胸部CT在良恶性胸腔积液诊断中的应用价值
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摘要
目的通过分析良、恶性胸腔积液患者胸部电子计算机断层扫描(computed tomography,CT)的特征性表现,探讨胸部CT在恶性胸腔积液患者中的诊断价值。方法回顾性分析439例胸腔积液患者胸部CT征象,观察胸腔积液单双侧、胸膜结节、胸膜均匀、胸膜增厚程度、纵膈胸膜增厚、胸膜下脂肪影消失、胸腔积液包裹、CT值等征象。结果单因素分析显示胸腔积液单双侧、胸膜结节、胸膜均匀、胸膜增厚程度、纵膈胸膜增厚、胸膜下脂肪影消失、胸腔积液包裹、胸腔积液量、纵膈淋巴结肿大、心影增大、心包积液量、其他部位转移指标在良、恶性胸腔积液中均有统计学差异(P均<0.05)。多因素分析中胸膜均匀、纵膈胸膜增厚、胸腔积液包裹、纵膈淋巴结肿大、胸膜结节与恶性胸腔积液相关(P均<0.01),其联合诊断恶性胸腔积液的诊断率、敏感度、特异度分别为98.58%、97.12%、92.43%。结论胸部CT在恶性胸腔积液的诊断中具有较高的指导价值,是一种安全、有效、诊断率高的检查方法。
Objective To analyze the computed tomography(CT) features of patients with benign and malignant pleural effusion,and explore the diagnostic and clinical value of chest CT in patients with malignant pleural effusion.Methods The chest CT features of 439 pleural effusion patients were retrospectively analyzed.The unilateral and bilateral of pleural effusion,pleural nodules,pleural uniformity,pleural thickening,mediastinal pleural thickening,extrapleural disappeared fat layer,encapsulated effusion,CT value of pleural effusion and other meaningful characteristics were evaluated.Results The variables of unilateral pleural effusion,pleural nodules,pleural uniformity,pleural thickening,mediastinal pleural thickening,extrapleural disappeared fat layer,pleural effusion volume,encapsulated effusion,mediastinal lymph node enlargement,cardiac shadow enlargement,pericardial effusion volume and tumor metastasis were significantly different between benign and malignant pleural effusion(all P<0.05).Multivariate analysis showed that pleural uniformity,mediastinal lymph node enlargement,encapsulated effusion,mediastinal lymph node enlargement and pleural nodules were correlated with malignant pleural effusion(all P<0.01),and the diagnosis rate,sensitivity and specificity of the combined diagnosis for malignant pleural effusion were 98.58%,97.12%,92.43%,respectively.Conclusion Chest CT has a high guiding value in the diagnosis of malignant pleural effusion.It is a safe,effective examination with high diagnostic rate.
Objective To analyze the computed tomography(CT) features of patients with benign and malignant pleural effusion,and explore the diagnostic and clinical value of chest CT in patients with malignant pleural effusion.Methods The chest CT features of 439 pleural effusion patients were retrospectively analyzed.The unilateral and bilateral of pleural effusion,pleural nodules,pleural uniformity,pleural thickening,mediastinal pleural thickening,extrapleural disappeared fat layer,encapsulated effusion,CT value of pleural effusion and other meaningful characteristics were evaluated.Results The variables of unilateral pleural effusion,pleural nodules,pleural uniformity,pleural thickening,mediastinal pleural thickening,extrapleural disappeared fat layer,pleural effusion volume,encapsulated effusion,mediastinal lymph node enlargement,cardiac shadow enlargement,pericardial effusion volume and tumor metastasis were significantly different between benign and malignant pleural effusion(all P<0.05).Multivariate analysis showed that pleural uniformity,mediastinal lymph node enlargement,encapsulated effusion,mediastinal lymph node enlargement and pleural nodules were correlated with malignant pleural effusion(all P<0.01),and the diagnosis rate,sensitivity and specificity of the combined diagnosis for malignant pleural effusion were 98.58%,97.12%,92.43%,respectively.Conclusion Chest CT has a high guiding value in the diagnosis of malignant pleural effusion.It is a safe,effective examination with high diagnostic rate.
