高分辨CT对新诊孤立性肺结节的定性诊断价值

Value of High-resolution CT in Qualitative Diagnosis of Newly Diagnosed Solitary Pulmonary Nodules

目的探讨高分辨CT(HRCT)在新诊孤立性肺结节(SPN)良恶性鉴别诊断中的应用价值。方法70例SPN患者均行HRCT检查,以病理学诊断为“金标准”,分析HRCT在SPN良恶性病变鉴别诊断中的应用价值。结果70例SPN患者术后病理诊断:恶性病变46例(64.29%),良性病变24例(34.29%);恶性SPN组HRCT扫描胸膜凹陷征、毛刺征、分叶征、血管集束征等征象检出率均显著高于良性SPN组(P<0.05);HRCT扫描恶性SPN组与良性SPN组最大CT值(CT_(Max))、CT值标准差(CT_(Std))比较均有统计学差异(P<0.05);以病理结果为诊断“金标准”,HRCT征象联合CT测量参数诊断SPN良恶性病变的灵敏度为92.68%(38/41),特异度为72.41%(21/29),准确率为84.29%[(38+29)/70],与病理诊断的一致性良好(Kappa=0.843,P<0.01)。结论良恶性SPN患者HRCT征象及CT测量参数存在差异,联合HRCT征象检查和CT参数测量有利于对SPN进行定性分析。

Objective To explore the application value of high-resolution CT(HRCT)in the differential diagnosis of benign and malignant solitary pulmonary nodules(SPN).Methods 70 patients with SPN were subjected to HRCT.Taking pathological diagnosis as the golden standard,the detection rates of imaging signs and CT parameters of benign and malignant SPN were compared.The application value of HRCT in the differential diagnosis of benign and malignant SPN was analyzed.Results Postoperative pathological diagnosis showed that there were 46 cases(64.29%)with malignant lesions and 24 cases(34.29%)with benign lesions in the 70 SPN patients.The detection rates of imaging signs(pleural indentation,spiculation,lobulation,vessel convergence sign)by HRCT scan in malignant SPN group were significantly higher than those in benign SPN group(P<0.05).The differences in the maximum CT value(CT_( Max))and standard deviation of CT value(CT_(Std))between malignant and benign SPN groups were statistically significant(P<0.05).Taking pathological diagnosis as the golden standard,the sensitivity,specificity and accuracy rates of HRCT signs combined with CT measurement parameters in the diagnosis of benign and malignant SPN were 92.68%(38/41),72.41%(21/29)and 84.29%[(38+29)/70],whose consistency with pathological diagnosis was good(Kappa=0.843,P<0.01).Conclusion There are differences in HRCT signs and CT parameters between patients with benign and malignant SPN.The combination of HRCT signs and CT parameters is conducive to qualitative analysis of SPN.