CT 平扫征象在孤立性肺结节诊断中的应用价值

摘要

Objective To explore the value of single and combined features of multi - slice spiral CT scan in the diagnostic of solitary pul-monary nodules(SPN). Methods One hundred and eighty - nine cases of SPN patients were involved to the author collected as the research ob-ject. Clinical data were retrospectively analyzed. Patients were performed by CT scan. The single and combined features had statistical significance in differentiating benign and malignant were screened. And the diagnostic efficacy of those were evaluated. Results One hundred and eighty -nine cases of SPN patients had CT scanning. The diagnosis was based on the results of surgical pathology. The individual features of statistically significant were lobulation( P = 0. 000),speculation( P = 0. 001),pleural indentation( P = 0. 003),irregular margin( P = 0. 008)and vascular convergence( P = 0. 009). The difference between a single CT findings are statistically significant group of five kinds. Diagnostic effica-cy was the highest of three lobulation,spiculation and pleural indentation. The highest sensitivity and positive predictive value of signs of pleural indentation were found. The possibility of two to three kinds of feature pair appears significantly lower than the single signs,including malignant SPN while presenting lobulation,short spiculation and pleural indentation lowest probability of three phenomena. Conclusion Spiral CT has high application value for the diagnosis of SPN. CT plain scan can make accurate diagnosis of the majority SPN for benign and malignant,There is not statistically significant difference in the diagnostic ability between single signs and combined features,but the more typical signs the case of illness has,the higher reliability and the greater positive predictive value there is to confirm a malignant nodule .%目的：探讨多层螺旋 CT 平扫的单一征象及组合征象在孤立性肺结节（SPN）诊断中的价值。方法选取经病理证实的 SPN 患者189例作为研究对象，对其临床资料进行回顾性分析。采用常规16排螺旋 CT 机对患者行平扫，统计分析平扫征象，筛选对良恶性判别具有统计学意义的单个征象及组合征象，评判诊断效能。结果189例 SPN 患者行CT 平扫，以手术病理结果为诊断标准，差异有统计学意义的单个征象为分叶征（ P =0.000）、毛刺征（ P =0.001）、胸膜凹陷征（ P =0.003）、边缘不光滑（ P =0.008）及血管集束征（ P =0.009）。单个 CT 征象组间比较差异具统计学意义的有5种，诊断效能最高的三种是分叶征、毛刺征和胸膜凹陷征。其中敏感性和阳性预测值最高的征象为胸膜凹陷征。两到三种特征结对出现的可能性较单一征象大幅降低，其中在恶性 SPN 中，同时呈现分叶征、短毛刺征及胸膜凹陷征三种现象的概率最低。结论螺旋 CT 对 SPN 的诊断具有较高的应用价值，CT 平扫能对多数（准确性58.7%~77.8%） SPN 良恶性做出准确诊断。单一和组合征象于诊断效能方面的差异无统计学意义，但病例具有的典型征象愈多，其确诊恶性病变的可信度和阳性预测值愈高。