胸部X线与CT联合诊断早期肺部感染的临床价值

Clinical value of chest X-ray combined with CT in the diagnosis of early pulmonary infection

目的探讨胸部X线与CT联合诊断早期肺部感染的临床价值。方法选取2015年1月至2016年4月于本院就诊的109例肺部感染疑似病例为研究对象。入组病例均行64排螺旋CT检查及胸部X线检查,由两名高年资影像科医生阅片,与肺部感染诊断标准进行对照分析。比较单独使用64排螺旋CT检查/胸部X线检查与联合检查早期肺部感染的敏感度、特异度、阳性预测值、阴性预测值和准确度。结果经胸部X线检查诊断为肺部感染56例、漏诊22例、误诊11例。肺部感染者X线片主要表现为两肺弥漫性、对称性的微细结节或者网状浸润。经胸部CT检查诊断为肺部感染62例、漏诊14例、误诊9例,主要表现为膜玻璃影、实变影及网格影或者狭长细线样影等多种征象混合存在。联合检查诊断早期肺部感染的灵敏度、特异度、阳性预测值、阴性预测值和诊断准确率分别为94.0%、92.9%、95.5%、90.7%和93.6%,胸部X线检查分别为77.6%、73.8%、80.4%、58.5%和69.7%,64排螺旋CT分别为79.1%、78.6%、85.5%、70.2%和78.9%,联合检查灵敏度、特异度、阳性预测值、阴性预测值、诊断准确率显著高于单纯使用胸部X线或者64排螺旋CT检查(χ~2=7.924、5.065、6.661、12.337、20.290,P=0.019、0.024、0.021、0.002、0.000)。结论联合检查对早期肺部感染诊断价值优于单纯应用胸部X线或者64排螺旋CT检查,有助于提高早期肺部感染诊断的准确性。

Objective To investigate the clinical value of chest X-ray combined with CT in the diagnosis of early pulmonary infection. Methods Total of 109 suspected patients with pulmonary infection in our hospital from January 2015 to April 2016 were collected. All cases were examined by 64 slice spiral CT and chest X-ray. The images were analyzed by two senior radiologists and compared with pulmonary infection diagnosis standard. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 64 slice spiral CT scan and chest X-ray examination in early lung infection were compared, respectively. Results There were 56 cases diagnosed with pulmonary infection by chest X-ray, 22 cases were never diagnosed and 11 cases were misdiagnosed. X-ray film in pulmonary infection patients mainly showed two lung diffuse, symmetrical micro nodules or reticular infiltration. There were 62 cases diagnosed with pulmonary infection by chest CT, 14 cases never diagnosed and 9 cases misdiagnosed. CT film in pulmonary infection patients mainly showed mixed glass shadow, real change shadow and grid shadow or thin wire like shadow. The sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy rate of combination diagnosis were 94.0%, 92.9%, 95.5%, 90.7% and 93.6%; while chest X-ray were 77.6%, 73.8%, 80.4~,5, 58.5% and 69.7%, respectively; which were 79.1%, 78.6%, 85.5%, 70.2% and 78.9% in chest CT, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy rates of combination diagnosis were significantly higher than those of the single application of chest X-ray or 64 slice spiral CT （X^2 = 7.924, 5.065, 6.661, 12.337, 20.290; P = 0.019, 0.024, 0.021, 0.002, 0.000）. Conclusions The value of combined examination in early diagnosis of pulmonary infection was better than single application of chest X-ray or 64 slice spiral CT examination. It was helpful to improve the accuracy of early diagnosis of pulmonary infection. It was worthy of clinical popularization and application.