胸部CT检出胸外偶发病变的价值及临床意义

The value of incidental detection of non-thoracic lesions in chest CT scan

目的:探讨胸部CT对非选择性患者胸外偶发病变的检出价值,并分析其检出率、分布及在不同年龄及性别患者组间的差异。方法:回顾性分析2016年4月-2017年4月我院接受胸部CT检查的37045例受检者的影像及临床资料。胸部CT共检出6854例患者(18.5%)合并胸外病变,其中男4233例,女2621例;年龄1~97岁,平均(59.77±14.17)岁。分析偶发病变的部位及病变的良恶性,并将纳入人群按年龄段和性别进行分组,采用卡方检验或Fisher精确检验分析胸外偶发病变的检出率及分布情况。结果:6854例患者中CT检出胸外偶发病变7671个,最常见的发病器官为肝脏,共计5717个(74.52%),在不同年龄段(P<0.001)及性别间(P<0.001)差异有统计学意义;其次为甲状腺病变,在不同年龄段(P=0.004)及性别间(P<0.001)的差异也有统计学意义。胸外偶发良性病变共计7225个(94.15%),以肝囊肿(2816个,38.97%)最为常见,在不同年龄段(P<0.001)及性别间(P<0.001)的差异有统计学意义。胸外偶发恶性病变共449例(5.85%),以转移性肝癌(215例,占47.8%)最为常见,老年组的发病率明显高于青年组(P=0.003)。结论:胸部CT检查时约1/5的患者合并胸外偶发病变,绝大部分为良性病变,恶性病变的检出率约为6%;不同年龄段及性别之间胸外偶发病变的检出率也不尽相同,需要放射科医师有针对性的观察并诊断。

Objective:The purpose of this study was to investigate the value of incidental detection of non-thoracic lesions in chest CT scan,and to evaluate the differences of incidence,distribution and discrepancies of these lesions among groups of different ages and genders.Methods:The imaging and clinical data of 37045 consecutive patients who underwent chest CT scan in our hospital from April 2016 to April 2017 were retrospectively analyzed.A total of 6854 patients(18.5%)with non-thoracic lesions were found and diagnosed during chest CT scan,including 4233 males and 2621 females with average age of(59.77±14.17)years(1 to 97 years old).Patients were divided into different groups according to age and gender.The incidence and the distribution of incidental findings were analyzed by Chi-square test or Fisher's exact test.Results:A total of 7761 non-thoracic lesions were incidentally found in 6854 patients.The liver was the most frequently involved organ,with a total of 5717 lesions(74.50%),with a significant difference observed among different age and gender groups(all P<0.001).Similar results were found in thyroid lesions.Hepatic cysts(38.97%)were the most common in 7225(94.15%)benign lesions,and a significant difference was observed among different age and gender groups(all P<0.001).Metastatic liver cancer(n=215,47.8%)was the most common lesion detected in a total of 449 malignant lesions(5.85%).The incident rate in the elderly groups was significantly higher compared with young group(P=0.003).Conclusion:About 1/5 patients were found to have non-thoracic lesions in chest CT scan,most of which are benign,the malignant lesions is only about 6%.The incidence of non-thoracic findings varies among different age and gender groups,which requires radiologists to observe and diagnose.