对比低浓度对比剂结合低剂量宝石CT灌注及增强成像在孤立性肺结节良恶性鉴别诊断中的应用价值

Low dose contrast medium combined with low dose gemstone CT perfusion versus enhanced imaging in differential diagnosis of solitary pulmonary nodules

目的 探讨低浓度对比剂结合低剂量宝石CT灌注及增强成像对孤立性肺结节（SPN）良恶性的鉴别诊断价值.方法 收集经穿刺或手术病理证实为SPN良性患者（38例）与SPN恶性患者（62例）,所有患者均行低浓度对比剂结合低剂量宝石CT灌注及增强成像检查,记录血流量（BF）、血容量（BV）、表面通透性（PS）、平均通过时间（MTT）及结节增强峰值（PH）,并绘制ROC曲线分析相关指标的诊断效能.结果 良、恶性SPN的BV、PS值比较,差异有统计学意义（P＜0.05）,BF、MTT比较,差异无统计学意义（P＞0.05）.良、恶性SPN的PH值比较,差异有统计学意义（P＜0.05）.BV单独诊断对恶性SPN的敏感度为85.3％、特异度为60.3％、阳性预测值为80.6％、阴性预测值为66.5％;PS分别为88.1％、66.5％、85.8％、76.8％;PH分别为82.9％、87.0％、83.8％、86.5％;联合检测分别为92.3％、89.0％、89.8％、90.5％.结论 低浓度对比剂结合低剂量宝石CT灌注及增强成像对鉴别诊断SPN良恶性具有较高的诊断效能.

Objective To explore the values of low concentration contrast agent combined with low dose gemstone CT perfusion and enhanced imaging in the differential diagnosis of solitary pulmonary nodules （SPN）. Methods 38 patients with benign SPN and 62 patients with milignant SPN were confrmed by puncture or surgical pathology. All patients underwent CT perfusion and enhanced imaging with low-contrast contrast agent and low-dose gemstone. The blood fow （BF ）, blood volume （BV）, surface permeability （PS）, mean transit time （MTT）, and nodule enhancement peak （PH） were measured. The diagnostic effcacy of ROC curve was analyzed. Results There were statistical differences in BV and PS between benign and malignant SPN （P 〈0.05） but no in BF and MTT （P〉 0.05）. The PH values of benign and malignant SPNs were signifcantly different （P 〈0.05）. The sensitivity, specifcity, and specifcity of BV in the diagnosis of malignant SPN were 85.3%, 60.3%, 80.6%, and 66.5%, respectively; those of PS were 88.1%, 66.5%, 85.8%, and 76.8%, respectively; and those of S/A were 82.9%, 87.0%, 83.8%, and 86.5%, respectively; and those of cooperative detection were 92.3%, 89.0%, 89.8%, and 90.5%, respectively. Conclusions CT perfusion and enhanced imaging of low-dose contrast agent combined with low-dose gemstone have high diagnostic effcacy in the differential diagnosis of benign and malignant SPN.