数字断层融合检查对肺内孤立性结节筛检的初步应用

Preliminary Study of Chest Digital Tomosynthesis for the Screening of Solitary Pulmonary Nodules

目的探讨胸部数字断层融合(digital tomosynthesis,DTS)检查对肺内孤立性结节(solitary pulmonary nod-ules,SPN)的检出能力。资料与方法肺部可疑结节患者及恶性肿瘤随访患者共87例,均行常规数字化胸部平片和胸部DTS检查,以多层CT作为参照,观察分析DTS和胸部平片对SPN的检出结果,分别统计敏感性、特异性、准确性、阳性预测值、阴性预测值,并进行χ2检验,比较两者差异性。结果 87例经CT发现54个结节,胸部平片检出24个,假阳性8个,假阴性30个。DTS检出49个,假阳性1个,假阴性5个。胸部平片和DTS对SPN的敏感性、特异性、准确性、阳性预测值、阴性预测值分别为44.4%、75.8%、56.3%、75%、45.5%和90.7%、96.9%、92%、98%、86.1%,DTS与胸部平片对SPN检查的各项指标差异具有统计学意义(P<0.05)。结论 DTS是普通放射学检查的有力补充,能够提高普通放射学对SPN的诊断能力,可作为影像检查链中的重要环节,在肺部肿瘤高危人群低剂量筛检、复诊方面可以替代常规胸片检查。

Objective To discuss the value of digital tomosynthesis in detection of solitary pulmonary nodules.Materials and Methods Eighty seven patients suspected of pulmonary nodules and cancer underwent chest X ray radiography,digital tomosynthesis and CT examination in follow up.Imaging data were transferred to post processing workstation and were reviewed by 2 radiologists in a double blind method.The sensitivity,specificity,accuracy,positive and negative predictive values of chest X-ray radiography and digital tomosynthesis for detection of solitary pulmonary nodules were calculated according to the CT results.Chi square test was used for the detection index of radiography and digital tomosynthesis examination.Results Fifty four nodules were detected by CT examination in 87 patients.24 nodules were detected by X-ray radiography and 30 nodules were negative,8 patients were false positive.40 nodules were detected by digital tomosynthesis,and only 5 nodules were negative,1 patient was false positive.The sensitivity,specificity,accuracy,positive and negative predictive values of the X-ray radiography were 44.4%,75.8%,56.3%,75%,45.5% respectively,and those of the digital tomosynthesis were 90.7%,96.9%,92%,98%,86.1%（P0.05 respectively）.Conclusion Digital tomosynthesis as a high sensitivity for detection of solitary pulmonary nodules compared with X-ray radiography,could be an excellent supplementary technique of X-ray radiography.Digital tomosynthesis would be well suited as a low-dose screening technique substitute for X ray radiography.