Ground-GlassOpacityatCT规范.pptxVIP

南昌大学第二附属医院 呼吸科 况九龙 肺部磨玻璃样病变临床思路 肺组织的基本结构 小叶中央区和淋巴周边去 磨玻璃影影像学表现 X 线胸片和CT 表现： 磨玻璃影在X 线胸片上表现为模糊的肺密度增加区，常较广泛，其内肺血管显示不清。在CT 上表现为模糊的肺密度增加，其内可见支气管和血管纹理。 Dark bronchus sign in ground glass opacity. Complete obscuration of vessels in consolidation. 磨玻璃影基本概念 Ground-glass opacity is defined as hazy opacity that does not obscure underlying bronchial structures or pulmonary vessels at high-resolution computed tomography. 磨玻璃样阴影的定义是在高分辨率计算机断层扫描 模糊的不透明,不掩盖潜在的支气管或肺血管结构 局灶性GGO 弥漫性GGO 磨玻璃影形成机制 A, Pixel contains normal lung parenchyma at full inspiration with normal alveolar walls and alveolar air spaces. Normal amounts of air, blood, and tissue in pixel will yield a certain expected Hounsfield attenuation and will be assigned gray-scale value (e.g., -800 H). B, Pixel shows thickening of interstitium of lung, which may result from either inflammatory or fibrotic response to insult (e.g., alveolitis or microfibrosis), which in turn creates more “tissue” per pixel relative to air, thus increasing the Hounsfield value assigned that pixel (e.g., -650 H). C, Pixel shows fluid filling alveoli (e.g., edema), again increasing Hounsfield value assigned that pixel. D, Pixel shows normal parenchyma at end of exhalation. Note increased number of alveolar walls per pixel and less air than in A. Results include increased gray-scale values. 磨玻璃影形成机制 Ground-glass opacity may be caused by: Filling of the alveolar spaces with pus, edema, hemorrhage, inflammation or tumor cells. Thickening of the interstitium or alveolar walls below the spatial resolution of the HRCT as seen in fibrosis So ground-glass opacification may either be the result of air space disease (filling of the alveoli) or interstitial lung disease (i.e. fibrosis). 其病理基础是气腔的部分充盈，由于液体、细胞和（或）纤维化所致的间质增厚，部分肺泡萎陷，毛细血管容量增加或上述诸因素的综合作用，最常见因素是空气的部分被置换。磨玻璃影较实变密度低，后者内部的支气管血管边缘被掩盖。也见于实变。 磨玻璃阴影的临床意义 HRCT对磨玻璃阴影的诊断价值: 普通胸片和常规CT亦能显示磨玻璃阴影，但由于胸片结构重叠，常规CT的容积效应优势可能将其他表现误为磨玻璃阴影。故HRCT对磨玻璃阴影的显示更为确切。并可显示普通片和常规CT不能显示的密度较低膜玻璃阴影。 GGO影像征象为非特异性： 可见许多不同的病因所