基于高分辨率CT显示孤立性肺结节与肺动静脉关系在鉴别结节良恶性中的价值研究  

Value of HRCT in differentiating benign and malignant solitary pulmonary nodules from pulmonary artery and vein

作　　者：赵亚波 董鑫 郭彦璞 靳国庆[1] 吕小宁 Zhao Yabo;Dong Xin;Guo Yanpu;Jin Guoqing;Lyu Xiaoning(Department of Radiology,Puyang People's Hospital,Henan457000,China;不详)

机构地区：[1]河南省濮阳市人民医院放射科,457000 [2]河南省濮阳市人民医院肿瘤科,457000

出　　处：《实用医学影像杂志》2023年第3期177-180,共4页Journal of Practical Medical Imaging

摘　　要：目的探讨孤立性肺结节(solitary pulmonary nodule,SPN)与周围肺动静脉的关系在鉴别结节良恶性中的应用价值。方法回顾性纳入我院2020年3月至2022年3月经高分辨率CT(HRCT)诊断的SPN节患者50例,其中恶性病变36例(含腺癌28例,鳞癌4例,转移瘤4例),良性病变14例(含非特异性炎性结节11例,结核3例),各病例均行GE Rovelution 256排CT或SOMATOM Sensation 64排双源CT胸部平扫加增强扫描,并对图像进行MPR重建,分别观察SPN与肺动脉(PA)、SPN与肺静脉(PV)走行情况、管径变化、管壁完好性并以此进行分型(Ⅰ~Ⅴ型),统计每种类型例数及其所占比例;然后使用SPSS20.0软件对良性组与恶性组每种类型的例数及所占比例进行χ^(2)检验,对良性组与恶性组SPN周围肺动脉管径进行独立样本t检验。结果①在SPN-PA关系中,Ⅰ型仅见于恶性组,Ⅳ/Ⅴ型在良恶性组均可见,差异无统计学意义(P>0.05);②在SPN-PV关系中,同样Ⅰ型仅见于恶性组,Ⅱ型以恶性组多见,差异有统计学意义(P<0.05),Ⅳ/Ⅴ型在良恶性组均可见,差异无统计学意义(P>0.05);③对比恶性SPN-PA与恶性SPN-PV对血管的侵犯情况(Ⅰ型与Ⅱ型),PA受侵诊断恶性SPN的特异度为100%,灵敏度为44.4%。PV受侵诊断恶性SPN的特异度为88.9%,灵敏度为66.7%;④近肺门侧(距离SPN 1 cm)PA的管径最大值,良性组与恶性组之间差异无明显统计学意义(P>0.05)。结论在增强CT图像上多角度观察SPN与PV、SPN与PV的关系有助于提高良恶性结节的诊断准确率,其中以PA受侵诊断恶性SPN的特异性最高,以PA受侵诊断恶性SPN的敏感性最高,二者具有较高的临床诊断价值。Objective To investigate the application value of the relationship between solitary pulmonary nodules(SPN)and peripheral pulmonary arteries and veins in differentiating benign and malignant nodules.Methods Fifty patients with solitary pulmonary nodules diagnosed by high-resolution CT(HRCT)in our hospital from March 2020 to March 2022 were retrospectively included,including 36 patients with malignant lesions(including 28 cases of adenocarcinoma,4 cases of squamous cell carcinoma,4 cases of metastatic tumors),14 patients with benign lesions(including 11 cases of non-specific inflammatory nodules,3 cases of tuberculosis).All patients underwent 256-row GE Rovelution CT or 64-row SOMATOM Sensation dual-source CT chest plain plus enhanced scanning,and the images were reconstructed by multiplanar reconstruction(MPR),SPN and pulmonary artery(PA),SPN and pulmonary vein(PV)routing,pipe diameter changes,and pipe wall integrity were observed and classified(Ⅰ-Ⅴ type),and the number of cases of each type and its proportion(%)were counted.Then use SPSS20.0 software to analyze the number and proportion of cases of each type in the benign group and malignant group.The diameter of the pulmonary artery around SPN in the benign group and malignant group was tested by independent sample t-test.Results①In the SPN-PA relationship,type Ⅰ was only seen in the malignant group,and type Ⅳ/Ⅴ was seen in both benign and malignant groups,with no significant difference(P>0.05).②In the SPN-PV relationship,the same type Ⅰ was only seen in the malignant group,and type Ⅱ was more common in the malignant group,with a statistically significant difference(P<0.05).Type Ⅳ/Ⅴ was seen in both benign and malignant groups,with no statistically significant difference(P>0.05).③Comparing the vascular invasion of malignant SPN-PA and malignant SPN-PV(type Ⅰ and type Ⅱ),the specificity and sensitivity of PA invasion in diagnosing malignant SPN were 100% and 44.4% respectively,and the specificity and sensitivity of PV invasion in diagn

关 键 词：孤立型性肺结节 增强CT 肺动脉 肺静脉 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]