超高分辨率CT靶扫描与CT靶重建在肺磨玻璃样结节定性诊断中的价值

The value analysis in qualitative diagnosis of ultrahigh resolution CT scan and CT target reconstruction in lung glass nodules

目的比较超高分辨率CT（UHRCT）靶扫描与常规CT靶重建的肺磨玻璃样结节微征象，分析这两种方法对肺磨玻璃样结节定性诊断的价值。方法收集2016年8月至2017年12月在山东省胸科医院筛查疑诊为肺结核的患者120例。本组患者CT扫描均发现有肺内单发磨玻璃样结节影。患者行常规CT扫描，然后进行靶重建和UHRCT靶扫描，共计结节灶120个。由2名副高级以上诊断医师阅片，分析上述两种CT成像技术所显示的肺磨玻璃样结节征象（结节边缘、增粗肺纹理、结节内实性成分、毛刺征、空泡征、支气管征、胸膜牵拉征），分别定性诊断癌前病变[不典型腺瘤样增生（AAH）、肺原位腺癌（AIS）]、微浸润腺癌（MIA）、浸润腺癌（IAC），最终根据病理结果比较两种成像技术对肺腺癌分期诊断的正确率。采用SPSS17．0软件进行统计学处理，计数资料用卡方检验，以P〈0．05差异具有统计学意义。结果结节边缘清晰，UHRCT靶扫描为71个（78.0％），CT靶重建为56个（61．5％）（X2=5．863，P=0．015）。肺纹理增粗，UHRCT靶扫描为60个（65．9％），CT靶重建为45个（49．5％）（X2=5．065，P=0．024）。结节内实性成分，UHRCT靶扫描为66个（72．5％），CT靶重建为50个（54．9％）（X2=6．086，P=0．014）。毛刺征UHRCT靶扫描为34个（37．4％），CT靶重建为29个（31．9％）（X2=0．319，P=0．572）。空泡征UHRCT靶扫描为22个（24．2%），CT靶重建为18个（19．8％）（X2=0．513，P=0．474）。支气管征UHRCT靶扫描为28个（30．8％），CT靶重建为26个（28．6％）（X2=0．105，P=0．746）。胸膜牵拉征UHRCT靶扫描为30个（33．0％），CT靶重建为21个（23．1％）（X2=2．207，P=0．137）。常规CT靶重建诊断与病理符合数为75个（82．4％），不符合数为16个（17．6％）。UHRCT靶扫描检查与病理符合数为86个（94．5％），不符合数为5个（5．5％）（X2=6．513，P=0．011）。结论UHRCT靶扫描较常规CT靶重建显示的肺磨玻璃样结节微征象更清楚，有助于对肺磨玻璃样结节的病理分期。

Objective The aim of this study was to assess the differences in microscopic signs of the pulmonary glass nodules between the ultra-high resolution CT （UHRCT） target scan and conventional CT target reconstruction, and analyzed the difference of the two methods in qualitative diagnosis of pulmonary ground glass nodules. Methods From August 2016 through December 2017, 120 cases of suspected pulmonary tuberculosis were screened in Shandong Provincial Chest Hospital, who with a single glass nodule in lung. The patients underwent routine CT scanning, followed by target reconstruction and UHRCT target scanning, a total of 120 nodules. Two experienced radiologists with subtropical high or above physicians, were asked to analyze the two kinds of lung CT image ground glass nodules signs （Margin of nodles, pulmonary markings thickening, solid component, burr fin, bubble sign, air bronchogram, pleural pull） respectively, the diagnosis of precancerous lesions （AAH, AIS）, microinvasive adeno-carcinoma （MIA） and infiltrating adenocarcinoma （IAC） were determined, and the accuracy of the diagnosis of lung adenocarcinoma by two methods was compared according to the pathological results. In this study, Chi square test was used in SPSS 17.0 statistical software, and P〈0.05 difference was statistically significant. Results Margin of nodule, UHRCT target scanning was 71 （78.0%）, and CT target reconstruction was 56 （61.5%） （X2=5. 863, P=0. 015）. Thickening pulmonary markings, the UHRCT target scanning was 60 （65.9%）, and the CT target reconstruction was 45 （49.5%） （X2 = 5. 065, P = 0. 024）. Solid component, the UHRCT target scanning was 66 （72. 5%）, and the CT target reconstruction was 50 （54. 9%） （X2 =6. 086, P=0. 014）. Burr fin, the UHRCT target scanning was 34 （37. 4%）, and the target reconstruction of CT was 29 （31.9%） （X2 =0. 319, P=0. 572）. Bubble sign, UHRCT target scanning was 22 （24.2%）, CT target reconstruction was 18 （19.8%） （X2=0. 513, P=0. 474）. Air bronchogram, UHRCT target scanning was 28 （30. 8%） and CT target reconstruction was 26 （28.6%） （X2 =0. 105, P=0. 746）. Pleural indentation, UHRCT target scanning is 30 （32.9%） ,and CT target reconstruction was 21 （23.1%） （X2=2. 207, P= 0.137）. The number of the pathologic coincidence CT target reconstruction was 75 （82.4%） and discrepancy was 16 （17. 6%）. The number of the pathologic coincidence UHRCT was 86 （94. 5%） and discrepancy is 5 （5.5%）. Chi-square test, X2=6. 513, P=0. 011. Conclusion The target scan of UHRCT is more clear than that of conventional target reconstructed images, and it is helpful for pathological stages of pulmonary glass nodules.