引文
[1] 施焕中.规范恶性胸腔积液的诊断与治疗[J].中华内科杂志,2014,53(3):166-167
[2] Goldstraw P,Chansky K,Crowley J,et al.The IASLC lung cancer staging project:proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer[J].J Thorac Oncol,2016,11(1):39-51
[3] Thomas JM,Musani AI.Malignant pleural effusions:a review[J].Clin Chest Med,2013,34(3):459-471
[4] Hooper C,Lee YC,Maskell N.Investigation of a unilateral pleural effusion in adults:British thoracic society pleural disease guideline 2010[J].Thorax,2010,65 Suppl 2:ii4-ii17
[5] Roberts ME,Neville E,Berrisford RG,et al.Management of a malignant pleural effusion:British thoracic society pleural disease guideline 2010[J].Thorax,2010,65 Suppl 2:ii32-ii40
[6] Lee CY,Hong JY,Lee MG,et al.Identification of 10 candidate biomarkers distinguishing tuberculous and malignant pleural fluid by proteomic methods[J].Yonsei Med J,2017,58(6):1144-1151
[7] Birnie KA,Prêle CM,Thompson PJ,et al.Targeting microRNA to improve diagnostic and therapeutic approaches for malignant mesothelioma[J].Oncotarget,2017,8(44):78193-78207
[8] 王欣同,程方圆,钟殿胜,等.胸腔积液沉淀物在恶性胸腔积液诊断中的临床应用价值[J].中国肺癌杂志,2017,20(6):395-401
[9] Laisaar T,Palmiste V,Vooder T,et al.Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis[J].Interact Cardiovasc Thorac Surg,2006,5(3):307-310
[10] Tomlinson JE,Byrne E,Pusterla N,et al.The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses:25 Cases (2007-2012)[J].J Vet Intern Med,2015,29(5):1403-1409
[11] Yang L,Hu YJ,Li FG,et al.Analysis of Cytokine Levers in Pleural Effusions of Tuberculous Pleurisy and Tuberculous Empyema[J].Mediators of Inflamm,2016:3068103
[12] Idell S,Girard W,Koenig KB,et al.Abnormalities of pathways of fibrin turnover in the human pleural space[J].Am Rev Respir Dis,1991,144(1):187-194
[13] 陈华文,彭光明.多层螺旋CT在恶性胸腔积液诊断中的应用价值[J].现代医用影像学,2017,26(6):1545-1550
[14] Leung AN,Müller NL,Miller RR.CT in differential diagnosis of diffuse pleural disease[J].AJR Am J Roentgenol,1990,154(3):487-492
[15] Porcel JM,Pardina M,Bielsa S,et al.Derivation and validation of a CT scoring system for discriminating malignant from benign pleural effusions[J].Chest,2015,147(2):513-519
[16] Yilmaz U,Polat G,Sahin N,et al.CT in differential diagnosis of benign and malignant pleural disease[J].Monaldi Arch Chest Dis,2005,63(1):17-22
[2] Goldstraw P,Chansky K,Crowley J,et al.The IASLC lung cancer staging project:proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer[J].J Thorac Oncol,2016,11(1):39-51
[3] Thomas JM,Musani AI.Malignant pleural effusions:a review[J].Clin Chest Med,2013,34(3):459-471
[4] Hooper C,Lee YC,Maskell N.Investigation of a unilateral pleural effusion in adults:British thoracic society pleural disease guideline 2010[J].Thorax,2010,65 Suppl 2:ii4-ii17
[5] Roberts ME,Neville E,Berrisford RG,et al.Management of a malignant pleural effusion:British thoracic society pleural disease guideline 2010[J].Thorax,2010,65 Suppl 2:ii32-ii40
[6] Lee CY,Hong JY,Lee MG,et al.Identification of 10 candidate biomarkers distinguishing tuberculous and malignant pleural fluid by proteomic methods[J].Yonsei Med J,2017,58(6):1144-1151
[7] Birnie KA,Prêle CM,Thompson PJ,et al.Targeting microRNA to improve diagnostic and therapeutic approaches for malignant mesothelioma[J].Oncotarget,2017,8(44):78193-78207
[8] 王欣同,程方圆,钟殿胜,等.胸腔积液沉淀物在恶性胸腔积液诊断中的临床应用价值[J].中国肺癌杂志,2017,20(6):395-401
[9] Laisaar T,Palmiste V,Vooder T,et al.Life expectancy of patients with malignant pleural effusion treated with video-assisted thoracoscopic talc pleurodesis[J].Interact Cardiovasc Thorac Surg,2006,5(3):307-310
[10] Tomlinson JE,Byrne E,Pusterla N,et al.The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses:25 Cases (2007-2012)[J].J Vet Intern Med,2015,29(5):1403-1409
[11] Yang L,Hu YJ,Li FG,et al.Analysis of Cytokine Levers in Pleural Effusions of Tuberculous Pleurisy and Tuberculous Empyema[J].Mediators of Inflamm,2016:3068103
[12] Idell S,Girard W,Koenig KB,et al.Abnormalities of pathways of fibrin turnover in the human pleural space[J].Am Rev Respir Dis,1991,144(1):187-194
[13] 陈华文,彭光明.多层螺旋CT在恶性胸腔积液诊断中的应用价值[J].现代医用影像学,2017,26(6):1545-1550
[14] Leung AN,Müller NL,Miller RR.CT in differential diagnosis of diffuse pleural disease[J].AJR Am J Roentgenol,1990,154(3):487-492
[15] Porcel JM,Pardina M,Bielsa S,et al.Derivation and validation of a CT scoring system for discriminating malignant from benign pleural effusions[J].Chest,2015,147(2):513-519
[16] Yilmaz U,Polat G,Sahin N,et al.CT in differential diagnosis of benign and malignant pleural disease[J].Monaldi Arch Chest Dis,2005,63(1):17-22