CT平扫与CT动态增强扫描对孤立性肺结节良恶性的鉴别诊断价值  

The Differential Diagnostic Value of CT Plain Scan and CT Dynamic Enhanced Scan for Benign and Malignant Solitary Pulmonary Nodules

作　　者：刘艳华 高鹏[2] LIU Yanhua;GAO Peng(CT Room,Shangqiu Fourth People's Hospital,Shangqiu 476000,China;Department of Imaging,Luoyang Central Hospital,Luoyang 471000,China)

机构地区：[1]商丘市第四人民医院CT室,河南商丘476000 [2]洛阳市中心医院影像科,河南洛阳471000

出　　处：《临床医学工程》2025年第4期374-377,共4页Clinical Medicine & Engineering

基　　金：河南省二〇二三年科技发展计划项目(项目编号:232102310108)。

摘　　要：目的对比分析电子计算机断层扫描(CT)平扫与CT动态增强扫描对孤立性肺结节(SPN)良恶性的鉴别诊断价值。方法选取2021年1月至2024年12月于商丘市第四人民医院CT室就诊的100例SPN患者作为研究对象,所有患者均接受CT平扫和CT动态增强扫描,以病理检查结果作为金标准,评估CT平扫和CT动态增强扫描对SPN良恶性的鉴别诊断价值。结果病理检查结果显示,100例SPN患者确诊为良性62例,恶性38例。CT平扫和CT动态增强扫描对SPN空泡征、磨玻璃征、棘突征、分叶征和胸膜凹陷的检出率比较,差异无统计学意义(P>0.05),而CT平扫对毛刺和血管集束的检出率低于CT动态增强扫描,差异具有统计学意义(P<0.05)。以病理检查结果作为金标准,CT平扫诊断恶性结节51例,良性结节49例,误诊18例,漏诊5例;CT动态增强扫描诊断恶性结节50例,良性结节50例,误诊14例,漏诊2例。CT平扫诊断与病理检查结果一致性Kappa值为0.542,CT动态增强扫描诊断与病理检查结果一致性Kappa值为0.680。CT动态增强扫描诊断SPN的敏感度(94.74%vs.86.94%)、特异度(77.42%vs.70.97%)、准确度(84.00%vs.77.00%)、阳性预测值(72.00%vs.64.71%)和阴性预测值(96.00%vs.89.80%)与CT平扫比较,差异无统计学意义(P>0.05)。良性结节的CT动态增强扫描参数BF、BV、MTT和PS值均低于恶性结节,差异具有统计学意义(P<0.05)。结论CT动态增强扫描能够在CT平扫的基础上分析血供情况,结合多种影像学征象和功能性参数(BF、BV、MTT和PS),有助于临床更精准地判断SPN的良恶性。Objective To compare and analyze the differential diagnostic value of CT plain scan and CT dynamic enhanced scan for benign and malignant solitary pulmonary nodules(SPN).Methods A total of 100 patients with SPN who were treated in the CT room of Shangqiu Fourth People's Hospital from January 2021 to December 2024 were selected as the research objects.All patients underwent CT plain scan and CT dynamic enhanced scan.Taking pathological examination results as the gold standard to evaluate the differential diagnosis value of CT plain scan and CT dynamic enhanced scan for benign and malignant SPN.Results The pathological examination results showed that among 100 SPN patients,there were 62 benign cases and 38 malignant cases.No significant difference was found in the detection rate of SPN vacuole sign,ground glass sign,spinous process sign,lobulation sign and pleural depression between CT plain scan and CT dynamic enhanced scan(P>0.05),while the detection rate of burr and vascular cluster in CT plain scan was lower than that in CT dynamic enhanced scan,with statistically significant difference(P<0.05).Taking pathological examination results as the golden standard,CT plain scan showed that there were 51 cases with malignant nodules,49cases with benign nodules,18 cases with misdiagnosis and 5 cases with missed diagnosis,while CT dynamic enhanced scan showed that there were 50 cases with malignant nodules,50 cases with benign nodules,14 cases with misdiagnosis and 2 cases with missed diagnosis.The Kappa value of consistency between CT plain scan diagnosis and pathological examination results was 0.542,and the Kappa value of consistency between CT dynamic enhanced scan diagnosis and pathological examination results was 0.680.No significant difference was found in sensitivity(94.74%vs.86.94%),specificity(77.42%vs.70.97%),accuracy(84.00%vs.77.00%),positive predictive value(72.00%vs.64.71%)and negative predictive value(96.00%vs.89.80%)between CT dynamic enhanced scan and CT plain scan(P>0.05).The CT dynamic enhanced scan par

关 键 词：孤立性肺结节 CT平扫 CT动态增强扫描 

分 类 号：R563[医药卫生—呼吸系统]