多层螺旋CT动脉扫描及三维重建在孤立性肺小结节诊断中的应用比较

A comparison about application of arterial scan of MSCT and its 3D reconstruction in the diagnosis of small SPN

目的:观察比较多层螺旋CT(MSCT)动脉扫描及三维重建在孤立性肺结节(SPN)诊断中的应用价值。方法:对120例SPN患者行MSCT增强扫描,其中恶性76例,良性44例,注入对比剂进行增强扫描,测得肺动脉期和主动脉期图像,0.5 mm层厚图像用于多平面重建(MPR)观察SPN血管及形态特点,对比分析MSCT动脉扫描及三维重建对SPN血管显示率、形态特征显示率和诊断效能。结果:三维重建技术在SPN血管显示率和形态特征显示率均高于MSCT动脉扫描,血管显示率比较差异具有统计学意义(x^2=13.199,P<0.05)。MPR的三维重建技术评估良、恶性的准确率、灵敏度、特异度、阳性预测值和阴性预测值分别为85.0%、85.53%、84.09%、90.28%和77.08%,均明显高于MSCT动脉扫描。结论:三维重建技术相对于MSCT动脉扫描具有明显优势,能够通过多层面、多方位显示肺结节的征象,并能够清楚显示结节与支气管、血管、胸膜等的关系,有利于恶性结节早期临床诊断。

Objective:To observe and compare the arterial scan of multi-slice spiral CT(MSCT)and its threedimensional(3D)reconstruction in diagnosis of small solitary pulmonary nodules.Methods:120 patients with solitary pulmonary nodules(SPN),who included 76 malignant ones and 44 benign ones,were implemented the MSCT enhancement scan.And all of them were implemented enhancement scan after contrast agent was injected,and the images of pulmonary artery stage and aorta stage were measured.And 0.5 mm images were used in multiplanar reconstruction(MPR)so as to observe vascular and morphological characteristics of SPN.And then the display rate of vessel and display rate of morphological characteristics of SPN and diagnostic efficiency between arterial scan of MSCT and its 3D reconstruction were compared and analyzed.Results:The display rate of vessel and display rate of morphological characteristics about SPN of 3D reconstruction based on arterial scan of MSCT were higher than that of MSCT arterial scan,and the difference of display rate of vessel between the two methods was significant(x^2=13.199,P<0.05).The accuracy,sensitivity,specificity,positive predictive value and negative predictive value of 3D reconstruction based on arterial scan of MSCT were higher than that of MSCT arterial scan in the diagnosis of benign and malignant small SPNs.Conclusion:Compared with MSCT arterial scan,3D reconstruction technique based on MSCT arterial scan has obvious advantages.It can display signs of pulmonary nodules through multi-level and multiazimuth,and can clearly show the relationship between nodules and bronchi,vessels and pleura.Therefore,it is beneficial to the clinical diagnosis of early malignant nodules,and it is worthy in clinical use.