Lung-RADS分级和CT征象诊断孤立性肺结节的价值
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摘要
目的:研究肺部影像报告和数据系统(Lung-RADS)分级、CT征象及联合两种方法对孤立性肺结节的定性诊断价值。方法:分析240例孤立性肺结节的CT表现,观察其特征性影像学表现(边界是否光整、有无钙化、胸膜牵拉、毛刺、分叶、支气管截断、支气管充气、空泡、空洞及肿瘤血管征象)并测量大小。按照Lung-RADS分级标准对病灶重新分类,通过对有差异性的各个征象分值累计每个病灶的CT征象计分,对照病理结果,绘制ROC曲线,比较各方法对良恶性孤立性肺结节的诊断价值。结果:Lung-RADS分级诊断孤立性肺结节的敏感度、特异度、符合率分别为54.9%、68.9%、57.5%,ROC曲线下面积(AUC)为0.628(P<0.05);CT征象分值诊断肺结节的敏感度、特异度、符合率分别为81.5%、91.1%、83.3%,AUC为0.910(P<0.001);联合两种方法诊断时,诊断孤立性肺结节的敏感度、特异度、符合率分别为97.9%、95.6%、97.5%,AUC为0.988(P<0.001)。结论:Lung-RADS分级、CT征象对鉴别诊断肺结节良恶性均有重要价值,但CT征象评估的诊断效能优于Lung-RADS分级,两者联合应用可为孤立性肺结节的鉴别诊断提供重要依据。
Objective:To study the qualitative diagnostic value of lung imaging report and data system(Lung-RADS) and CT signs for solitary pulmonary nodules.Methods:Two hundred and forty cases of solitary pulmonary nodules were retrospectively analyzed,and their characteristic imaging features were reviewed(signs such as margin,pleural traction,burr,lobulation,bronchial truncation,bronchial aeration,vacuoles,cavities and tumor vessels) and the size was measured.According to the Lung-RADS standards,every lesion of all was reclassified.The CT scores of each lesion were calculated by signs with a statistically significant difference.The pathological results were compared,and the ROC curves were applied to compare the diagnostic value of benign and malignant solitary pulmonary nodules among different methods.Results:The sensitivity,specificity,and accuracy of Lung-RADS standards in diagnosing solitary pulmonary nodules were 54.9%,68.9%,and 57.5%,respectively.The area under the ROC curve(AUC) was 0.628(P<0.05).The sensitivity,specificity,and accuracy of CT signs scores were 81.5%,91.1%,and 83.3%,respectively,and the AUC was 0.910(P<0.001).The sensitivity,specificity,and accuracy of combined two-method in diagnosis of solitary pulmonary nodules were 97.9%,95.6%,and 97.5%;AUC was 0.988(P<0.001).Conclusion:Lung-RADS classification and CT signs are important for the differential diagnosis of benign and malignant pulmonary nodules,but the diagnostic efficacy of CT signs is significantly better than that of the Lung-RADS classification.The combination of the two can provide important differential diagnosis basis for solitary pulmonary nodules.
Objective:To study the qualitative diagnostic value of lung imaging report and data system(Lung-RADS) and CT signs for solitary pulmonary nodules.Methods:Two hundred and forty cases of solitary pulmonary nodules were retrospectively analyzed,and their characteristic imaging features were reviewed(signs such as margin,pleural traction,burr,lobulation,bronchial truncation,bronchial aeration,vacuoles,cavities and tumor vessels) and the size was measured.According to the Lung-RADS standards,every lesion of all was reclassified.The CT scores of each lesion were calculated by signs with a statistically significant difference.The pathological results were compared,and the ROC curves were applied to compare the diagnostic value of benign and malignant solitary pulmonary nodules among different methods.Results:The sensitivity,specificity,and accuracy of Lung-RADS standards in diagnosing solitary pulmonary nodules were 54.9%,68.9%,and 57.5%,respectively.The area under the ROC curve(AUC) was 0.628(P<0.05).The sensitivity,specificity,and accuracy of CT signs scores were 81.5%,91.1%,and 83.3%,respectively,and the AUC was 0.910(P<0.001).The sensitivity,specificity,and accuracy of combined two-method in diagnosis of solitary pulmonary nodules were 97.9%,95.6%,and 97.5%;AUC was 0.988(P<0.001).Conclusion:Lung-RADS classification and CT signs are important for the differential diagnosis of benign and malignant pulmonary nodules,but the diagnostic efficacy of CT signs is significantly better than that of the Lung-RADS classification.The combination of the two can provide important differential diagnosis basis for solitary pulmonary nodules.
