CT增强对不同大小密度孤立性肺结节的诊断价值

Diagnostic value of CT enhancement for solitary pulmonary nodules of different size

目的探讨肺部CT增强对不同大小、密度孤立性肺结节(SPN)的诊断价值。方法回顾性调查病理确诊孤立性肺结节患者204例,以病理结果为参考标准,比较CT增强峰值在不同大小、不同密度SPN良恶性分布差异,并探讨其在不同病理类型SPN中的鉴别诊断价值。结果 CT增强在实性和/或直径在2~3 cm的SPN鉴别诊断价值较高(OR值分别为5.15,95%CI:2.62~10.14和5.39,95%CI:1.89~15.39),在部分实性、直径≤2的结节中良恶性鉴别能力较差;CT增强峰值是否≥15 HU在不同病理类型SPN中的差异具有统计学意义;CT增强阳性率随着直径增大及密度变实而逐渐增加。结论在孤立性肺结节的鉴别诊断中,应参考结节的密度、直径及可能的病理结果,合理选择CT增强扫描。

Objective The aim of this study was to investigate the diagnostic value of CT enhancement in different size and density of solitary pulmonary nodules（ SPN）. Methods A retrospective cohort study was performed on 204 patients with SPN. The pathological results were used as reference standards to compare the difference of CT enhancement peaks in different sizes and densities of SPN,and to explore the differential diagnosis of different pathological types of SPN. Results CT enhancement was more valuable in the differential diagnosis of SPN with solid and/or diameter of 2 - 3 cm（ OR = 5. 15,95% CI： 2. 62 - 10. 14; OR = 5. 39,95%CI： 1. 89 - 15. 39）. However,in partial solid,the differentiation of benign and malignant in nodules with diameter ≤2 was poor; the peak of CT enhancement（ ≥15 HU） was statistically significant in different pathological types of SPN. The positive rate of CT enhancement gradually increased with increasing diameter and density. Conclusion In the differential diagnosis of SPNs,CT enhancement scan should be reasonably selected with reference to the density,diameter and possible pathological findings of the nodules.