超高分辨率薄层CT对直径2cm以下肺小结节诊断价值的初步研究
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摘要
目的:孤立肺结节(SPN)的形态学特征是判断其良恶性的重要依据,CT成像的分辨率高低是提高SPN细微形态学特征显示率的关键因素。本研究的目的就是比较常规高分辨率薄层CT(512×512矩阵,HRCT)与超高分辨率薄层CT(1 024×1 024矩阵,ultra-HRCT)对直径≤2 cm肺小结节的几项细微形态学特征的显示是否存在差异,分析HRCT与ultra-HRCT成像在显示病变特征、图像质量及影响因素等方面的优劣性。方法:分别对人活体内72枚直径在2 cm以下的肺小结节进行HRCT及ultra-HRCT扫描成像。比较SPN的形态学指标包括:结节边缘,分叶(深、浅),晕征(清晰、模糊),毛刺(细短毛刺、细长毛刺、棘征);内部征象(空泡征、细支气管充气征、空洞),结节密度(钙化、磨玻璃密度)等。对HRCT和ultra-HRCT的图像质量及其影响因素进行主观评分,比较二者图像质量有无差异。同时对ultra-HRCT增加的X线辐射剂量进行分析。结果:对ultra-HRCT和HRCT成像对SPN的几项形态学指标的检出率比较后提示ultra-HRCT在显示边缘毛刺、空泡征等方面优于HRCT,但卡方检验P值均>0.05,没有统计学意义。二者图像质量主观评分HRCT图像质量优于ultra-HRCT,ultra-HRCT运动伪影和噪声发生率较HRCT高,二者差异卡方检验P值>0.05没有统计学意义。同时ultra-HRCT检查可增加X线辐射剂量,总体剂量在安全范围内。结论:ultra-HRCT对直径≤2 cm SPN的几项特征检出率均不低于HRCT,对边缘分叶、毛刺、晕征、空泡征、空气支气管征、GGO检出率均高于HRCT,提示ultra-HRCT在显示边缘分叶、毛刺、晕征、空泡征、空气支气管征、GGO等细微结构方面优于HRCT,但二者不存在显著统计学差异。图像质量主观评分HRCT高于ultra-HRCT;ultra-HRCT图像显示病变边缘及血管结构质量优于HRCT,运动伪影和噪声发生率较HRCT高,二者差异没有统计学意义。二者的X线辐射剂量均在安全范围内。
Objective:Morphological features of solitary pulmonary nodules is an important basis to judge the malignant and benign,high resolution CT imaging is a key factor to improve the detection rate of SPN subtle morphological characteristics.The objective of this study is to comparatively analyze the difference of pulmonary nodules diameter less than 2 cm imaging features between high resolution thin slice CT(512×512 matrix,HRCT) and ultra- high resolution thin slice CT(1 024×1 024 matrix,ultra-HRCT),and to analyze the advantages and disadvantages of ultra-HRCT in showing the fine structure of SPN and the image quality.Method:72 SPN in living body were scanned by ultra-HRCT and HRCT.The occurrence rate of various features of SPN was calculated,the features of SPN include:edge:lobulated sign(deep,shallow),halo sign(clear,fuzzy),burr sign(thin and short burr,thin and long burr,spine sign),internal structure(bubble sign/air bronchogram/cavity),nodules density(calcification,ground glass density).Meanwhile the image quality of ultra-HRCT and HRCT was observed,and their statistical difference was analyzed.Results:The occurrence rate of various features of SPN prompts that ultra-HRCT is better than HRCT,but P>0.05,which showed no significant statistically difference.The image quality of ultra-HRCT is better than that of HRCT,but P>0.05,which showed no significant statistically difference.Conclusions:The occurrence rate of various features of SPN on ultra-HRCT is less than that on HRCT,ultra-HRCT on the lobulated sign,burr sign,halo sign,bubble sign,air bronchogram,the detection rate of GGO is higher than that of HRCT,suggesting that ultra-HRCT in displaying the lobulated sign,burr sign,halo sign,bubble sign,air bronchogram,GGO and other fine is better than HRCT in terms of structure,but the two has no significant statistical difference.Subjective image quality score of HRCT was higher than Ultra-HRCT,ultra-HRCT image display quality is better than that of the edge of the lesion and vascular structure of HRCT,but the motion artifacts and noise occurrence rate is higher,the difference was not statistically significant.X-ray radiation dose of the two are in a safe range.
