多层螺旋CT同层动态增强扫描对孤立性肺结节的诊断意义

The Diagnostic Significance of Solitary Pulmonary Nodules with Dynamic Enhanced Multi-slice Spiral Computed Tomography Scanning

目的利用多层螺旋CT(MSCT)动态对比增强评价孤立性肺结节(SPN)血流特点,探讨该方法在SPN良、恶性鉴别诊断中的应用价值。资料与方法对63例无钙化的SPN(直径≤4.0cm)的患者进行同层动态增强CT扫描,其中恶性结节48例,炎性结节6例,良性结节9例,记录SPN增强前后密度、强化峰值(PH)、SPN与主动脉强化峰值的比值(SPH/APH)以及SPN的强化模式,分析SPN的时间-密度曲线(TDC)模式。结果恶性、良性和炎性结节显示了不同的TDC模式。恶性和炎性结节的PH、SPH/APH显著高于良性结节(P<0.01),而恶性和炎性结节的PH和SPH/APH差异无统计学意义。恶性与良性结节平扫密度差异无统计学意义(P>0.01),炎性结节平扫密度低于恶性结节(P<0.01)。结论CT动态增强扫描可反映结节的血流动态变化过程及强化特征,可无创性评价和诊断SPN。

Objective To evaluate the blood flow features of solitary pulmonary nodules （SPN） using dynamic enhanced multislice spiral computed tomography （MSCT）, and to investigate its clinical efficacy in differential diagnosis between benign and malignant pulmonary nodules. Materials and Methods 63 patients （48 malignant nodules, 6 inflammatory nodules, and 9 benign nodules） with non calcified nodules （diameter≤4 cm） were studied with dynamic contrast enhanced MSCT. The precontrast density, peak height after enhanced （PH）, and the ratio of the PH of SPN over aorta （SPH/APH） were recorded. Enhancement patterns of SPN were also recorded. Patterns of time density curve （TDC） were analyzed. Results Malignant, benign, and inflammatory nodules showed different patterns in TDC, PH and SPH/APH ratio of the malignant and inflammatory nodules were significantly higher than those of the benign nodules （P 〈 0.01）, while no statistical difference of the PH and ratio was found between the malignant and inflammatory nodules （P 〉 0.01 ）. No statistical difference of precontrast density of malignant and benign nodules was found （ P 〉 0.01）. Precontrast density of inflammatory nodules was significantly lower than that of the malignant nodules （P 〈 0.01 ）. Conclusion Dynamic contrast enhanced CT can reflect the hemodynamic characteristics of SPN and can be used non-invasively in the evaluation of solitary pulmonary nodules.