GGO的病理解读,这是什么？,a,b,GGO的定义,GGO定义 ：在高分辨率CT(HRCT) 上表现为密度轻度增加,但其内的支气管血管束仍可显示的病变,纵隔窗上病灶往往不能显示或仅能显示磨玻璃样病灶中的实性成分,GGO的病理解读,GGO 病理：由于肺泡内气体减少、细胞数量相对增多、肺泡上皮细胞增生、肺泡间隔增厚及终末气道部分充填等因素所致的病理变化。Pathology: Ground-glass opacity may be caused by partial airspace filling; interstitial thickening with inflammation, edema, fibrosis, or neoplastic proliferation; or interstitial thickening with partial airspace filling.,a.Transverse lung-window thin-section (1.25-mm-thick) CT scan shows 8-mm round, well-defined GGO nodule (arrow) in left upper lobe. b. Photomicrograph shows columnar tumor cells growing along thickened alveolar walls (lepidic growth).,a,b,AAH in 55-year-old man. a.Transverse lung-window thin-section (2.5-mm-thick) CT scan shows 12-mm round, well-defined GGO nodule (arrow) in left upper lobe. b.shows alveolar wall thickening and increased numbers of alveolar lining cells with minimal wall thickening.,a,b,GGO演变为周围型肺癌的过程,肺泡上皮不典型样增生 （AAH）,原位癌（AIS）,进展期肺癌,肺癌前病变演化成原位癌的病理变化过程,基底细胞增生,轻度不典型增生,中度不典型增生,重度不典型增生,原位癌,肺泡上皮不典型样增生 （AAH）,原位癌（AIS）,肺腺癌病变病理衍化过程图（腺癌）,侵袭性,AIS,AAH,二、高分辨率CT对GGO的评价,肺良好的自然对比，是CT成像的有利条件； 多排螺旋CT，主要是指16排以上螺旋CT，具有高时间、高空间、高密度辨分率以及高信噪比的成像特点； 任意层厚重建，能检出1mm的小病灶； 高分辨率CT(HRCT)对肺内小病灶细节的显示优于常规CT，能检出0.5mm的小病灶，是评价GGO最佳的无创性方法。,肺多排螺旋CT扫描技术参数,容积扫描,准备,多层、无间隔、连续的图像,薄层，小FOV，多发方位重建,第一种分型,第二种分型,局限性GGO的CT分型,单纯型GGO(pure GGO，pGGO) : 整个病灶密度浅淡, 内见血管或支气管壁, 完全无实性组织成分, 只能在肺窗下看到,混合型GGO (mixed GGO,mGGO): 病灶内部见部分实性组织, 相应部分血管被遮盖, 实性病变部分可在纵隔窗下看到,第一种分型,:单纯磨玻璃样影 :密度不均的磨玻璃样影 :中央高密度,外围淡薄模糊磨玻璃样影 :单纯结节影,第二种分型,GGO分型和肿瘤发生及CT表现,型：纯磨玻璃样结节,病理改变为肿瘤细胞沿肺泡壁生长,无肺泡塌陷,肿瘤内弹性纤维轻度增生,型：低密度不均匀结节,病理为肿瘤细胞沿肺泡壁生长,伴有散在肺泡塌陷,肿瘤内弹性纤维、重度增生,但其网状结构仍保存,型：中心高密度伴周边磨玻璃样结节,病理为肺泡塌陷,瘤体中心弹性纤维增生,伴弹性纤维网状结构断裂,周边区肿瘤细胞伏壁生长,型：均匀软组织密度结节,病理上肿瘤呈实体生长,无含气肺泡组织,肿瘤内弹性纤维增生,网状结构中断、破坏,型:单纯磨玻璃样阴影,GGO发展成肺癌的动态演变过程,型:密度不均的磨玻璃样阴影,型:中央高密度,外围淡薄模糊的磨玻璃样阴影,型:单纯结节影,GGO发展成肺癌CT表现的四步曲,pGGO：pure GGO （纯毛玻璃样病变） mGGO: mixed GGO（混合型毛玻璃样病变） SOLID SPN(3cm，肿块，实体瘤，进展期肺癌),肺腺癌的演变过程是和CT的表现相对应的,pGGO：AAH,mGGO：AIS,MASS:腺癌,从病理学角度看肺癌的CT图像的演变过程,Illustration of the relationship between the Noguchi histologic classification of adenocarcinoma of the lung (Noguchi types A though F) and corresponding CT appearances of these lesions.,Persistent nodular ground-glass opacity in an 80-year-old man with adenocarcinoma. Adenocarcinoma was found at histopathologic analysis of an excised specimen.,a. Initial thick-section CT image obtained at the level of the right inferior pulmonary vein shows a subtle nodule (arrow) in the middle lobe of the right lung. b.Follow-up CT image obtained 12 months later shows an increase in the lesion size and an additional subtle internal solid component (arrow). c.Follow-up thin-section CT image obtained at 16 months shows an increase in the size of the solid component within the lesion (arrow).,a,b,c,BAC. Sequential magnified 1-mm CT sections through the right upper lobe show minimal increase in size of a nodule with GGO over a 3-year period. The central area of higher attenuation represents a vessel bifurcation and not a solid component, which was better characterized on sequential images.,（一）肺恶性GGO的CT评价,GGO和AAH,Atypical adenomatous hyperplasia in a 53-year-old woman. a.Thin-section CT image of the right lung shows an 11-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe. b. photomicrograph shows thickened alveolar walls lined by an intermittent single layer of atypical cuboidal pneumocytes.,a,b,Concurrent atypical adenomatous hyperplasia and adenocarcinoma in a 71-year-old woman. Thin-section CT image at the level of the carina shows an 18-mm-diameter mixed nodular ground-glass opacity with a solid component in the upper lobe of the right lung and a 10-mm pure nodular ground-glass opacity in the lower lobe of the left lung.,AAH,carcinoma of the bronchioloalveolar,Multiple AAHs in a 42-year-oldwoman. CT scans show round well-defined, pure GGO nodules (arrow).Photomicrograph of the nodule in the left upper lobe show AAH.,a,b,c,bronchioloalveolar carcinoma in a 63-year-old woman. a.the right upper anterior segmental bronchus shows a 10-mm well-defined nodular ground-glass opacity without a solid component in the lower lobe of the right lung. Note the presence of pulmonary vessels in the lesion. b. Photomicrograph specimen shows replacement of the alveolar lining by neoplastic columnar epithelium, without evidence of stromal invasion.,GGO 和 BAC (AIS),a,b,bronchioloalveolar carcinoma in a 49-year-old woman.a.The level of the right bronchus intermedius shows a 14-mm well-defined nodular ground-glass opacity with a solid component (arrow) in the lower lobe of the right lung, abutting the vertebral body. b. Photomicrograph shows BAC (AIS),a,b,Adenocarcinoma with mixed acinar and bronchioloalveolar carcinoma in a 50-year-old woman. a. Thin-section CT image shows a 28-mm well-defined mixed ground-glass opacity lesion with peripheral ground-glass opacity in the upper lobe of the left lung. The mass abuts the pleura. b. Photomicrograph of a histologic specimen shows BAC (AIS).,