Objective:Morphological features of solitary pulmonary nodules is an important basis to judge the malignant and benign,high resolution CT imaging is a key factor to improve the detection rate of SPN subtle morphological characteristics.The objective of this study is to comparatively analyze the difference of pulmonary nodules diameter less than 2 cm imaging features between high resolution thin slice CT(512×512 matrix,HRCT) and ultra- high resolution thin slice CT(1 024×1 024 matrix,ultra-HRCT),and to analyze the advantages and disadvantages of ultra-HRCT in showing the fine structure of SPN and the image quality.Method:72 SPN in living body were scanned by ultra-HRCT and HRCT.The occurrence rate of various features of SPN was calculated,the features of SPN include:edge:lobulated sign(deep,shallow),halo sign(clear,fuzzy),burr sign(thin and short burr,thin and long burr,spine sign),internal structure(bubble sign/air bronchogram/cavity),nodules density(calcification,ground glass density).Meanwhile the image quality of ultra-HRCT and HRCT was observed,and their statistical difference was analyzed.Results:The occurrence rate of various features of SPN prompts that ultra-HRCT is better than HRCT,but P>0.05,which showed no significant statistically difference.The image quality of ultra-HRCT is better than that of HRCT,but P>0.05,which showed no significant statistically difference.Conclusions:The occurrence rate of various features of SPN on ultra-HRCT is less than that on HRCT,ultra-HRCT on the lobulated sign,burr sign,halo sign,bubble sign,air bronchogram,the detection rate of GGO is higher than that of HRCT,suggesting that ultra-HRCT in displaying the lobulated sign,burr sign,halo sign,bubble sign,air bronchogram,GGO and other fine is better than HRCT in terms of structure,but the two has no significant statistical difference.Subjective image quality score of HRCT was higher than Ultra-HRCT,ultra-HRCT image display quality is better than that of the edge of the lesion and vascular structure of HRCT,but the motion artifacts and noise occurrence rate is higher,the difference was not statistically significant.X-ray radiation dose of the two are in a safe range.
引文
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[14]李春平,周燕发.肺内孤立性小结节的HRCT和病理相关性的研究[J].实用放射学杂志,2001,17(9):669-671.Li CP,Zhou YF.HRCT-pathological correlative study of the small solitary pulmonary nodules[J].Journal of Practical Radiology,2001,17(9):669-671.
[15]刘甫庚,陈起航,周诚,等.肺孤立性小结节的HRCT[J].中国医学影像技术,2002,18(10):1003-1005.Liu FG,Chen QH,Zhou C,et al.HRCT of the small solitary pulmonary nodules[J].Chinese Journal of Medical Imaging Technology,2002,18(10):1003-1005.
[16]李唯,扬州,杨欣,等.孤立性肺结节的CT诊断[J].实用医学影像杂志,2011,12(3):156-159.Li W,Yang Z,Yang X,et al.CT diagnosis of solitary pulmonary nodules[J].Journal of Practical Medical Imaging,2011,12(3):156-159.
[17]王淼淼,伍建林,王圆圆,等.肺良性结节与周围型肺癌HRCT表现及病理对照研究[J].大连医科大学学报,2004,26(1):66-71.Wang MM,Wu JL,Wang YY,et al.Research on HRCT-pathologic correlation in benign pulmonary nodules and peripheral lung cancer[J].Journal of Dalian Medical University,2004,26(1):66-71.
[18]赵树伟,赵坛,张恩红,等.孤立性肺结节CT与HRCT表现的对照评价[J].医学影像学杂志,2004,14(10):806-808.Zhao SW,Zhao T,Zhang EH,et al.Evaluation of isolated pulmonary nodules:A comparison of HRCT with conventional CT[J].Journal of Medical Imaging,2004,14(10):806-808.
[19]陈建彪.高分辨率CT在肺孤立性结节诊断中的应用价值[J].亚太传统医药杂志,2011,7(7):53-54.Chen JB.The value of high-resolution CT in the diagnosis of solitary pulmonary nodules[J].Asia-Pacific Traditional Medicine,2011,7(7):53-54.
[2]Ohno Y,Koyama H,Matsumoto K,et al.Differentiation of malignant and benign pulmonary nodules with quantitative first-pass 320-detector row perfusion CT versus FDG PET/CT[J].Radiology,2011,258(2):599-609.
[3]Ikura H,Shimizu K,Junpei I,et al.In vitro evaluation of normal and abnormal lungs with ultra-high-resolution CT[J].Journal of Thoracic Imaging,2004,19(1):8-15.
[4]孟宪平,谢旭刚,朱建新,等.超高分辨率CT在肺部小结节诊断中的应用[J].实用临床医药杂志,2011,15(24):179-180.Meng XP,Xie XG,Zhu JX,et al.The application of super-high resolution CT in diagnosis of pulmonary nodules[J].Journal of Clinical Medicine in Practice,2011,15(24):179-180.
[5]陈群慧,张杰,叶晓丹,等.磨玻璃密度肺小腺癌病理亚型的ultra-HRCT分析[J].中国医学计算机成像杂志,2011,17:301-312.Chen QH,Zhang J,Ye XD,et al.Pathologic implications of ground glass opacity on ultra-high resolution CT of small peripheral adenocarcinoma of the lung[J].Chinese Computed Medical Imaging,2011,17:301-312.
