螺旋CT动态增强扫描在孤立性肺结节良恶性鉴别诊断中的应用探讨  

Application of dynamic contrast-enhanced spiral CT scan in differential diagnosis of benign and malignant solitary pulmonary nodules

作　　者：李强 LI Qiang(Imaging Department,Honglai Center Health Center,Nan'an 362331,Nan'an 362331,China)

机构地区：[1]南安市洪濑中心卫生院影像科,362331

出　　处：《中国现代药物应用》2024年第11期75-78,共4页Chinese Journal of Modern Drug Application

摘　　要：目的探讨螺旋CT动态增强扫描在孤立性肺结节(SPN)良恶性鉴别诊断中的应用价值。方法将103例SPN患者作为研究对象,均实施常规CT平扫及螺旋CT动态增强扫描。以穿刺或手术病理结果作为金标准,分析两种检查方法诊断结果;比较两种检查方法诊断效能;比较良恶性结节不同时期的CT值;比较良恶性结节的CT征象检出率。结果螺旋CT动态增强扫描中,恶性48例(真恶性45例,假恶性3例),良性55例(真良性53例,假良性2例);常规CT平扫中,恶性48例(真恶性35例,假恶性13例),良性55例(真良性43例,假良性12例)。以穿刺或手术病理结果作为金标准,螺旋CT动态增强扫描对恶性肺结节的诊断敏感度95.74%、特异度94.64%、准确度95.15%、恶性预测值93.75%、良性预测值96.36%均高于常规CT平扫的74.47%、76.79%、75.73%、72.92%、78.18%(P<0.05)。恶性结节在平扫期、增强后15 s的CT值与良性结节相当(P>0.05),而恶性结节在增强后30、60、120、180、240、300 s的CT值均高于良性结节(P<0.05)。恶性结节空泡征、棘突征检出率与良性结节相当(P>0.05);但恶性结节磨玻璃征、分叶征、毛刺征、血管集束、胸膜凹陷检出率分别为29.79%、61.70%、55.32%、44.68%、40.43%,均高于良性结节的3.57%、28.57%、16.07%、14.29%、7.14%(P<0.05)。结论螺旋CT动态增强扫描在SPN良恶性鉴别诊断中的应用效果显著,从CT值、CT征象上能有效鉴别良恶性结节,为临床诊断提供可靠依据。Objective To explore the application value of dynamic contrast-enhanced spiral CT scan in differential diagnosis of benign and malignant solitary pulmonary nodules(SPN).Methods 103 cases of SPN patients were taken as the research subjects,and all of them underwent conventional plain CT scan and dynamic contrast-enhanced spiral CT scan.The diagnostic results of the two examination methods were analyzed with the results of puncture or surgical pathology as the gold standard.Comparison was made on the diagnostic efficacy of the two examination methods,the CT values of benign and malignant nodules at different periods of time,and the detection rate of CT signs of benign and malignant nodules.Results In dynamic contrast-enhanced spiral CT scan,48 cases were malignant(45 true malignant cases and 3 pseudomalignant cases)and 55 cases were benign(53 true benign cases and 2 pseudomalignant cases).In conventional plain CT scan,48 cases were malignant(35 true malignant cases,13 pseudomalignant cases)and 55 cases were benign(43 true benign cases and 12 pseudomalignant cases).Using the results of puncture or surgical pathology as the gold standard,the diagnostic sensitivity of dynamic contrast-enhanced spiral CT scan for malignant lung nodules was 95.74%,the specificity was 94.64%,the accuracy was 95.15%,the malignant predictive value was 93.75%,and the benign predictive value was 96.36%,which were higher than 74.47%,76.79%,75.73%,72.92%,and 78.18%of conventional plain CT scan(P<0.05).The CT values of malignant nodules in plain scan and 15 s after enhancement were equivalent to those of benign nodules(P>0.05),while the CT values of malignant nodules at 30,60,120,180,240 and 300 s after enhancement were higher than those of benign nodules(P<0.05).The detection rate of vacuole sign and spinous process sign in malignant nodules was similar to that in benign nodules(P>0.05),but the detection rate of ground glass sign,lobulation sign,burr sign,vascular cluster and pleural depression in malignant nodules were 29.79%,61.70%,55.32%,44

关 键 词：孤立性肺结节 螺旋CT动态增强扫描 良恶性 鉴别诊断 

分 类 号：R563[医药卫生—呼吸系统]