肺内孤立性结节CT动态增强扫描诊断价值的探讨

Investigation of CT dynamic enhanced scanning in diagnosis of solitary pulmonary nodule

目的 分析肺内孤立性结节（SPN）的CT动态增强特点,为临床进一步治疗提供重要帮助。方法 回顾分析肺内29个孤立性结节,从病变强化特点、血供模式进行分析其影像学表现。结果 本组29例患者中,20例肺癌结节增强后均有不同程度强化,增强峰值位于1-3 min,大部分时间-密度曲线呈速升缓降型,增强后净增CT值15-78 HU;5例炎性结节均出现明显强化,增强后净增CT值均在40-70 HU之间,其中3例炎性结节中心可见低密度区,延迟后未见进一步强化征象,增强曲线呈速升型,达峰后仍有上升趋势;1例肺良性结节增强后净增CT值24 HU,但动态增强曲线呈平台型;3例结核球病灶,1例内部未见强化,1例边缘部呈轻度薄壁环状强化,1例呈轻度不均匀强化。结论 动态增强CT扫描可提供结节血液动力学特点及增强模式等功能信息,对良恶性结节的诊断具有较高的应用价值,可协助良恶性结节的鉴别诊断。

Objective To analyze the CT dynamic enhanced characteristics of solitary pulmonary nodules（SPN） and pro- vide important reference for further clinical treatment. Methods Imaging findings of 29 patients with SPN were retrospectively analyzed, including characteristics of lesions and pattern of blood supply. Results Among the 29 patients, 20 with lung nod- ules were strengthened to various degrees after enhancement, and the enhanced peak time was in 1 -3 minutes. Furthermore, most of the time-density curve took a fast-increase and slow-decrease pattern, and the net increased CT values were from 15 HU to 78HU after enhancement. Inflammatory nodules of 5 cases were strengthened obviously, and their net increased CT values were between 40HU and 70HU after enhancement. In 3 cases of the 5 ,low density area was seen in inflammatory nodules＇center. No further enhanced signs demonstrated after delay-and the enhancement curve took a fast-increase pattern and showed a rising trend even after reaching the peak. One case with benign pulmonary nodules had an increased net CT value of 24HU af- ter the enhancement, but the time-intensity curve was a plateau type. Of the 3 cases with pulmonary tuberculoma lesions, no inside strengthening was seen in one case, mild thin-wall ring type enhancement at the margin took place in another, and mild heterogeneous enhancement appeared in the third. Conclusion The dynamic enhanced CT scanning can provide functional information such as characteristics of hemodynamic and enhancement pattern＇ which has great application value in benign and malignant nodules＇ diagnosis, and also can play an assistant role in differential diagnosis.