64排螺旋CT对肺孤立性结节的征象分析及诊断价值

64-slice spiral CT characteristics of solitary pulmonary nodules

目的研究64排螺旋CT孤立性肺结节(SPN)影像学特征,提高良恶性结节的诊断准确性。方法收集连云港市第二人民医院2015年8月至2018年12月病理确诊的170例SPN,恶性结节(116例)作为肺腺癌组,良性结节(54例)作为良性结节组,采用χ^(2)检验比较组间结节的CT表现(位置、病灶形态、内部成分、瘤-肺界面、瘤周毛刺征、胸膜牵拉征、支气管截断征等)及强化方式的差异,采用t检验比较组间病灶直径和距胸膜距离的差异。结果肺腺癌组与良性结节组比较,实性、亚实性结节(42.2%vs 22.2%、44.8%vs 29.6%)、不规则形(88.7%vs 35.2%)、瘤-肺界面不光滑(77.6%vs 22.2%)、分叶(62.9%vs 14.8%)、瘤周毛刺征(56.9%vs 3.7%)、胸膜牵拉征(45.7%vs 3.7%)等征象表现所占比例均大,且差异均具有统计学意义(χ^(2)=25.17、52.24、47.03、23.54、43.43、29.66,P均<0.05);2组间病灶直径和距胸膜距离比较,差异无统计学意义(P>0.05)。增强动脉期肺腺癌组结节轻-中度度强化比例高于良性结节组(57.4%vs 28.6%),结节明显强化比例低于良性结节组(35.2%vs 53.5%),差异具有统计学意义(χ^(2)=4.68,P<0.05);静脉期肺腺癌组结节延迟强化比例高于良性结节组(83.3%vs 53.5%),结节强化减退比例低于良性结节组(9.2%vs 46.5%),差异具有统计学意义(χ^(2)=64.23,P<0.05)。结论CT是检出肺结节的主要方法,通过特征性表现结合增强特点可以提高影像诊断准确性,尽早对肺癌结节进行正确的临床干预。

Objective To investigate the 64-slice spiral CT imaging characteristics of solitary pulmonary nodules(SPNs)and improve the diagnostic accuracy for benign and malignant SPN.Methods A total of 170 patients who were pathologically diagnosed with SPNs were eligible for the enrollment between August 2015 and December 2018 at the Second People's Hospital of Lianyungang,including 116 with lung adenocarcinomas(LACs)and 54 with benign nodules(BNs).Theχ^(2) test was used to compare the differences of CT findings(such as nodule position,morphology,and composition,tumor-lung interface,burr sign at the edge of the tumor,pleural violation,and bronchial amputation)and the patterns of enhancement,while the t test was applied for comparing the differences of the size of the lesions and the distance to pleura.Results There were significant differences in the solid and sub-solid nodules(42.2%vs 22.2%,44.8%vs 29.6%),irregular pattern(88.7%vs 35.2%),rough tumor-lung interface(77.6%vs 22.2%),lobulated morphology(62.9%vs 14.8%),burrs at the edge of the tumor(56.9%vs 3.7%),and pleural invasion(45.7%vs 3.7%)between LACs and BNs(χ^(2)=25.17,52.24,47.03,23.54,43.43 and 29.66,respectively;P<0.05).There was no statistically significant difference in the size of the lesions or the distance to pleura between the two groups(P>0.05).In the arterial period,the proportion of lesions with mild to moderate uneven enhancement was significantly higher in LACs than in BNs(57.4%vs 28.6%),whereas the proportion of lesions with pronounced enhancement was significantly lower in the BNs group(35.2%vs 53.5%;χ^(2)=4.68,P<0.05).In the venous period,the proportion of lesions with delayed enhancement was significantly higher in LACs than in BNs(83.3%vs 53.5%),while the proportion of lesions with hypoenhancement was significantly lower in the BNs group(9.2%vs 46.5%;χ^(2)=64.23,P<0.05).Conclusion CT is the main method for detection of pulmonary nodules,and the combination of CT characteristics and enhancement features can improve the diagnostic accuracy,thus improving the clinical management of malignant nodules.