螺旋CT动态增强扫描在孤立性肺结节良恶性鉴别诊断中的应用探讨

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中文摘要：目的探讨螺旋CT动态增强扫描在孤立性肺结节(SPN)良恶性鉴别诊断中的应用价值。方法将 103 例SPN患者作为研究对象，均实施常规CT平扫及螺旋CT动态增强扫描。以穿刺或手术病理结果作为金标准，分析两种检查方法诊断结果;比较两种检查方法诊断效能;比较良恶性结节不同时期的CT值;比较良恶性结节的CT征象检出率。结果螺旋CT动态增强扫描中，恶性 48 例(真恶性 45 例，假恶性 3 例)，良性 55 例(真良性 53 例，假良性 2 例);常规CT平扫中，恶性 48 例(真恶性 35 例，假恶性 13 例)，良性 55 例(真良性 43 例，假良性 12 例)。以穿刺或手术病理结果作为金标准，螺旋CT动态增强扫描对恶性肺结节的诊断敏感度 95。74%、特异度 94。64%、准确度 95。15%、恶性预测值 93。75%、良性预测值 96。36%均高于常规CT平扫的 74。47%、76。79%、75。73%、72。92%、78。18%(P<0。05)。恶性结节在平扫期、增强后 15 s的CT值与良性结节相当(P>0。05)，而恶性结节在增强后 30、60、120、180、240、300 s的CT值均高于良性结节(P<0。05)。恶性结节空泡征、棘突征检出率与良性结节相当(P>0。05);但恶性结节磨玻璃征、分叶征、毛刺征、血管集束、胸膜凹陷检出率分别为 29。79%、61。70%、55。32%、44。68%、40。43%，均高于良性结节的 3。57%、28。57%、16。07%、14。29%、7。14%(P<0。05)。结论螺旋CT动态增强扫描在SPN良恶性鉴别诊断中的应用效果显著，从CT值、CT征象上能有效鉴别良恶性结节，为临床诊断提供可靠依据。

外文标题：Application of dynamic contrast-enhanced spiral CT scan in differential diagnosis of benign and malignant solitary pulmonary nodules

外文摘要：Objective To explore the application value of dynamic contrast-enhanced spiral CT scan in differential diagnosis of benign and malignant solitary pulmonary nodules(SPN).Methods 103 cases of SPN patients were taken as the research subjects,and all of them underwent conventional plain CT scan and dynamic contrast-enhanced spiral CT scan.The diagnostic results of the two examination methods were analyzed with the results of puncture or surgical pathology as the gold standard.Comparison was made on the diagnostic efficacy of the two examination methods,the CT values of benign and malignant nodules at different periods of time,and the detection rate of CT signs of benign and malignant nodules.Results In dynamic contrast-enhanced spiral CT scan,48 cases were malignant(45 true malignant cases and 3 pseudomalignant cases)and 55 cases were benign(53 true benign cases and 2 pseudomalignant cases).In conventional plain CT scan,48 cases were malignant(35 true malignant cases,13 pseudomalignant cases)and 55 cases were benign(43 true benign cases and 12 pseudomalignant cases).Using the results of puncture or surgical pathology as the gold standard,the diagnostic sensitivity of dynamic contrast-enhanced spiral CT scan for malignant lung nodules was 95.74%,the specificity was 94.64%,the accuracy was 95.15%,the malignant predictive value was 93.75%,and the benign predictive value was 96.36%,which were higher than 74.47%,76.79%,75.73%,72.92%,and 78.18%of conventional plain CT scan(P<0.05).The CT values of malignant nodules in plain scan and 15 s after enhancement were equivalent to those of benign nodules(P>0.05),while the CT values of malignant nodules at 30,60,120,180,240 and 300 s after enhancement were higher than those of benign nodules(P<0.05).The detection rate of vacuole sign and spinous process sign in malignant nodules was similar to that in benign nodules(P>0.05),but the detection rate of ground glass sign,lobulation sign,burr sign,vascular cluster and pleural depression in malignant nodules were 29.79%,61.70%,55.32%,44.68%and 40.43%,which were higher than 3.57%,28.57%,16.07%,14.29%and 7.14%in benign nodules(P<0.05).Conclusion Dynamic contrast-enhanced spiral CT scan is effective in differential diagnosis of benign and malignant SPN,which can effectively distinguish benign and malignant nodules from CT values and CT signs,and provide reliable basis for clinical diagnosis.

外文关键词：

Solitary pulmonary nodulesDynamic contrast-enhanced spiral CT scanBenign and malignantDifferential diagnosis

作者：

李强

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作者单位：

362331 南安市洪濑中心卫生院影像科

关键词：

孤立性肺结节螺旋CT动态增强扫描良恶性鉴别诊断

出版年：

2024

DOI：