容积再现技术在孤立性肺结节鉴别诊断中的价值
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摘要
目的探讨容积再现技术(Volume rendering,VR)在孤立性肺结节(Solitary Pulmonary Nodules,SPN)鉴别诊断中的价值。方法收集我院门诊就诊,经术后病理证实的SPN患者482例,通过VR分析良恶性SPN的影像学特征。结果 482例患者包括恶性SPN 416例,良性SPN 66例。在恶性SPN中肿瘤微血管CT成象征(卡方值225. 51,P <0. 001)、血管集束征(卡方值19. 79,P <0. 001)、毛刺(卡方值14. 83,P <0. 001)和支气管充气征(卡方值3. 48,P <0. 05)检出率高于良性SPN,随着SPN密度的增加,肿瘤微血管CT成像征(趋势卡方值55. 08)的检出率逐渐降低(P <0. 001),而血管集束征(趋势卡方值92. 78),分叶征(趋势卡方值35. 87)及毛刺(趋势卡方值55. 62)的检出率逐渐增高(P <0. 001)。结论肿瘤微血管CT成象征在非实性结节和部分实性结节定性诊断中起到重要作用,而血管集束征、分叶征及毛刺在实性结节的定性诊断中更有价值。通过VR来评判SPN与血管之间的关系对恶性SPN早期诊断更有意义。
Objective To analyze the value of volume rendering in the differential diagnosis of solitary pulmonary nodules. Methods The imaging characters of 482 patients with SPN confirmed by operation and pathology were analyzed by VR. Results There were 416 malignant cases and 66 benign cases. In malignant SPN,the detection rate of CT tumor micro-angioimaging( chi square value 225. 51,P < 0. 001),vascular convergence sign( chi square value 19. 79,P < 0. 001),spiculation( chi square value = 14. 83,P < 0. 001) and air bronchogram( chi square value = 3. 48,P < 0. 05) were higher than those in benign SPN. With the increase of SPN density,the detection rate of CT tumor micro-angioimaging( trend chi square value = 55. 08) decreased gradually( P < 0. 001),while vascular convergence sign( trend card square value = 92. 78),lobular sign( trend chi square value = 35. 87) and spiculation( trend card square value = 55. 62) increased gradually( P < 0. 001). Conclusion CT tumor micro-angio imaging plays an important role in the qualitative diagnosis of part-solid and nonsolid nodules,while vascular convergence sign,lobular sign and spiculation are more valuable in qualitative diagnosis of solid nodules. It is more significant to judge the relationship between SPN and blood vessels by VR in the early diagnosis of malignant SPN.
Objective To analyze the value of volume rendering in the differential diagnosis of solitary pulmonary nodules. Methods The imaging characters of 482 patients with SPN confirmed by operation and pathology were analyzed by VR. Results There were 416 malignant cases and 66 benign cases. In malignant SPN,the detection rate of CT tumor micro-angioimaging( chi square value 225. 51,P < 0. 001),vascular convergence sign( chi square value 19. 79,P < 0. 001),spiculation( chi square value = 14. 83,P < 0. 001) and air bronchogram( chi square value = 3. 48,P < 0. 05) were higher than those in benign SPN. With the increase of SPN density,the detection rate of CT tumor micro-angioimaging( trend chi square value = 55. 08) decreased gradually( P < 0. 001),while vascular convergence sign( trend card square value = 92. 78),lobular sign( trend chi square value = 35. 87) and spiculation( trend card square value = 55. 62) increased gradually( P < 0. 001). Conclusion CT tumor micro-angio imaging plays an important role in the qualitative diagnosis of part-solid and nonsolid nodules,while vascular convergence sign,lobular sign and spiculation are more valuable in qualitative diagnosis of solid nodules. It is more significant to judge the relationship between SPN and blood vessels by VR in the early diagnosis of malignant SPN.
引文
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[13]SOUBANI A O.The evaluation and management of the solitary pulmonary nodule[J].Postgrad Med J,2008,84(995):459-466.
