European Radiology

, Volume 23, Issue 12, pp 3271–3277 | Cite as

Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels

  • Feng Gao
  • Ming Li
  • Xiaojun Ge
  • Xiangpeng ZhengEmail author
  • Qingguo Ren
  • Yan Chen
  • Fangzhen Lv
  • Yanqing HuaEmail author



To investigate the relationships between pulmonary ground-glass nodules (GGN) and blood vessels and their diagnostic values in differentiating GGNs.


Multi-detector spiral CT imaging of 108 GGNs was retrospectively reviewed. The spatial relationships between GGNs and supplying blood vessels were categorized into four types: I, vessels passing by GGNs; II, intact vessels passing through GGNs; III, distorted, dilated or tortuous vessels seen within GGNs; IV, more complicated vasculature other than described above. Relationship types were correlated to pathologic and/or clinical findings of GGNs.


Of 108 GGNs, 10 were benign, 24 preinvasive nodules and 74 adenocarcinomas that were pathologically proven. Types I, II, III and IV vascular relationships were observed in 9, 58, 21 and 20 GGNs, respectively. Type II relationship was the dominating relationship for each GGN group, but significant differences were shown among them. Correlation analysis showed strong correlation between invasive adenocarcinoma and type III and IV relationships. Subgroup analysis indicated that type III was more commonly seen in IAC with comparison to type IV more likely seen in MIA.


Different GGNs have different relationships with vessels. Understanding and recognising characteristic GGN-vessel relationships may help identify which GGNs are more likely to be malignant.

Key Points

Multi-detector CT offers new information about ground-glass nodules

In particular we can now study their relationship with vessels

Different types of ground-glass nodules have different relationships with vessels

This may help identify which ground-glass nodules are likely to be malignant


Vessel Ground-glass nodule Tomography Adenocarcinoma X-ray computed 



Feng Gao and Ming Li contributed equally to this article.

This study was partly financially supported by the Science and Technology Commission Foundation of Shanghai (no. 10411952600, 124119a0400) and the Young Investigator Fund of Fudan University (grant no. EYF163006).


