螺旋CT靶扫描及重建对肺部小结节良恶性判断的价值与限度

The Value and Limitation of Spiral CT Scan and Reconstruction for the Benign and Malignant Pulmonary Nodules

目的:分析肺部小结节螺旋CT靶扫描及重建对结节良恶性判断的价值与限度,总结诊断经验。方法:2016年1月～2017年12月,医院采用螺旋CT靶扫描及重建诊断肺部小结节80例,回顾性分析,以病理诊断作为"金标准",评价CT诊断效用。结果:恶性36例、良性44例。螺旋CT靶扫描及重建诊断灵敏度94.4%、特异度86.4%、阳性预测值85.0%、阴性预测值95.0%、符合率90.0%。恶性病灶的晕征、深分叶征、毛刺、空泡征、边缘不清、淋巴结肿大率均高于良性病灶,恶性病灶钙化率低于良性病灶,差异有统计学意义(P<0.05)。风险比从高到低前5位分别为深分叶征、晕征、直边征、空泡征、毛刺。结论:肺部小结节螺旋CT靶扫描及重建定性诊断效用较好,误漏诊主要与病灶较小、结节缺乏特征性、良恶性影像征象重叠有关。

Objective:to analyze the value and limitation of CT scanning and reconstruction of pulmonary nodules for benign and malignant nodules and summarize the diagnostic experience.Methods:from January 2016 to December 2017, 80 cases of pulmonary nodules were diagnosed by spiral CT scanning and reconstruction in the hospital. Retrospective analysis was conducted to evaluate the diagnostic efficacy of CT with pathological diagnosis as the "gold standard".Results:36 cases were malignant and 44 cases were benign. The diagnostic sensitivity of spiral CT scanning and reconstruction was 94.4%, the specificity was 86.4%, the positive predictive value was 85.0%, the negative predictive value was 95.0%, and the coincidence rate was 90.0%. The incidence of halos, deep dividing, burr, vacuolar, unclear margin, and lymph node enlargement in malignant lesions were all higher than that in benign lesions, while the incidence of calcification in malignant lesions were lower than that in benign lesions, with statistically significant differences (P < 0.05). The top five risk ratios from high to low were deep dividing, halo, straight edge, cavitation and burr.Conclusion:qualitative diagnosis of pulmonary nodules by spiral CT scanning and reconstruction is effective, and misdiagnosis is mainly related to small lesions, lack of characteristic nodules, and overlap of benign and malignant images.