螺旋CT灌注成像对孤立性肺结节的诊断意义

The clinical significance of spiral perfusion CT for diagnosis of solitary pulmonary nodules

目的利用螺旋CT灌注成像评价孤立性肺结节(SPN),并讨论该方法在肺部结节良恶性鉴别诊断中的意义。方法对35例患有无钙化SPN(直径≤<30mm)的患者进行动态增强CT扫描。评价SPN的时间-密度曲线(T- DC)。记录增强前密度值,强化峰值(PH),SPN与主动脉PH值的比值(S／A),结节强化达到峰值时间(Tp),计算SPN灌注值。结果良性、恶性结节显示出不同的T-DC模式,恶性同炎性结节的PH(P<0．001;P<0．001)和S／A比值(x2=33．74,P<0．001;x2=16．01,P<0．001)显著高于良性结节;而恶性与炎性结节PH(P=0．78),S／A(P= 0．51)差异无显著意义。恶性与炎性结节的灌注值均高于良性结节(P<0．001,P<0．01),恶性结节与炎性结节灌注值之间的差异无显著性(P=0．39)。结论肺灌注CT对区分良恶性肺结节具有较高的诊断价值。

Objective To distinguish solitary pulmonary nodules （SPN） by perfusion computed tomography （CT）, and evaluate its clinical significance in differential diagnosis for benign and malignant pulmonary nedules.Methods Thirty-five patients with non-calcified SPN（diameter≤30mm） were studied with dynamic contrast enhanced CT. Patterns of time-density curve （T-DC） were assessed. The pre-eontrast density, peak height in density （PH）, the time of peak height（Tp）, and the ratio of the PH of SPN over aorta （S/A） were measured. The perfusion of SPN were calculated. Results Malignant, benign, and inflammatory nodules showed quite different patterns of T-DC. PH and S/A ratio of malignant and inflammatory nodules were significant higher than those of the benign nodules （ P 〈 0.001 ; P 〈 0.001 ;χ^2 = 33.74, P 〈 0. 001 ; χ^2= 16.01, P 〈 0.001）,but no statistical difference of the PH or S/A ratio was found between the malignant and inflammatory nodules（ P =0.78,P =0.51）.Both malignant and inflammatory nodules showed significant higher perfusions than the benign nodules（ P 〈 0.001,P 〈 0.01）,while the difference of the perfusions between the ma- lignant and inflammatory nodules was not significant （ P = 0.39）. Conclusion Pulmonary perfusion CT has higher diagnostic value for the differentiation of malignant and benign nodules.