目的探讨窗宽调整对表现为磨玻璃影的肺腺癌浸润性的诊断作用，为正确诊断不同类型的肺腺癌提供指导。资料与方法回顾性分析肺窗表现为磨玻璃影且纵隔窗病灶不可见的浸润前病变102例和浸润性病变107例肺腺癌患者的术前CT 资料，102例浸润前病变中，不典型腺瘤样增生25例，原位腺癌77例；107例浸润性病变中，微浸润腺癌78例，浸润性腺癌29例。固定纵隔窗窗位（40 HU），调节窗宽值至病灶不可见，比较两组不同病灶消失时的窗宽值，然后通过 ROC 曲线确定两组病灶消失的窗宽值的最佳截断点。结果浸润前病变与浸润性病变病灶消失的窗宽值不同（Z=－6.203，P<0.05），窗宽值对于肺腺癌浸润性的诊断价值较好（ROC 曲线下面积0.748，P<0.05），1303 HU 为浸润前病变和浸润性病变病灶消失的最佳窗宽截断点（敏感度为56.9%，特异度为86.0%）。结论窗口技术对于磨玻璃性肺腺癌浸润性的诊断有一定的指导意义，当窗宽>1303 HU 时，病灶消失为浸润前病变的可能性大；当窗宽<1303 HU 时，病灶消失为浸润性病变的可能性大。%Purpose To explore the value of window width adjustment in diagnosing the invasiveness of lung adenocarcinoma manifested as ground glass opacities on high-resolution CT, and to provide guidance for the diagnosis of lung adenocarcinoma in different types. Materials and Methods The preoperative CT data of 102 preinvasive lesions and 107 invasive lesions of lung adenocarcinoma were analyzed retrospectively. Among 102 cases of preinvasive lesions, 25 were atypical adenomatous hyperplasia (AAH), 77 were adenocarcinoma in situ (AIS). Among 107 cases of invasive lesions, 78 were minimally invasive adenocarcinoma (MIA), and 29 were invasive adenocarcinoma. The lesions were ground glass opacity (GGO) on lung window while were invisible on mediastinal window. The window width was adjusted constantly until the lesions were invisible with the fixed mediastinal window level (40 HU). When the lesions became invisible, the window width was compared and the best cut-off was found on ROC curve in the two groups. Results The window width of lesions between preinvasive lesions and invasive lesions was different (Z= - 6.203, P<0.05). Window width was a good indicator for the invasiveness of pulmonary adenocarcinoma (area under the ROC was 0.748, P<0.05), and the window width of 1303 HU was the best cut-off for preinvasive lesions and invasive lesions (sensitivity was 56.9%, specificity was 86.0%. Conclusion Window width may be useful for the diagnosis of the invasiveness of the GGO of lung adenocarcinoma on HRCT. The lesion disappearing when the window width is larger than 1303 HU is more likely to be preinvasive; while the lesion disappearing when the window width is smaller than 1303 HU is more likely to be an invasive one.
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