肺内常见孤立性结节鉴别诊断方法的探索—应用最大似然法  

Study of the discrimination method of large log-likelihood in the differential diagnosis of common solitary pulmonary nodule

作　　者：李复 王淼淼[2] 伍建林 李智勇 刘铁利 

机构地区：[1]辽宁省瓦房店市中心医院CT室,116300 [2]大连医科大学附属医院放射科

出　　处：《中国CT和MRI杂志》2008年第2期43-46,共4页Chinese Journal of CT and MRI

摘　　要：目的探讨应用最大似然法鉴别周围性肺癌、肺错构瘤及结核球3种SPN的诊断价值。方法对150例经临床和手术病理证实的SPN(周围性肺癌、肺错构瘤、结核球各50例)的HRCT影像学征象进行分类统计分析,运用最大似然判别法,将其各种征象转化为记分值,以数值的大小来判定肺结节所属的类型。结果最大似然法对周围型肺癌、肺错构瘤及结核球的诊断正确率分别为86%、92%及90%,平均诊断正确率为89.3%,高于常规阅片法的82%,但两组间差异无统计学意义(2=2.434,P>0.05)。最能提示为肺癌的征象依次为空泡征、分叶征、支气管充气征和血管集束征;最能提示为肺错构瘤的征象依次为脂肪、边缘清楚及钙化;最能提示为结核球的征象依次为空洞、卫星灶、钙化及胸膜凹陷征。结论最大似然法对常见SPN的鉴别诊断正确率有所提高,是一种辅助影像学诊断的有价值的方法。Objective To evaluate the diagnostic value of the discrimination method of large log-likelihood study in differentiating the 3 kinds of solitary pulmonary nodule （SPN） among peripheral lung carcinoma, hamartoma andtuberculoma. Methods 150 patients with peripheral lung carcinomas（n=50）, hamartomas（n=50）and tuberculomas （n=50）, pathologically proved by clinic and operation, were studied statistically with HRCT manifestations. With the discrimination method of large log-likelihood, the CT signs of the 3 kinds of SPN were analyzed and then translated into probability scores to identify the nodular category. Results The diagnostic accuracy with the discrimination method of large log-likelihood for peripheral lung carcinoma, hamartoma and tuberculoma were 86%, 92% and 90% respectively. The mean accuracy （89.3%） of the discrimination method of large log-likelihood was higher than that（82%） of routine diagnostic method, but there was no statistical difference between each other（2=2.434, P〉0.05）. The most probable CT signs for lung cancer were vacuole sign, lobulation, bron-chogram and vascularconvergence; the most probable CT signs for hamartoma were fat, welldefined margin and calcification; the most probable CT signs for tuberculoma were cavitation, satellite, calcification and pleural indentation. Conclusion The discrimination method of large log-likelihood is a kind of valuable method to assist imaging diagnosis, and can improve the differential diagnostic accuracy for common SPN.

关 键 词：肺癌 肺孤立结节 结核球 错构瘤 最大似然法 X线计算机 

分 类 号：R814.42[医药卫生—影像医学与核医学] R734.2[医药卫生—放射医学]