  1. 1.
    Tammemagi MC, Katki HA, Hocking WG et al (2013) Selection criteria for lung-cancer screening. N Engl J Med 368:728–736PubMedCrossRefGoogle Scholar
  2. 2.
    Henschke CI, Yankelevitz DF, Mirtcheva R et al (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178:1053–1057PubMedCrossRefGoogle Scholar
  3. 3.
    Mori K, Saitou Y, Tominaga K et al (1990) Small nodular lesions in the lung periphery: new approach to diagnosis with CT. Radiology 177:843–849PubMedGoogle Scholar
  4. 4.
    Mihara N, Kuriyama K, Kido S et al (1998) The usefulness of fractal geometry for the diagnosis of small peripheral lung tumors. Nihon Igaku Hoshasen Gakkai Zasshi 58:148–151PubMedGoogle Scholar
  5. 5.
    Choi JA, Kim JH, Hong KT et al (2000) CT bronchus sign in malignant solitary pulmonary lesions: value in the prediction of cell type. Eur Radiol 10:1304–1309PubMedCrossRefGoogle Scholar
  6. 6.
    Yabuuchi H, Murayama S, Sakai S et al (1999) Resected peripheral small cell carcinoma of the lung: computed tomographic-histologic correlation. J Thorac Imaging 14:105–108PubMedCrossRefGoogle Scholar
  7. 7.
    Kim HY, Shim YM, Lee KS et al (2007) Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology 245:267–275PubMedCrossRefGoogle Scholar
  8. 8.
    Ko JP (2005) Lung nodule detection and characterization with multi-slice CT. J Thorac Imaging 20:196–209PubMedCrossRefGoogle Scholar
  9. 9.
    Aoki T, Tomoda Y, Watanabe H et al (2001) Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 220:803–809PubMedCrossRefGoogle Scholar
  10. 10.
    Travis WD, Brambilla E, Noguchi M et al (2011) International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6:244–285PubMedCrossRefGoogle Scholar
  11. 11.
    Henschke CI, Yankelevitz DF, Naidich DP et al (2004) CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans. Radiology 231:164–168PubMedCrossRefGoogle Scholar
  12. 12.
    Midthun DE, Swensen SJ, Jett J et al (2003) Evaluation of nodules detected by screening for lung cancer with low dose spiral computed tomography. Lung Cancer 41:S40CrossRefGoogle Scholar
  13. 13.
    MacMahon H, Austin JH, Gamsu G et al (2005) Fleischner society. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the fleischner society. Radiology 237:395–400PubMedCrossRefGoogle Scholar
  14. 14.
    Takashima S, Maruyama Y, Hasegawa M et al (2003) CT findings and progression of small peripheral lung neoplasms having a replacement growth pattern. Am J Roentgenol 180:817–826CrossRefGoogle Scholar
  15. 15.
    Nambu A, Araki T, Taguchi Y et al (2005) Focal area of ground-glass opacity and ground-glass opacity predominance on thin-section CT: discrimination between neoplastic and non-neoplastic lesions. Clin Radiol 60:1006–1017PubMedCrossRefGoogle Scholar
  16. 16.
    Tsutsui S, Ashizawa K, Minami K et al (2010) Multiple focal pure ground-glass opacities on high-resolution CT images: Clinical significance in patients with lung cancer. Am J Roentgenol 195:W131–W138CrossRefGoogle Scholar
  17. 17.
    Naidich DP, Bankier AA, MacMahon H et al (2013) Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 266:304–317PubMedCrossRefGoogle Scholar
  18. 18.
    National Comprehensive Cancer Network (2011) NCCN clinical practice guidelines in oncology: Non-small cell lung cancer. V.2.2010. 2011Google Scholar
  19. 19.
    Soda H, Nakamura Y, Nakatomi K et al (2008) Stepwise progression from ground-glass opacity towards invasive adenocarcinoma: long-term follow-up of radiological findings. Lung Cancer 60:298–301PubMedCrossRefGoogle Scholar
  20. 20.
    Lee HJ, Goo JM, Lee CH et al (2007) Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean J Radiol 8:22–31PubMedCrossRefGoogle Scholar
  21. 21.
    Noguchi M, Morikawa A, Kawasaki M et al (1995) Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer 75:2844–2852PubMedCrossRefGoogle Scholar
  22. 22.
    Zwirewich CV, Vedal S, Miller RR et al (1991) Solitary pulmonary nodule: high-resolution CT and radiologic-pathologic correlation. Radiology 179:469–476PubMedGoogle Scholar
  23. 23.
    Folkman J (1995) Angiogenesis in cancer, vascular, rheumatoid and other disease. Nat Med 1:27–31PubMedCrossRefGoogle Scholar
  24. 24.
    Fridman WH, Dieu-Nosjean MC, Pages F, et al. (2012) The immune microenvironment of human tumors: general significance and clinical impact. Cancer MicroenvironGoogle Scholar
  25. 25.
    Fontanini G, Vignati S, Boldrini L et al (1997) Vascular endothelial growth factor is associated with neovascularization and influences progression of non-small cell lung carcinoma. Clin Cancer Res 3:861–865PubMedGoogle Scholar
  26. 26.
    Yang CF, Yasukawa T, Kimura H et al (2000) Experimental corneal neovascularization by basic fibroblast growth factor incorporated into gelatin hydrogel. Ophthalmic Res 32:19–24PubMedCrossRefGoogle Scholar
  27. 27.
    Max R, Gerritsen RR, Nooijen PT et al (1997) Immunohistochemical analysis of integrin alpha vbeta3 expression on tumor-associated vessels of human carcinomas. Int J Cancer 71:320–324PubMedCrossRefGoogle Scholar
  28. 28.
    Yang Z, Sone S, Takashima S et al (1999) Small peripheral carcinomas of the lung: thin-section CT and pathologic correlation. Eur Radiol 9:1819–1825PubMedCrossRefGoogle Scholar
  29. 29.
    Kakinuma R, Ohmatsu H, Kaneko M et al (1999) Detection failures in spiral CT screening for lung cancer: analysis of CT findings. Radiology 212:61–66PubMedCrossRefGoogle Scholar
  30. 30.
    de Hoop B, Gietema H, van de Vorst S et al (2010) Pulmonary ground-glass nodules: increase in mass as an early indicator of growth. Radiology 255:199–206PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • Feng Gao
    • 1
  • Ming Li
    • 1
  • Xiaojun Ge
    • 1
  • Xiangpeng Zheng
    • 2
    Email author
  • Qingguo Ren
    • 1
  • Yan Chen
    • 3
  • Fangzhen Lv
    • 4
  • Yanqing Hua
    • 1
    Email author
  1. 1.Department of RadiologyHuadong Hospital Fudan UniversityShanghaiChina
  2. 2.Department of Radiation OncologyHuadong Hospital Fudan UniversityShanghaiChina
  3. 3.Department of PathologyHuadong Hospital Fudan UniversityShanghaiChina
  4. 4.Department of Thoracic SurgeryHuadong Hospital Fudan UniversityShanghaiChina

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