[14]张菁,马靖,王广发.实性和亚实性肺结节临床处理:ACCP最新肺结节诊疗指南简介[J].中华结核和呼吸杂志,2014,37(3):202-205.
[15]龙从杰.全身CT与MRI征象诊断学[M].北京:人民军医出版社,2008:114-174.
[16]SHI C Z,ZHAO Q,LUO L P,et al.Size of solitary pulmonary nodule was the risk factor of malignancy[J].J Thorac Dis,2014,6(6):668-676.
[17]史华莉,孙琼芳,涂蓉,等.CT三维重建技术对肺内孤立性结节的诊断价值[J/OL].中华临床医师杂志(电子版),2014,8(5):922-926[2018-09-11].http://med.wanfangdata.com.cn/Paper/Detail?id=Periodical Paper_zhlcyszz201405025&dbid=WF_QK.DOI:10.3877/cma.j.issn.1674-0785.2014.05.025.
[2]中华医学会呼吸病学分会肺癌学组,中国肺癌防治联盟.原发性支气管肺癌早期诊断中国专家共识(草案)[S].中华结核和呼吸杂志,2014,37(3):172-176.
[3]DAKOVI'C-BJELAKOVI'CM,POPOVI'CJ,ANTI'CM,et al.Analysis of the anatomical variations of the supraorbital transcranial passage in southeast Serbian population on volume rendered CT scans[J].Acta Medica Medianae,2017,56(3):81-87.
[4]李镛,周进,严峻海,等.CT三维重建在孤立性肺结节鉴别诊断中的价值[J].内科理论与实践,2015,10(6):403-406.
[5]周进,张柏膺,严峻海,等.81例恶性肺微小结节的影像学征象分析[J].内科理论与实践,2017,12(3):191-193.
[6]WANG Y X J,GONG J S,SUZUKI K,等.孤立性肺结节的循证医学影像处理[J].临床与病理杂志,2015,35(2):169-174.
[7]张国桢,郑向鹏,李铭,等.微小肺癌:影像诊断与应对策略[M].北京:人民军医出版社,2015:82.
[8]赵宝英,耿昶,邓宝忠,等.肺内孤立结节的CT血管集束征及其鉴别诊断[J].中国中西医结合影像学杂志,2006,4(5):339-341.
[9]王志强.早期周围型肺癌CT图像特征及其临床价值探讨[J].医学理论与实践,2015,28(20):2821-2822.
[10]熊曾,周晖,胡成平,等.肺内结节CT血管集束征与强化值的关系[J].中华医学杂志,2013,93(38):3015-3018.
[11]陈子敏,向子云,王毅,等.三维重建在孤立性肺结节血管集束征的诊断价值[J].CT理论与应用研究,2017,26(1):69-76.
[12]刘东宇.CT重建技术在小肺癌血管集束征的诊断价值[J].临床肺科杂志,2014,19(7):1341-1343.
[13]SOUBANI A O.The evaluation and management of the solitary pulmonary nodule[J].Postgrad Med J,2008,84(995):459-466.
[14]张菁,马靖,王广发.实性和亚实性肺结节临床处理:ACCP最新肺结节诊疗指南简介[J].中华结核和呼吸杂志,2014,37(3):202-205.
[15]龙从杰.全身CT与MRI征象诊断学[M].北京:人民军医出版社,2008:114-174.
[16]SHI C Z,ZHAO Q,LUO L P,et al.Size of solitary pulmonary nodule was the risk factor of malignancy[J].J Thorac Dis,2014,6(6):668-676.
[17]史华莉,孙琼芳,涂蓉,等.CT三维重建技术对肺内孤立性结节的诊断价值[J/OL].中华临床医师杂志(电子版),2014,8(5):922-926[2018-09-11].http://med.wanfangdata.com.cn/Paper/Detail?id=Periodical Paper_zhlcyszz201405025&dbid=WF_QK.DOI:10.3877/cma.j.issn.1674-0785.2014.05.025.