【摘要】 目的探讨多层螺旋CT(MSCT)征象对肺内孤立性结节(slitary pulmonary nodule,SPN)良恶性的鉴别诊断价值。方法回顾性分析经病理证实或临床随访确诊的69例SPN患者的CT表现,使用卡方检验对不同CT征象在良恶性SPN中的发生率进行比较,计算具有统计学意义的单一征象及组合征象的敏感性、特异性、阳性预测值及阴性预测值;判断单一征象和组合征象的诊断效能是否存在差异。结果 69例SPN包括45例恶性结节和24例良性结节,预测恶性结节前4位的单一CT征象依次为分叶征、毛刺征、胸膜凹陷征和血管集束征,均高于在良性结节的发生率(P<0.05),其中诊断效能前三位的征象,其敏感性、特异性、准确性、阳性预测值及阴性预测值分别为:分叶征:88.9%、79.2%、85.5%、88.9%、79.2%,毛刺征:68.9%、70.8%、69.6%、81.6%、54.8%,胸膜凹陷征:64.4%、70.8%、66.7%、80.6%、51.5%。组合CT征象的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为:分叶征+毛刺征:64.4%、91.7%、73.9%、93.5%、57.9%,分叶征+胸膜凹陷征:60.0%、91.7%、71.0%、93.1%、55.0%。毛刺征+胸膜凹陷征:44.4%、83.3%、58.0%、83.3%、44.4%。分叶征+毛刺征+胸膜凹陷征:44.4%、100%、63.8%、100%、50.0%。结论MSCT能够清晰显示SPN的形态特征。分叶征、毛刺征、胸膜凹陷征和血管集束征是鉴别SPN良恶性的重要CT征象。单一征象诊断效能高,但是随着组合征象增多,可进一步提高鉴别诊断的阳性预测值和特异性。更多还原

【Abstract】 Objective To study the value of multislice spiral CT( MSCT) in differentiating benign and malignant solitary pulmonary nodules( SPN). Methods Retrospective analysis was made on the MSCT features of 69 cases of SPN confirmed by surgery,pathology or clinical follow-up( 45 cases of malignant nodules and 24 cases of benign nodules). Chi-square test was performed to compare the incidence of different CT features in benign and malignant SPN. It calculated statistically significant single signs and combination signs of sensitivity,specificity,positive predictive value and negative predictive value to evaluate its diagnostic value. Results 69 cases of SPN underwent CT scan,including 45 malignant cases and 24 benign cases. The top 4 CT signs predicting malignant nodules were lobulation,spiculation,pleural indentation,and vessel convergence,which had higher incidence in malignant nodules than in benign nodules( P < 0. 05). The sensitivity,specificity,accuracy,positive predictive value and negative predictive value respectively were 88. 9%,79. 2%,85. 5%,88. 9%,79. 2% for lobulation,68. 9%,70. 8%,69. 6%,81. 6%,54. 8% for spiculation,and 64. 4%,70. 8%,66. 7%,80. 6% and 51. 5% for pleural indentation. The sensitivity,specificity,accuracy,positive predictive value and negative value of combined signs respectively were 64. 4%,91. 7%,73. 9%,93. 5%,57. 9% for lobulation and spiculation,60. 0%,91. 7%,71. 0%,93. 1%,55. 0% for lobulation and pleural indentation,44. 4%,83. 3%,58. 0%,83. 3%,44. 4% for spiculation and pleural indentation,and 44. 4%,100%,63. 8%,100% and 50. 0% for lobulation + spiculation + pleural indentation. Conclusion Morphological features of SPN could be clearly shown by MSCT. Lobulation,spiculation,pleural indentation,and vessel convergence are important CT signs in differentiating benign from malignant. Single sign diagnosis efficiency is high,but the combined signs could further improve the reliability of the diagnosis malignant and the positive predictive value and specificity.更多还原