孤立性肺结节的MSCT诊断与鉴别诊断

Diagnosis and differentiation of solitary pulmonary nodules with Multi-slice spiral CT

目的:分析良恶性孤立性肺结节的不同CT征象,并探讨各种不同征象及联合多种征象在肺部孤立性结节定性诊断中的价值,以期提高对其的诊断符合率。方法:回顾性分析105例经手术病理和临床随访证实的孤立性肺结节的相关临床及CT资料(包括后处理重建资料)。结果:分叶征、短毛刺征、血管集束征、胸膜凹陷征、空泡或空气支气管征在恶性结节组中的出现率依次为72.4%、65.5%、51.7%、53.4%、36.2%,明显高于良性结节组的25.5%、8.5%、8.5%、23.4%、10.6%,差异具有统计学意义(P<0.05),而上述征象在细支气管肺泡癌组与非细支气管肺癌泡组中的差异无统计学意义(P>0.05),联合上述2种或2种以上征象诊断恶性结节的敏感性(81.0%)、特异性(80.9%)及准确性(81.0%)较高,而假阳性率(19.2%)和假阴性率(19.0%)相对较低。良性结节多边缘光滑(74.5%),长毛刺的出现率(29.8%)较高,结节内钙化的发生率(21.3%)等与恶性结节组相比较,差异均具有统计学意义(P<0.05)。结论:联合分叶征、短毛刺征、血管集束征、胸膜凹陷征、空泡或空气支气管征中2种或2种以上的征象并结合强化特征等对恶性结节的诊断准确性较高。

Objective： To analyze the various CT findings of solitary pulmonary nodules and to assess their diagnostic value in distinguishing benign nodules from malignant nodules. Methods： CT （including post- processing data） and clinical data of 105 patients with a solitary puhnonary nodule proved by pathology/ clinical follow-up were analyzed retrospectively. Results： Occurrence rates of lobulation, short spieulation, vascular convergence, pleural indentation and vacuole sign or air bronchogram for malignant nodules （72.4% , 65.5G, 51.7%, 53.4%0, 36.2% , respectively） were significantly higher than that for benign nodules （25.5%, 8.5%, 8.5%, 23.4%, 10.6%, respectively, P〈0.05）. But no statistical significance between the bronchioloalveolar carcinoma and non-bronchioloalveolar carcinoma groups regarding those signs （P 〉0.05）. While the sensitivity, specificity and diagnostic accuracy for malignancy were high up to 81.0%, 80.9%, 81.0%, respectively, with the coexistence of two or more signs mentioned above, the false positive and the false negative rate were as low as 19.2% and 19.0%, respectively. The incidence of smooth, well defined margins （74.5%） and long spikes （29.8%） were higher in benign nodules than that of malignant nodules; Since calcifications were observed in 21.3 % of benign nodules, there was statistical significance between malignant and benign nodules （P 〈0.05）. Conclusion： The coexistence of two or more signs among lobulation, short spiculation, vascular convergence, pleural indentation and vacuole sign or air bronchogram with the additional support by contrast enhancement characteristics can improve the diagnostic accuracy for malignant nodules.