螺旋CT动态增强扫描对良、恶性肺结节的鉴别

The differentiation of benign and malignant lung node of dynamic contrast enhancement with CT.

目的 探讨螺旋CT动态增强扫描对肺孤立性结节病变的良、恶性鉴别诊断价值。方法经病理证实的70例肺孤立性结节，平扫后，以2ml／s速度注入造影剂后1、2、3、4、5min薄层扫描。分析强化值、时间-密度曲线及强化形态对良、恶性结节的鉴别价值。结果 恶性结节的强化值（38．6±14．9）HU，明显高于良性结节（18．6±16．2）HU（P〈0．01）。周围型肺癌的主要强化形态是完全性强化及周围性强化。恶性结节增强后CT值立即升高，2min形成强化高峰，然后逐渐下降，而良性结节特别是结核球增强后CT值缓慢上升，无明显峰值出现。结核球的主要强化形态是无强化及包膜样强化，占90．5％。结论 强化值≤15HU提示良性结节；强化值〉20HU考虑恶性结节。动态增强CT对周围型肺癌与结核球的鉴别有较高价值。

Objective To analyze the feature of the solitary pulmonary nodules at dynamic contrast -enhanced spiral CT. Methods 70 patients with solitary pulmonary nodules proved by pathology were studied. Thin - section CT scans were obtained before and after enhancement 1,2,3,4 and 5 minutes. Results Malignant nodules enhanced （38.6 ± 14.9）HU significantly more than benign nodules （ 18. 6 ± 16. 2） HU. The major enhancement pattern of peripheral lung carcinoma was complete enhancement, a little show peripheral enhancement. Tuberculoma show capsular enhancement or non enhancement. Conclusion Absence of significant lung noldue enhancement （ ≤ 15） HU at CT is strongly predictive of benignity. Malignant nodules enhanced significantly more than benign nodules. Dynamic contrast enhanced CT is useful in the differentiation diagnosis of lung carcinoma and tuberculoma.