低剂量多层螺旋CT对直径<2.0cm孤立性肺结节的诊断价值分析
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摘要
目的探讨低剂量多层螺旋计算机体层摄影(CT)对直径﹤2.0 cm的孤立性肺结节(SPN)的诊断价值。方法回顾性分析44例影像学检查直径﹤2.0 cm、高度怀疑为恶性SPN患者(共67枚结节)的临床资料。所有患者均行常规CT扫描和低剂量CT扫描。比较两种CT扫描图像质量主观评分、图像噪声、辐射剂量(剂量长度乘积、有效管球剂量、CT容积剂量指数),分析良恶性SPN的CT征象差异。结果 67枚肺结节中,良性结节11枚,恶性结节56枚。两种CT扫描图像质量主观评分、图像噪声比较,差异均无统计学意义(P﹥0.05)。低剂量CT扫描的剂量长度乘积、有效管球剂量、CT容积剂量指数均明显低于常规剂量CT扫描,差异均有统计学意义(P﹤0.01)。低剂量CT诊断SPN良恶性的准确率、灵敏度、特异度与常规CT比较,差异均无统计学意义(P﹥0.05)。低剂量CT诊断显示,良恶性SPN的混合磨玻璃结节、毛刺征、分叶征、空泡及支气管征、胸膜牵拉征、胸膜凹陷征的比例比较,差异均无统计学意义(P﹥0.05);良性SPN的纯磨玻璃结节、血管集束征的比例分别为9.09%、36.36%,均低于恶性结节的48.21%、75.00%,差异均有统计学意义(P﹤0.05)。结论与常规剂量多层螺旋CT扫描比较,低剂量多层螺旋CT扫描的图像质量可满足临床诊断,且可减少辐射剂量,对直径﹤2.0 cm的恶性SPN检查具有一定的特征性。
Objective To investigate the value of low-dose multi-slice spiral computerized tomography(CT) in the diagnosis of solitary pulmonary nodules(SPN) with diameter<2.0 cm. Method The clinical data of 44 patients(67 nodules) with SPN which with diameter<2.0 cm on imaging and highly suspected as malignant solitary were retrospectively analyzed. All patients underwent routine dose and low-dose CT scanning. The subjective score of image quality of CT,image noise and radiation dose(dose-length product, effective rube dose and CT volume dose index) were compared between the two groups. Differences of CT imaging findings of benign and malignant SPN were analyzed. Result There were 67 small pulmonary nodules in 44 cases, including 11 benign nodules and 56 malignant nodules. There was no statistical difference between the two kinds of CT scanning in subjective score of image quality or image noise(P>0.05). The dose-length product, effective tube dose and CT volume dose index of low-dose CT were significantly lower than those of routine dose CT(P<0.01). The accuracy, sensitivity and specificity of low-dose CT in the diagnosis of benign and malignant SPN were similar to those of routine dose, without statistical difference(P>0.05). Diagnosis of low-dose CT showed that there was no significant difference between benign and malignant SPN in the proportions of mixed ground glass nodules, spicule sign, lobulation sign, vacuoles and bronchial air sign, pleural retraction sign or pleural indentation sign(P>0.05). The proportions of pure ground glass nodules and vessel convergence sign of benign SPN were 9.09% and 36.36%respectively, which were both significantly lower than those of malignant nodules as 48.21% and 75.00%(P<0.05). Con Conclusion Compared with routine dose multi-slice spiral CT, the image quality of low-dose multi-slice CT can meet the clinical diagnosis and reduce the radiation dose. There are certain characteristics of malignant SPN with diameter<2.0 cm.
