Lung-RADS分级、CT对孤立性肺结节的定性诊断价值

Qualitative Diagnostic Value of Lung-RADS Classification and CT in the Diagnosis of Solitary Pulmonary Nodules

目的研究肺部影像报告和数据系统(Lung-RADS)分级、CT对孤立性肺结节(SPN)的定性诊断价值。方法回顾性分析本院2016年7月到2018年4月90例SPN患者资料,根据CT影像观察患者病灶的类型[纯磨玻璃病灶(p GGO)、部分实性结节(m GGO)、实性结节(SSN)]、病灶形态、病灶的大小、边界、胸膜牵拉、支气管截断、支气管充气、结节与周围血管的关系;并对患者的结节进行Lung-RADS分级。结果结合病理检查结果,90例患者中26例为良性病灶,64例为恶性病灶。良性组的p GGO病灶率、≤10mm的病灶率显著高于恶性组,病灶形态Ⅰ型、胸膜牵拉、支气管截断、结节与周围血管Ⅰ型率显著低于恶性组,差异均有统计学意义(P<0.05);两组的边界不光整、支气管充气率比较,差异均无统计学意义(P>0.05)。90例患者中,Lung-RADS 1级3例,Lung-RADS 2级17例,Lung-RADS 3级23例,Lung-RADS 4A级11例,Lung-RADS 4B级8例,Lung-RADS 4X级2例。Lung-RADS分级、CT及联合诊断预测SPN性质的ROC曲线下面积分别为0.678、0.896、0.957;通过约登指数计算方法,Lung-RADS分级的敏感度66.87%、特异度75.50%、符合度67.03%,CT征象的敏感度81.56%、特异度91.12%、符合度82.78%,联合诊断的敏感度97.25%、特异度96.24%、符合度97.12%。结论CT对SPN的定性诊断准确率显著高于Lung-RADS分级,但二者联合诊断的精确性更高,临床可根据患者实际情况加以运用。

Objective To study the qualitative diagnosis value of Lung Imaging reporting and data system(LungRADS) and CT for Solitary pulmonary nodule(SPN).Methods The data of 90 cases of SPN patients from July 2016 to April 2018 were retrospectively analyzed.The type of lesions were observed according to CT images [pure ground glass lesions(pGGO),partial solid nodules(mGGO),solid nodules(SSN)],lesion morphology,lesion size,border,pleural traction,bronchial truncation,bronchial aeration,relationship between nodules and peripheral blood vessels,and the patients’ nodules were ca rried out Lu ng-RADS classification.Results Combined with pathological examination results,of the 90 patients,26 were benign lesions and 64 were malignant lesions.The pGGO lesion rate and the lesion rate of ≤10 mm in the benign group were significantly higher than those in the malignant group.The lesion type Ⅰ,pleural traction,bronchial truncation,nodules and peripheral blood vessel type Ⅰ rate were significantly lower than the malignant group.The difference was statistically significant(P<0.05).The boundaries of the two groups are not just complete.There was no significant difference in the rate of the bronchial inflation(P>0.05).Of the 90 patients,3 were Lung-RADS grade 1,17 were Lung-RADS grade 2,23 were Lung-RADS grade 3,11 were Lung-RADS grade 4 A,8 were Lung-RADS grade 4 B,and 2 were LungRADS grade 4 X.The area under the ROC curve of Lung-RADS classification,CT and joint diagnosis for predicting SPN properties were 0.678,0.896,0.957,respectively.According to the Yoden index calculation method,the sensitivity of Lung-RADS classification is 66.87%,the specificity is 75.50%,the degree of compliance is 67.03%,the sensitivity of CT signs is 81.56%,the specificity is 91.12%,the degree of compliance is 82.78%,and the sensitivity of joint diagnosis 97.25%,specificity 96.24%,and compliance 97.12%.Conclusion The accuracy of CT qualitative diagnosis of SPN is significantly higher than that of Lung-RADS grade,but the combined diagnosis of the two is more accu rate,and the clinical application can be applied according to the actual situation of the patient.