256排螺旋CT在肺孤立性小结节良恶性鉴别中的价值分析  

Value Analysis of 256-slice Spiral CT in Differentiating Benign and Malignant Solitary Small Pulmonary Nodules

作　　者：王梅 薛敏君 Wang Mei;Xue Minjun(Department of Radiology,Taicang Port District Hospital,Taicang,Jiangsu 215400;Department of Radiology,The Second Affiliated Hospital of Soochow University,Suzhou,Jiangsu 215004)

机构地区：[1]太仓市港区医院影像科,江苏太仓215400 [2]苏州大学第二附属医院影像科,江苏苏州215004

出　　处：《现代医用影像学》2022年第4期608-610,613,共4页Modern Medical Imageology

摘　　要：目的:探讨256排螺旋CT在肺孤立性小结节良恶性鉴别中的价值。方法:回顾性分析苏州大学第二附属医院58例经手术病理证实的孤立性肺小结节患者的CT影像资料。观察肺小结节的大小、位置、形状、内部结构(空泡征和钙化)、边缘特征(毛刺征、晕征、分叶征和直边征)和邻近结构改变特征(胸膜凹陷征和血管集束征)。以病理结果为金标准,评价螺旋CT对肺孤立性小结节良恶性的诊断效能。比较肺孤立性良恶性小结节间的影像特征差异。结果:58例患者病理证实良性38例,恶性20例;良性结节分别为结核19例,炎性假瘤10例,错构瘤5,隐球菌4例;恶性结节分别为腺癌16例,鳞癌2例,腺鳞癌1例,小细胞癌1例。螺旋CT对肺孤立性小结节良恶性的诊断敏感性、特异性、阳性预测值、阴性预测值和准确率分别为90.0%、89.5%、81.8%、94.4%和89.7%。恶性结节的空泡征、毛刺征、晕征、分叶征、胸膜凹陷征及血管血管集束征出现的比例均高于良性结节(均P<0.05)。良性结节的钙化和直边征出现比例高于恶性结节(均P<0.05)。结论:256排螺旋CT对鉴别肺孤立性小结节良恶性具有较高的价值。Objective:To investigate the value of 256-slice spiral CT in differentiating benign and malignant solitary small pulmonary nodules.Methods:CT imaging data of 58 patients with solitary small pulmonary nodules confirmed by operation and pathology in the Second Affiliated Hospital of Soochow University were retrospectively analyzed.The size,position,shape,internal structure(vacuolar sign and calcification),marginal features(burr sign,halo sign,lobulation sign and straight edge sign)and adjacent structural changes(pleural depression sign and vascular cluster sign)of small pulmonary nodules were observed.Using the pathological results as the gold standard,the diagnostic efficacy of spiral CT for benign and malignant pulmonary solitary small pulmonary nodules was evaluated.To compare the differences of imaging features between benign and malignant solitary small pulmonary nodules.Results:Among the 58 patients,38 cases were pathologically benign and 20 cases were malignant.The benign nodules were tuberculosis in 19 cases,inflammatory pseudotumor in 10 cases,hamartoma in 5 cases,cryptococcus in 4 cases.The malignant nodules were adenocarcinoma in 16 cases,squamous cell carcinoma in 2 cases,adenosquamous cell carcinoma in 1 case,and small cell carcinoma in 1 case.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of spiral CT in the diagnosis of benign and malignant solitary small pulmonary nodules were 90.0%,89.5%,81.8%,94.4%and 89.7%,respectively.The proportions of vacuolar sign,burr sign,halo sign,lobulation sign,pleural depression sign and vascular cluster sign in malignant nodules were higher than those in benign nodules(all P<0.05).The proportion of calcification and straight edge sign in benign nodules was higher than that in malignant nodules(all P<0.05).Conclusion:256-slice spiral CT has high value in differentiating benign and malignant solitary small pulmonary nodules.

关 键 词：螺旋CT 肺结节 良恶性 鉴别诊断 

分 类 号：R734.2[医药卫生—肿瘤]