肺部亚厘米结节的CT影像学特点及其诊断价值分析  

CT Imaging Features of Pulmonary Sub-centimeter Nodules and Its Clinical Value

作　　者：王玉涛[1] 赵晓东[2] 王海涛[1] 周成伟[2] 卢斌[2] 朱勇刚[2] 周银杰[2] 葛明亮[1] 张霞萍[1] 邓生德[1] 汪建华[1] 

机构地区：[1]宁波大学医学院附属医院影像科,浙江省宁波市315020 [2]宁波大学医学院附属医院胸外科,浙江省宁波市315020

出　　处：《中国全科医学》2013年第32期3846-3848,共3页Chinese General Practice

基　　金：宁波市社会发展科研项目(2011C50032);宁波市医学科技计划项目(2011B14)

摘　　要：目的探讨肺部亚厘米结节的CT影像学特点及其诊断价值。方法选择2010年10月—2012年12月我院收治的肺部亚厘米结节患者37例(43枚结节),均经胸部CT检查发现肺部亚厘米结节,并在低剂量CT引导下行Hook-wire定位及胸腔镜手术治疗。以病理学诊断为金标准,分析CT对肺部亚厘米结节的诊断价值。结果 43枚亚厘米结节的病理学诊断:恶性结节25枚,其中原位腺癌11枚,不典型腺瘤样增生9枚(1枚合并肺脑膜瘤),微浸润性腺癌2枚,低分化鳞状细胞癌1枚,直肠癌肺转移1枚,类癌1枚;良性结节18枚,其中炎性肉芽肿6枚,结核3枚,间质性肺炎2枚,纤维组织结节2枚,炭末沉积1枚,肺内淋巴结增生2枚,硬化性血管瘤1枚,错构瘤1枚。CT诊断肺部亚厘米结节的敏感度为36.0%,特异度为94.4%,漏诊率为64.0%,误诊率为5.6%。结论 CT诊断肺部亚厘米结节敏感度较低,存在一定局限性,无典型恶性病变征象的肺部亚厘米结节患者应定期复查CT;对于高度怀疑恶性的肺部亚厘米结节,行Hook-wire定位技术及胸腔镜手术可以达到诊断和治疗的双重目的。Objective To investigate the CT imaging features of pulmonary sub - centimeter nodules and its diagnostic values. Methods Thirty - seven patients with pulmonary sub - centimeter nodules （43 nodules） admitted to this hospital from October 2010 to December 2012 were given chest CT examinations to find pulmonary sub -centimeter nodules, and Hook -wire localization and thoracoscopic surgery performed under the guide of low - dose CT. Taking pathological diagnosis as the gold standard, the diagnostic values of CT for pulmonary sub - centimeter nodules were analyzed. Results By pathological diagnoses of the 43 sub - centimeter nodules, there were 25 malignant nodules including 11 adenocareinomas in situ, 9 atypical adenoma- told hyperplasia （1 combined with pulmonary meningioma） , 2 microinvasive adenocarcinoma, 1 poorly differentiated squamous cell carcinoma, 1 colorectal cancer lung metastasis, 1 carcinoid; There were 18 benign nodules including 6 inflammatory granu- loma, 3 TB, 2 interstitial pneumonia, 2 fibrous tissue nodules, 1 anthracosis, 2 intrapulmonary lymph node hyperplasia, 1 sclerosing angioma, 1 hemartoma. The sensitivity, specificity, missed diagnosis rate, misdiagnosis rate were 36. 0%, 94. 4%, 64. 0%, 5.6%, respectively in CT diagnosing pulmonary sub - centimeter nodules. Conclusion The sensitivity of CT diagnosing pulmonary sub - centimeter nodules is low with some limitations. Patients without typical malignant lesion sign should have periodic CT review. For highly suspected malignant pulmonary sub - centimeter nodules, Hook - wire positioning technology and thoracoscopic surgery can reach the dual purpose of diagnosis and treatment.

关 键 词：结节病 肺 锥束计算机体层摄影术 病理学 诊断 肺部亚厘米结节 

分 类 号：R445.3[医药卫生—影像医学与核医学] R446.83[医药卫生—诊断学]