MSCT薄层靶重建及后处理技术在孤立性肺结节良恶性鉴别诊断中的应用价值

Clinical value of MSCT thin-section target reconstruction and post-processing techniques in differential diagnosis of benign and malignant solitary pulmonary nodules

目的探讨多层螺旋计算机断层扫描(MSCT)薄层靶重建及后处理技术在孤立性肺结节(SPN)良恶性鉴别诊断中的应用价值。方法回顾性收集2020年1月至2021年3月周口市中医院收治的67例SPN患者作为研究对象,均行MSCT平扫和薄层靶扫描检查,并使用多平面重组(MPR)、容积再现(VR)、最大密度投影(MIP)等后处理技术对图像进行重建,诊断SPN的良恶性,同时行病理组织学检查,比较CT平扫和薄层靶重建诊断SPN的敏感度、特异度、准确率、阳性预测值、阴性预测值和Kappa值。结果 67例SPN患者中,经病理学诊断为恶性病变40例(59.70%),良性病变27例(40.30%)。MSCT薄层靶重建对SPN分叶征、毛刺征、血管集束征、胸膜牵拉征、空泡征和支气管气相征的检出率均高于CT平扫(P均<0.05),且其诊断SPN良恶性的灵敏度、特异度、准确度、阳性预测值和阴性预测值均高于CT平扫(P均<0.05)。MSCT薄层靶重建诊断与病理诊断的Kappa值为0.814,大于CT平扫诊断与病理诊断的Kappa值0.380。结论 MSCT后处理重建技术可较好地检出SPN的形态学特征,其鉴别SPN良恶性的灵敏度、特异度和准确率均较高,并与病理学诊断结果具有较高的一致性。

Objective To investigate the clinical value of multi-slice spiral computed tomography(MSCT)thin-section target reconstruction and post-processing techniques in differential diagnosis of benign and malignant solitary pulmonary nodules(SPN).Methods Sixty-seven SPN patients admitted to Zhoukou Hospital of Traditional Chinese Medicine from January 2020 to March 2021 were retrospectively enrolled as the research objects.All of them underwent MSCT plain scans and thin-section target scans.The images were reconstructed by post-processing techniques,such as multi-plane reconstruction(MPR),volume rendering(VR),maximum intensity projection(MIP).The benign and malignant SPN were diagnosed,and histopathological examination was conducted.The sensitivity,specificity,accuracy,positive predictive value,negative predictive value and Kappa value of CT plain scan and thin-section target reconstruction in the diagnosis of SPN were compared.Results Among the 67 patients with breast NMLE lesions,pathological diagnosis showed that there were 40 cases(59.70%)with malignant lesions and 27 cases(40.30%)with benign lesions.The detection rates of lobulation sign,spiculation,vessel convergence sign,pleural indentation sign,vacuole sign and air bronchogram sign by MSCT thin-section target reconstruction were higher than those by CT plain scan(all P<0.05),and its sensitivity,specificity,accuracy,positive predictive value and negative predictive value were all higher than those by CT plain scan in the diagnosis of benign and malignant SPN(all P<0.05).The Kappa value between MSCT thin-section target reconstruction and pathological diagnosis was 0.814,greater than that between CT plain scan and pathological diagnosis(Kappa=0.380).Conclusions MSCT post-processing reconstruction technique can better detect morphological characteristics of SPN,and its sensitivity,specificity and accuracy are relatively higher in differential diagnosis of benign and malignant SPN,which is of high consistency with pathological diagnosis results.