European Radiology

, Volume 26, Issue 9, pp 2921–2928 | Cite as

HRCT features distinguishing pre-invasive from invasive pulmonary adenocarcinomas appearing as ground-glass nodules

  • Yu Zhang
  • Yan Shen
  • Jin Wei QiangEmail author
  • Jian Ding YeEmail author
  • Jie Zhang
  • Rui Ying Zhao
Computed Tomography



To investigate the high-resolution computed tomography (HRCT) features that distinguish lung adenocarcinomas in situ (AISs) and minimally invasive adenocarcinomas (MIAs) from invasive adenocarcinomas (IACs) appearing as ground-glass nodules (GGNs), and to select candidates for sublobar resection.


Two hundred and twenty-nine patients with 237 GGNs of less than 2 cm (139 AIS-MIA nodules and 98 IAC nodules) confirmed by surgery and pathology were retrospectively reviewed. The HRCT features of the AIS-MIAs and IACs were analysed and compared. Receiver operating characteristic (ROC) analyses were conducted to determine the cutoff values for the qualitative variables and their diagnostic performances.


Significant differences were found in the density, nodule and solid component diameters, CT values of the ground-glass and solid components, lobulated shape, spiculated margin, abnormal pulmonary vein and artery, air bronchogram, and pleural indentation of the GGNs between the two groups. Multivariate and ROC analyses revealed that larger diameter of nodules (≥12.2 mm) and solid components (≥6.7 mm), and higher CT values of the solid components (≥ -192 HU) in the GGNs with air bronchogram were significantly associated with IACs.


HRCT can identify distinguishing morphological features between AIS-MIAs and IACs, and is helpful for selecting candidates for sublobar resection.

Key Points

IACs appearing as GGNs were often ≥ 12.2 mm in diameter.

IACs were often ≥ 6.7 mm in solid component diameter.

The solid components of the IACs often exhibited ≥ -192 HU.

IACs exhibited air bronchogram more frequently than AIS-MIAs.


Lung neoplasms Ground-glass nodule Adenocarcinoma in situ Adenocarcinoma Invasive Tomography X-ray computed 



Adenocarcinoma in situ


Minimally invasive adenocarcinoma


Invasive adenocarcinoma


Atypical adenomatous hyperplasia


Ground-glass nodule


Pure ground-glass nodule


Mixed ground-glass nodule


High-resolution computed tomography



The scientific guarantor of this publication is Jin Wei Qiang. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by grants from national natural science foundation of China (81171340) and Science and Technology Commission of Shanghai (10411956800). One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  1. 1.Department of Radiology, Jinshan Hospital & Shanghai Medical CollegeFudan UniversityShanghaiChina
  2. 2.Department of Radiology, Chest HospitalShanghai Jiaotong UniversityShanghaiChina
  3. 3.Department of Pathology, Chest HospitalShanghai Jiaotong UniversityShanghaiChina

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