[6]Siegelman SS,Khouri NF,Leo FP,et al.Solitary pulmonary nodules:CT assessment[J].Radiology,1986,160(2):307-312.
[7]张超,韦菊临.肺内孤立结节周边结构CT征象对良恶性病变的诊断价值初步分析[J].医学理论与实践,2011,24(8):879-884.Zhang C,Wei JL.Diagnostic value of CT features in peripheral solitary pulmonary nodule to determine benign or malignant lesions[J].The Journal of Medical Theory and Practice,2011,24(8):879-884.
[8]蔡祖龙,高建华,宋学坤,等.早期周围型肺癌的CT诊断(附65例分析)[J].中国医学影像杂志,1997,7(1):1-4.Cai ZL,Gao JH,Song XK,et al.The CT diagnosis of early peripheral pulmaonary bronchogenic carcinoma(an analysis of 65 cases)[J].Chinese Journal of Medical Imaging,1997,7(1):1-4.
[9]王晓华,马大庆,陈卉.毛刺征在CT诊断周围型小肺癌中的价值[J].中国医学影像学杂志,2006,14(2):127-130.Wang XH,Ma DQ,Chen H.Value of spiculation on CT in diagnosis of small peripheral lung carcinoma[J].Chinese Journal of Medical Imaging,2006,14(2):127-130.
[10]蔡祖龙,赵绍宏.细支气管肺泡癌的影像学[J].中国医学计算机成像杂志,2001,7(1):24-29.Cai ZL,Zhao SH.Imaging of bronchioloalveolar lung carcinoma[J].Chinese Computed Medical Imaging,2001,7(1):24-29.
[11]王晓华,马大庆,周新华.气腔密度影诊断周围型小肺癌的价值及其病理基础[J].中国医学影像学杂志,2005,13(6):427-430.Wang XH,Ma DQ,Zhou XH.The diagnostic value and pathological basis of air space in small peripheral lung carcinoma[J].Chinese Journal of Medical Imaging,2005,13(6):427-430.
[12]陈楠,谢坪,付凯.空泡征对早期肺癌的诊断价值[J].医学影像学杂志,2002,12(1):13-15.Chen N,Xie P,Fu K.The value of vacuole sign in the early diagnosis of lung cancer[J].Journal of Medical Imaging,2002,12(1):13-15.
[13]吕岩,谢汝明,周新华,等.磨玻璃晕征环绕的周围型肺癌的CT特征及病理对照观察[J].中国医学影像技术,2010,26(6):1096-1099.Lv Y,Xie RM,Zhou XH,et al.CT and pathology observation of peripheral lung cancer with halo sign[J].Chinese Journal of Medical Imaging Technology,2010,26(6):1096-1099.
[14]李春平,周燕发.肺内孤立性小结节的HRCT和病理相关性的研究[J].实用放射学杂志,2001,17(9):669-671.Li CP,Zhou YF.HRCT-pathological correlative study of the small solitary pulmonary nodules[J].Journal of Practical Radiology,2001,17(9):669-671.
[15]刘甫庚,陈起航,周诚,等.肺孤立性小结节的HRCT[J].中国医学影像技术,2002,18(10):1003-1005.Liu FG,Chen QH,Zhou C,et al.HRCT of the small solitary pulmonary nodules[J].Chinese Journal of Medical Imaging Technology,2002,18(10):1003-1005.
[16]李唯,扬州,杨欣,等.孤立性肺结节的CT诊断[J].实用医学影像杂志,2011,12(3):156-159.Li W,Yang Z,Yang X,et al.CT diagnosis of solitary pulmonary nodules[J].Journal of Practical Medical Imaging,2011,12(3):156-159.
[17]王淼淼,伍建林,王圆圆,等.肺良性结节与周围型肺癌HRCT表现及病理对照研究[J].大连医科大学学报,2004,26(1):66-71.Wang MM,Wu JL,Wang YY,et al.Research on HRCT-pathologic correlation in benign pulmonary nodules and peripheral lung cancer[J].Journal of Dalian Medical University,2004,26(1):66-71.
[18]赵树伟,赵坛,张恩红,等.孤立性肺结节CT与HRCT表现的对照评价[J].医学影像学杂志,2004,14(10):806-808.Zhao SW,Zhao T,Zhang EH,et al.Evaluation of isolated pulmonary nodules:A comparison of HRCT with conventional CT[J].Journal of Medical Imaging,2004,14(10):806-808.
[19]陈建彪.高分辨率CT在肺孤立性结节诊断中的应用价值[J].亚太传统医药杂志,2011,7(7):53-54.Chen JB.The value of high-resolution CT in the diagnosis of solitary pulmonary nodules[J].Asia-Pacific Traditional Medicine,2011,7(7):53-54.