肺孤立结节增强CT研究

Enhanced CT Study on Diagnosis of Solitary Pulmonary Nodule

目的 :探讨增强CT扫描对肺孤立结节的鉴别诊断价值以及不同性质结节早期动脉期强化与实质期强化程度的相关性。方法 :共搜集肺孤立性结节病变 5 6例 ,其中周围型肺癌 2 6例、炎性结节 2 2例、结核瘤 8例 ,均经手术病理或CT导向经皮肺穿刺活检病理组织学证实以及 3～ 6月临床治疗追踪确诊。全部行CT平扫和以 2 .5ml s速率团注非离子造影剂 10 0ml后 30s和 12 0s增强扫描。观察结节强化形态 ,测定和分析强化程度并做动脉期和实质期强化程度的相关分析。结果 :周围型肺癌和炎性结节的强化程度明显高于结核瘤 (P <0 .0 1) ,而且强化形态也不同。周围型肺癌与炎性结节动脉期和实质期增强CT值和强化程度均无显著差异 (P >0 .0 5 ) ,两者强化形态相似。但炎性结节实质期和动脉期强化程度呈强相关 ,周围型肺癌实质期和动脉期强化程度呈弱相关。结论 :CT平扫不能鉴别肺孤立性结节的性质。增强CT扫描结核瘤与周围型肺癌和炎性结节的强化程度及强化形态均不同 ,可以进行鉴别。周围型肺癌与炎性结节强化程度及形态均无显著差异 ,不易鉴别。实质期强化程度超过 4 0HU ,高度提示炎性结节。

Objective: To investigate enhanced CT scanning in differentiation of solitary pulmonary nodules and correlation analysis between the enhancement in early arterial phase and the enhancement degree in tangible phase among different nodules. Methods: 26 patients with pulmonary carcinoma, 22 patients with inflammatory nodule and 8 patients with tuberculoma, confirmed by surgical operation or biopsy and clinical treatment, were studied with plain chest CT scan and enhanced scanning after bolus injection of 100 ml non ionized contrast medium to observe the enhancement degree in 30 s and 120 s. CT values of nodule were calculated and analysis correlation in enhancement degree on arterial and tangible phase. Results: The pulmonary carcinoma and inflammatory nodule showed a significantly higher degree of enhancement than that of tuberculoma (P<0.01). The carcinoma and the inflammation revealed no difference in degree and pattern between arterial and tangible enhancement(P>0.05). It easily reminded inflammatory nodules for the higher correlation coefficient in enhancement degree of arterial and tangible phase, whereas weak correlation coefficient in pulmonary carcinomas. Conclusion: The results suggest that the enhanced CT scanning is distinctively different between tuberculoma and carcinomas or inflammatory nodules. The characteristic of SPN can not be differentiated by the plain scan. There is no significant difference on arterial and tangible enhancement of pattern and degree in carcinoma and inflammatory nodules. Beyond 40 HU enhancement degree on tangible phase, it may be inflammatory nodules.