孤立性肺结节病灶CT动态增强扫描的价值  

The Value of Dynamic Enhanced CT in Solitary Pulmonary Nodule

作　　者：杨迎[1] 曾纪珍[1] 周晓琳 周建华[3] 陈友良[1] 朱智明[1] 

机构地区：[1]中南大学湘雅医院放射科 [2]长沙市第一医院CT室 [3]中南大学湘雅医院病理科

出　　处：《临床放射学杂志》2005年第7期597-601,共5页Journal of Clinical Radiology

摘　　要：目的探讨孤立性肺结节病灶动态增强扫描的强化程度与动态强化曲线及其机理。资料与方法对经手术、病理证实的孤立性肺结节病患者40例,行前瞻性螺旋CT动态增强扫描,分析最大强化值及时间密度曲线。并对20例手术标本行CD34染色。结果恶性结节的强化(范围16～76HU)明显高于良性结节(范围-6～46HU,P<0.01)。以强化值15HU为阈值,敏感性100%(27/27例恶性结节),特异性46.2%(6/13例良性结节),准确性82.5%(33/40例肺结节)。结节的强化程度与结节中央微血管数呈正相关(P=0.006)。结论强化值≤15HU,提示为良性结节;恶性结节较良性结节更富血管,其强化程度也明显高于良性结节。炎性假瘤是产生假阳性的主要原因,动态曲线分析对其与恶性结节的鉴别有一定帮助。Objective To evaluate the degree of enhancement and patterns of dynamic time-density curves in the solitary pulmonary nodule and study its mechanism of the enhancement.Materials and Methods 40 patients of pulmonary nodules proved pathologically were performed with dynamic enhanced CT to analyze peak net nodule enhancement and time-attenuation curves. 20 histologic specimens were underwent after immuoperoxidase microvascular staining with antibody to CD34 antigen staining.Results Malignant nodules were enhanced (16～76 HU) significantly more than benign nodules (-6～46 HU,P<0.01). With 15HU as the threshold, the sensitivity was 100% (27 of 27 malignant nodules), the specificity was 46% (6 of 13 benign nodules), the accuracy was 82.5% (33 of 40 nodules). The degree of enhancement was statistically significantly related to the amount of central microvascular staining (P=0.006).Conclusion Lung nodule enhancement less than 15HU at dynamic enhanced CT is strongly predictive of benignity. There are more central staining of microvessels in malignant nodules than benign nodules, so malignant nodules enhance significantly more than benign nodules. False-positive results mostly are caused by the inflammatory pseudotumor, analysis of its time-attenuation curve could help differentiate from the malignant nodule.

关 键 词：孤立性肺结节 CT动态增强扫描 鉴别诊断 微血管密度 

分 类 号：R816.41[医药卫生—放射医学]