动态增强CT扫描对孤立性肺结节鉴别诊断的应用价值  

Useful value of dynamic enhanced CT in differential diagnosis of solitary pulmonary nodules

作　　者：张连成[1] 李佩玲[1] 李柏冬[1] 黎庶[1] 王强[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院放射科,辽宁沈阳110001

出　　处：《中国临床医学影像杂志》2008年第3期158-160,167,共4页Journal of China Clinic Medical Imaging

摘　　要：目的:评价动态增强CT扫描对孤立性肺结节鉴别诊断的应用价值。材料与方法:收集发现孤立性肺结节(SPN)并行动态增强CT扫描的临床病例42例,将病灶的强化形态分成无强化、环状强化、均匀强化和不均匀强化4种类型,测量增强前后各扫描时点病灶的CT值,并根据增强后CT增加值绘制动态曲线。结果:增强后肺癌组18例表现为均匀一致的强化,其中2例病灶内部见点状血管性强化,7例表现为不均匀强化;10例炎性结节8例表现为均匀强化,2例环状强化;7例结核瘤增强后5例无强化,2例表现为边缘壳样环状强化。增强后强化峰值在肺癌与结核瘤、炎性结节与结核瘤间均有显著性差异(P<0.001;P<0.01)。肺癌组曲线呈先缓慢后迅速上升-缓慢下降型,到达强化峰值的时间为39s;炎性结节呈迅速上升-缓慢下降-再上升型,到达强化峰值的时间为36s;结核瘤表现为平稳型曲线。结论:动态增强CT图像上SPN的强化方式、强化程度及动态曲线可以补充更多的鉴别诊断信息,对提高定性诊断的准确率具有重要价值。Objective： To evaluate the value of dynamic enhanced CT in differential diagnosis of solitary pulmonary nodules. Material and Methods： Forty-two cases of SPN collected in this study all accepted dynamic enhanced CT scanning. The enhancement pattern included no enhancement, ring enhancement, homogeneous and heterogeneous enhancement. The CT values of SPNs on pre- and post-enhanced images were measured. The dynamic curves for different kinds of lesions were described, respectively. Results： Eighteen cases of lung cancer demonstrated homogeneous enhancement, 2 cases of whom showed spot vascular enhancement, 7 cases heterogeneous enhancement. Eight cases of inflammatory nodules（8/10） showed ho- mogeneous enhancement, 2 cases ring enhancement. Five cases of tuberculosis（5/7） demonstrated no enhancement, 2 cases rim enhancement. Peak heights of lung carcinoma and inflammatory nodules were significantly higher than that of tuberculosis （P〈 0.001; P〈0.01）. The dynamic curve of malignant SPNs showed a slowly progress, rapidly progress and then decreased slowly; Inflammatory nodules showed a rapidly increase, slowly decrease and then increase again; The curve for tuberculosis was a very low and smooth pattern. The durations of reaching peak height of malignant and inflammatory nodules were 39s and 36s after injection of contrast media, respectively. Conclusions： Dynamic enhanced CT can supply much more information about dynamic enhancement of SPNs. It possesses the important value in improving the qualitative diagnostic accuracy.

关 键 词：硬币病变 肺 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R814-42[医药卫生—内科学]