宝石能谱CT联合MSCT灌注成像在肺结节定性诊断中的应用

Application of gemstone spectral CT combined with MSCT perfusion imaging in the qualitative diagnosis of pulmonary nodules

目的探讨宝石能谱CT联合多层螺旋CT(MSCT)灌注成像在肺结节定性诊断中的应用价值。方法选取2019年4月至2020年4月本院收治的100例肺结节患者作为研究对象,以病理检查或穿刺活检结果作为金标准,分析宝石能谱CT、MSCT灌注成像及联合检查鉴别肺结节良恶性的价值。结果100例肺结节患者经病理或穿刺活检确诊恶性病变47例,良性病变53例;宝石能谱CT检出阳性49例,阴性51例,真阳性38例,真阴性42例;MSCT灌注成像检出阳性49例,阴性51例,真阳性37例,真阴性41例;联合检测阳性47例,阴性53例,真阳性46例,真阴性52例;宝石能谱CT联合MSCT灌注成像诊断肺结节准确度、灵敏度、特异度、阳性预测值、阴性预测值均高于宝石能谱CT和MSCT灌注成像单独检查,差异有统计学意义(P<0.05)。Kappa检验显示,宝石能谱CT与病理或穿刺活检一致性尚可(Kappa=0.600,P=0.000);MSCT灌注成像与病理或穿刺活检一致性尚可(Kappa=0.559,P=0.000);联合检测与病理或穿刺活检一致性极好(Kappa=0.960,P=0.000)。结论宝石能谱CT联合MSCT灌注成像在肺结节定性诊断中应用价值优于宝石能谱CT和MSCT灌注成像单独检查,可为临床诊断、治疗提供参考,值得临床推广应用。

Objective To investigate the application value of gemstone spectral CT combined with multi-slice spiral CT(MSCT)perfusion imaging in the qualitative diagnosis of pulmonary nodules.Methods 100 patients with pulmonary nodules admitted to our hospital from April 2019 to April 2020 were selected as the research subjects,pathological examination or needle biopsy results as the gold standard,the value of gemstone spectral CT,MSCT perfusion imaging and combined examination in differentiating benign and malignant pulmonary nodules was analyzed.Results 47 cases of malignant lesions and 53 cases of benign lesions were found in 100 patients with pulmonary nodules by pathology or needle biopsy;gemstone energy spectrum CT detected positive in 49 cases and negative in 51 cases,including 38 cases true postive and 42 cases true negative;49 cases were positive and 51 cases were negative by MSCT perfusion imaging,including 37 cases true positive and 41 cases true nagative;47 cases were positive and 53 cases were negative by combined detection biopsy comparison,including 46 true positives and 52 true negatives;accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of gemstone spectral CT combined with MSCT perfusion imaging in diagnosing pulmonary nodules were higher than gthose of emstone spectral CT and MSCT perfusion imaging alone,the difference was statistically significant(P<0.05).Kappa test showed that gemstone energy spectrum CT was in good agreement with pathology or puncture biopsy(Kappa=0.600,P=0.000);MSCT perfusion imaging was in good agreement with pathological or puncture biopsy(Kappa=0.559,P=0.000);combined detection was in excellent agreement with pathological or needle biopsy(Kappa=0.960,P=0.000).Conclusion The application value of gemstone spectral CT combined with MSCT perfusion imaging in the qualitative diagnosis of pulmonary nodules is better than that of gemstone spectral CT and MSCT individual examinations.It provides more valuable reference information for clinical diagnosis and treatment,and is worthy of clinical application.