肺磨玻璃样结节定性诊断中螺旋CT靶扫应用价值研究

Targeted scan by spiral CT in qualitative diagnosis of ground-glass-like pulmonary nodules

目的探讨肺磨玻璃样结节定性诊断中螺旋CT靶扫应用及其临床意义研究。方法选取2017年5月至2019年7月本院收治的肺磨玻璃样结节患者116例,经CT扫描发现入组患者均存在肺磨玻璃样结节影,对所有入组患者均进行常规CT扫描,在此基础上为患者进行靶重建以及超高分辨率CT靶扫描及靶重建,所探查结节共116个,分析超高分辨率CT靶扫描在肺磨玻璃样结节定性诊断中的应用价值。结果本次研究中经穿刺活检或手术病理证实恶性结节85个(含浸润性肺腺癌14个,癌前病变23个,微浸润腺癌48个),良性结节31个;经超高分辨率CT靶扫描显示恶性结节84个,良性结节32个,恶性诊断灵敏度为92.9%(79/85),特异度为83.9%(26/31),准确度为90.5%(105/116);常规扫描CT靶重建显示恶性结节83个,良性结节33个,恶性诊断灵敏度为85.9%(73/85),特异度为67.7%(21/31),准确度为81.0%(94/116);超高分辨率CT靶扫描重建边缘清晰、结节内增粗肺纹理以及结节内实性成分检出率高于常规扫描CT靶重建,差异均有统计学意义(均P<0.05);超高分辨率CT靶扫描重建毛刺征、支气管征、胸膜牵拉征以及空泡征与常规扫描CT靶重建结果比较,差异均无统计学意义(均P>0.05);超高分辨率CT靶扫描重建病理分型诊断符合率高于常规扫描CT靶重建病理分型诊断符合率,差异有统计学意义(P<0.05)。结论螺旋CT靶扫与常规CT扫描重建相比,可以提高肺磨玻璃样结节定性诊断准确性,提高病理分级诊断符合率,可在临床中进行进一步推广应用。

Objective To investigate the clinical significance of targeted scan by spiral CT in the qualitative diagnosis of ground-glass-like pulmonary nodules.Methods From May,2017 to July,2019,116 patients with ground-glass-like pulmonary nodules treated in our hospital were selected.CT scan showed that all the patients had ground-glass-like pulmonary nodules.All the patients were examined by routine CT scan.On this basis,targeted reconstruction,ultra high resolution CT target scanning and targeted reconstruction were performed on the patients,and a total of 116 nodules were explored.The value of ultra-high resolution CT targeted scan in the qualitative diagnosis of pulmonary ground vitreous nodules was analyzed.Results 85 malignant nodules,including 14 invasive lung adenomas,23 precancerous lesions,and 48 microinvasive adenomas,and 31 benign nodules were confirmed by puncture biopsies or surgery and pathology.84 malignant nodules and 32 benign nodules were found by ultra-high resolution CT targeted scan,with a sensitivity of 92.9%(79/85),a specificity of 83.9%(26/31),and an accuracy of 90.5%(105/116)for malignant nodules.Conventional CT target reconstruction showed 83 malignant nodules and 33 benign nodules,with a sensitivity of 85.9%(73/85),a specificity of 67.7%(21/31),and an accuracy of 81.0%(94/116)for malignant nodules.The reconstruction by ultra-high resolution CT targeted scan had clearer edge and higher the detection rate of thickening lung texture and solid components in the nodules than that by conventional CT targeted scan(P<0.05).There were no statistical differences in burr,bronchus,pleura traction,and vacuole signs between ultra-high resolution and conventional CT targeted reconstructions(all P>0.05).The diagnostic coincidence of pathological classification by ultra-high resolution CT target scan reconstruction was higher than that by conventional CT targeted scan reconstruction(P<0.05).Conclusion Compared with conventional CT reconstruction,spiral CT targeted scan can improve the accuracy of the qualitative diagnosis of ground-glass-like pulmonary nodules and the coincidence of pathological grade diagnosis,so it should be further popularized and applied in clinic.