多层螺旋CT单一征象及组合征象对孤立性肺结节的诊断价值

The Single Sign and Combinations Signs of Solitary Pulmonary Nodules in Multi- slice Spiral CT

目的探讨多层螺旋CT平扫的单一征象及组合征象在区分孤立性肺结节(solitary pulmonary nodule,SPN)良、恶性中的诊断价值。方法对60例经手术病理证实的SPN患者采用GE Light Speed l6排螺旋CT机进行平扫,应用GEADW4.3工作站的后处理技术对SPN进行分析,计算具有统计学意义的单个征象及组合征象的ROC曲线下面积、敏感性、特异性、阳性预测值及阴性预测值;判断单个征象和组合征象的诊断效能是否存在差异。结果 60例SPN患者进行了CT平扫,以手术病理结果为诊断标准,差异有统计学意义(P<0.05)的单个征象为分叶征、毛刺征、胸膜凹陷征、边缘不光整及血管集束征,其中诊断效能前三位的分别为分叶征、毛刺征及胸膜凹陷征,其ROC曲线下面积、敏感性、特异性、准确性、阳性预测值及阴性预测值分别为:分叶征:0.771、75.0%、79.2%、76.7%、84.4%、67.9%,毛刺征:0.694、72.2%、76.7%、70.0%、82.3%、64.9%,胸膜凹陷征:0.660、44.4%、87.5%、61.7%、84.2%、51.2%。组合征象的ROC曲线下面积、敏感性、特异性、准确性、阳性预测值及阴性预测值分别为:分叶征+毛刺征:0.743、61.1%、87.5%、71.7%、87.9%、60.0%,分叶征+胸膜凹陷征:0.674、38.9%、95.8%、61.7%、93.3%、51.1%,毛刺征+胸膜凹陷征:0.646、33.3%、95.8%、75.0%、92.2%、48.9%,分叶征+毛刺征+胸膜凹陷征:0.653、30.6%、100%、58.3%、100%、48.9%。单个征象及组合征象的诊断效能均无统计学差异,其各组间ROC曲线下面积Z检验均无差异统计学意义(P>0.05)。结论 CT平扫能对多数SPN良恶性做出准确诊断。随着组合征象的增多,诊断恶性的阳性预测值增大。

Objective To explore the diagnostic value of multi- slice spiral CT scanning distinguish between malignant and benign based on single sign and combinations signs of SPN. Methods 60 patients with solitary pulmonary nodules confirmed by pathology underwent l6- slices CT scan. We adopted postprocessing technique by GE ADW 4. 3 workstation to analysis of SPN. The statistical significance parameters in the diagnosis of benign and malignant SPN were obtained by calculating the sensitivity,specificity,positive predictive value,and negative predictive value. Results 60 patients with SPN underwent CT scan. Surgical and pathological findings as the diagnostic criteria,the statistically significant( P < 0. 05) single sign were lobulated,spiculated,pleural indentation,edge burrs and vessel convergence,in which the first three diagnostic performance was higher. Area under the ROC curve,sensitivity,specificity,accuracy,positive predictive value and negative predictive value respectively were: lobulated sign 0. 771,75. 0%,79. 2%,76. 7%,84. 4%,67. 9%,spiculated sign 0. 694,72. 2%,76. 7%,70. 0%,82. 3%,64. 9%,pleural indentation sign 0. 660,44. 4%,87. 5%,61. 7%,84. 2%,51. 2%. The area under the ROC curve,sensitivity,specificity,accuracy,positive predictive value and negative predictive value of combinations signs respectively were: lobulated sign + spiculated sign 0. 743,61. 1%,87. 5%,71. 7%,87. 9%,60. 0%,lobulated sign + pleural indentation sign 0. 674,38. 9%,95. 8%,61. 7%,93. 3%,51. 1%,spiculated sign + pleural indentation sign0. 646,33. 3%,95. 8%,75. 0%,92. 2%,48. 9%,lobulated sign + spiculated sign + pleural indentation sign 0. 653,30. 6%,100%,58. 3%,100%,48. 9%. The diagnostic efficacy of the single signs and combination signs showed significant difference while the Z test for area under ROC curve were not significant difference among groups( P > 0. 05). Conclusion For most SPN,CT scan can identify benign and malignant.There were not significant difference in the diagnostic performance between individual signs and combinations signs,but with the increase of the typical signs,the reliability of the diagnosis malignant and positive predictive value increases.