超高分辨率CT靶扫描对肺结节的诊断价值

Diagnosis value of targeted ultra high-resolution CT scanning for pulmonary nodules

目的探讨1 024超高分辨率CT靶扫描对直径8mm以下肺结节的诊断价值及其对随访方案的影响。方法前瞻性分析2015年7月—2016年8月于同济大学附属上海市肺科医院影像科门诊进行1 024超高分辨率CT靶扫描的57例患者的67个肺结节资料。肺结节平均直径为(5.97±1.34)mm。对其中32个结节进行手术切除,病理结果提示2个结节为良性,9个结节为不典型腺瘤样增生(AAH),14个结节为原位腺癌(AIS),7个结节为微浸润腺癌(MIA);16个结节怀疑恶性但未手术;19个结节随访或考虑良性病灶。对67个肺结节均行常规CT扫描和1 024超高分辨率CT靶扫描,由3位有3~10年工作经验的影像科医师阅片,评价图像质量、判断结节类型、评估诊断信心、给出诊断结果和处理方案,并对阅片结果进行统计学分析。结果 1 024超高分辨率CT靶扫描在显示肺结节内部混杂密度、结节边缘、分叶征等方面优于常规CT检查(P<0.05),两种扫描图像对判断纯磨玻璃结节和混杂密度结节的差异有统计学意义(P<0.05)。与常规CT比较,1 024超高分辨率CT靶扫描的诊断正确率增高(P<0.01),医师诊断信心提高(P<0.05),且基于两套图像给出的处理方案差异有统计学意义(P<0.05),其差异主要体现为随访例数减少、手术例数和无需随访例数增加。结论 1 024超高分辨率CT靶扫描对直径8mm以下肺结节可较常规CT检查提供更好的图像质量。对通过常规CT检查难以确诊或诊断信心不充足的结节,可采用1 024超高分辨率CT靶扫描进一步检查。

Objective To evaluate the diagnostic value of targeted 1 024 ultra high-resolution CT scanning for the pulmonary nodules under 8 mm in diameter and its effect on follow-up protocols.Methods A total of 67 pulmonary nodules with a mean diameter of（5.97±1.34）mm in 57 patients undergoing targeted scans at Department of Radiology,Shanghai Pulmonary Hospital,Tongji University between July 2015 and August 2016 were analyzed prospectively.Two of 32 nodules with surgical resection were benign,9 were atypical adenomatous hyperplasia（AAH）,14 were adenocarcinoma in situ（AIS）,and 7 were minimally invasive adenocarcinoma（MIA）.Sixteen nodules were considered to be malignant but not resected and 19 nodules were considered as benign lesions or required follow-up.The 67 pulmonary nodules were examined by conventional CT scan and targeted 1 024 ultra high-resolution CT scan.Three radiologists with 3-10 years of experience in imaging evaluated the image quality,type of nodules,diagnostic confidence using a 5-point score and gave the diagnosis result and treatment method.The film-reading results were analyzed using SPSS software.Results The images obtained by the targeted 1 024 ultra high-resolution CT scan were significantly superior to that of conventional CT in showing the margin of nodules,internal component,lobulation sign and other aspects（P〈0.05）.There were significant differences in judging the pure ground-glass opacity（GGO）nodules and mixed GGO nodules between the two kinds of CT images（P〈0.05）.The diagnostic accuracy of targeted 1 024 ultra highresolution CT scan was significantly increased versus the conventional CT scan（P〈0.05）,and the same was true for the diagnostic confidence（P〈0.05）.The treatment methods given by the two kinds of CT images were significantly different（P〈0.05）,which was reflected by the decreasing number of follow-up cases and increasing numbers of surgical cases and no follow-up cases.Conclusion The targeted 1 024 ultra high-resolution CT scan can provide a better image quality for pulmonary nodules below 8 mm in diameter.For patients with pulmonary nodules which are difficult to diagnose or with insufficient confidence,further examination should be performed using a targeted 1 024 ultra highresolution scan.