Objective To investigate the value of low-dose multi-slice spiral computerized tomography(CT) in the diagnosis of solitary pulmonary nodules(SPN) with diameter<2.0 cm. Method The clinical data of 44 patients(67 nodules) with SPN which with diameter<2.0 cm on imaging and highly suspected as malignant solitary were retrospectively analyzed. All patients underwent routine dose and low-dose CT scanning. The subjective score of image quality of CT,image noise and radiation dose(dose-length product, effective rube dose and CT volume dose index) were compared between the two groups. Differences of CT imaging findings of benign and malignant SPN were analyzed. Result There were 67 small pulmonary nodules in 44 cases, including 11 benign nodules and 56 malignant nodules. There was no statistical difference between the two kinds of CT scanning in subjective score of image quality or image noise(P>0.05). The dose-length product, effective tube dose and CT volume dose index of low-dose CT were significantly lower than those of routine dose CT(P<0.01). The accuracy, sensitivity and specificity of low-dose CT in the diagnosis of benign and malignant SPN were similar to those of routine dose, without statistical difference(P>0.05). Diagnosis of low-dose CT showed that there was no significant difference between benign and malignant SPN in the proportions of mixed ground glass nodules, spicule sign, lobulation sign, vacuoles and bronchial air sign, pleural retraction sign or pleural indentation sign(P>0.05). The proportions of pure ground glass nodules and vessel convergence sign of benign SPN were 9.09% and 36.36%respectively, which were both significantly lower than those of malignant nodules as 48.21% and 75.00%(P<0.05). Con Conclusion Compared with routine dose multi-slice spiral CT, the image quality of low-dose multi-slice CT can meet the clinical diagnosis and reduce the radiation dose. There are certain characteristics of malignant SPN with diameter<2.0 cm.
引文
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[12]时国朝,冯耘.美国胸科医师学会最新肺结节诊疗指南解读[J].内科理论与实践,2015,10(6):397-402.
[13]曹捍波,张永奎,王善军,等.肺部混合磨玻璃结节实性成分的CT表现[J].中国医学影像学杂志,2015,23(8):587-590.
[14]喻微,叶波,续力云,等.实性孤立性肺结节诊断模型的建立[J].中国肺癌杂志,2016,19(10):705-710.
[15]杨娟,孙雪丽,赖国祥,等.孤立性肺结节良恶性判别数学模型的建立与验证[J].第二军医大学学报,2015,36(4):407-412.
[2]孙沁莹,白冲.《2015美国预防医学工作组建议:肺癌筛查》解读[J].中国实用内科杂志, 2015, 35(11):931-934.
[3] Henschke CI, Yip R, Smith JP, et al. CT screening for lung cancer:part-solid nodules in baseline and annual repeat rounds[J]. AJR Am J Roentgenol, 2016, 207(6):1176-1184.
[4]宋婷妮,曾勇明.孤立性肺结节影像学检查技术及应用进展[J].重庆医学, 2016, 45(10):1409-1411.
[5]佘晖,方振剑,陈方榕,等.孤立性肺结节患者临床特征分析[J].中国呼吸与危重监护杂志, 2015, 14(4):376-379.
[6]何丽,刘斋,任庆云.健康者低剂量多层螺旋CT呼吸双相段支气管管径的定量研究[J].中国全科医学, 2016, 19(24):2904-2907.
[7]王甜,曹治婷,韩秋丽.低管电压联合低剂量对比剂在肺动脉CT成像中的应用[J].实用医学杂志, 2016, 32(15):2532-2534.
[8]赵江,唐栋.低剂量螺旋CT在肺部结节筛查中的应用价值[J].中华肿瘤防治杂志, 2016, 23(S1):90-91.
[9]陈一鸣,刘阳,任何,等.多层螺旋CT低剂量扫描对慢性阻塞性肺疾病患者复查的诊断价值[J].实用放射学杂志,2016, 32(9):1437-1439.
[10]王丽杰,马继文,王永丽,等.能谱CT鉴别诊断孤立性肺结节或肿块的价值[J].中国临床医学影像杂志, 2017, 28(4):245-249.
[11]叶峰,陈城,张永奎.直径1 cm肺结节CT定性诊断的可行性分析[J].实用放射学杂志,2016,32(5):699-702.
[12]时国朝,冯耘.美国胸科医师学会最新肺结节诊疗指南解读[J].内科理论与实践,2015,10(6):397-402.
[13]曹捍波,张永奎,王善军,等.肺部混合磨玻璃结节实性成分的CT表现[J].中国医学影像学杂志,2015,23(8):587-590.
[14]喻微,叶波,续力云,等.实性孤立性肺结节诊断模型的建立[J].中国肺癌杂志,2016,19(10):705-710.
[15]杨娟,孙雪丽,赖国祥,等.孤立性肺结节良恶性判别数学模型的建立与验证[J].第二军医大学学报,2015,36(4):407-412.