引文
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[9] Gaeta M,Barone M,Russi EG,et al.Carcinomatous solitary pulmonary nodules:evaluation of the tumor-bronchi relationship with thin-section CT[J].Radiology,1993,187(2):535-539.
[10] 李洋,范国华,张彩元,等.MSCT图像重组技术在肺部孤立局灶性磨玻璃密度结节诊断中的价值[J].实用放射学杂志,2015,31(3):397-401.
[11] 黎君翔.CT三维重建对孤立性肺结节与支气管关系的评价[J].海南医学,2017,28(17):2832-2834.
[12] 何其舟,余飞,代平,等.孤立性肺结节的多层螺旋CT表现与病理对照研究[J].重庆医学,2014,43(29):3912-3915.
[13] 王秋萍,金晨望,邓蕾,等.探讨肺结节内钙化密度与钙化征象的临床意义[J].医学影像学杂志,2014,24(10):1729-1733.
[14] 周晓秋,王宝春,操啸,等.多层螺旋CT征象对孤立性肺结节的诊断价值[J].临床肺科杂志,2017,22(12):2270-2274.
[2] Zhang L,Yankelevitz DF,Carter D,et al.Internal growth of nonsolid lung nodules:radiologic-pathologic correlation[J].Radiology,2012,263(1):279-286.
[3] 杨智明,陈亚男,陈武飞,等.肺磨玻璃结节形态学衍变模式研究进展[J].放射学实践,2017,32(12):1309-1312.
[4] 陆青云,陈武飞.不同病理类型肺部磨玻璃结节的HDCT征象分析[J].医学影像学杂志,2017,27(6):1084-1087.
[5] 李辉,姜春霞,宁培刚,等.肺内孤立结节的高分辨CT征象诊断价值[J].郑州大学学报(医学版),2014,49(6):872-875.
[6] Snoeckx A,Reyntiens P,Desbuquoit D,et al.Evaluation of the solitary pulmonary nodule:sizematters,but do not ignore the power of morphology[J].Insights Imaging,2018,9(1):73-86.
[7] 王志鹏,宗亮,孙清超,等.孤立性肺结节的危险因素[J].临床肺科杂志,2018,23(4):624-627,635.
[8] 李胜达,孙琼芳,王圣恩,等.CT三维重建图像对恶性肺内孤立性结节的诊断价值[J].广东医学,2015,36(2):266-269.
[9] Gaeta M,Barone M,Russi EG,et al.Carcinomatous solitary pulmonary nodules:evaluation of the tumor-bronchi relationship with thin-section CT[J].Radiology,1993,187(2):535-539.
[10] 李洋,范国华,张彩元,等.MSCT图像重组技术在肺部孤立局灶性磨玻璃密度结节诊断中的价值[J].实用放射学杂志,2015,31(3):397-401.
[11] 黎君翔.CT三维重建对孤立性肺结节与支气管关系的评价[J].海南医学,2017,28(17):2832-2834.
[12] 何其舟,余飞,代平,等.孤立性肺结节的多层螺旋CT表现与病理对照研究[J].重庆医学,2014,43(29):3912-3915.
[13] 王秋萍,金晨望,邓蕾,等.探讨肺结节内钙化密度与钙化征象的临床意义[J].医学影像学杂志,2014,24(10):1729-1733.
[14] 周晓秋,王宝春,操啸,等.多层螺旋CT征象对孤立性肺结节的诊断价值[J].临床肺科杂志,2017,22(12):2270-2274.
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