【摘要】 目的 探讨低剂量螺旋电子计算机断层扫描(CT)征象在孤立性肺结节诊断评估中的应用。方法 回顾性纳入2022年1月至2025年1月本院孤立性肺结节145例，所有患者均接受标准、低剂量螺旋CT扫描。比较两种螺旋CT扫描质量主观评分、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)；同时以病理诊断结果为金标准，比较两种螺旋CT扫描鉴别诊断孤立性肺结节良恶性的结果及效能；另外比较良、恶性结节患者不同低剂量螺旋CT征象。结果 以病理诊断结果为金标准，结果显示，145例孤立性肺结节患者检出良性结节69个(良性结节组)；恶性结节76个(恶性结节组)；两种螺旋CT扫描图像噪声、质量主观评分相当(P>0.05)；较标准剂量螺旋CT扫描，低剂量螺旋CT扫描CT容积剂量指数、剂量长度乘积、有效管球剂量更低(P<0.05)；低剂量螺旋CT扫描检查鉴别诊断恶性结节74个(51.03%,74/145)，良性结节71个(48.97%,71/145)；标准剂量螺旋CT扫描检查鉴别诊断恶性结节72个(49.66%,72/145)，良性结节73个(50.34%,73/145)；不同剂量螺旋CT诊断孤立性肺结节良恶性的诊断效能及kappa值比较差异均无统计学意义(P>0.05)；良性结节组纯磨玻璃结节、血管集束征占比均低于恶性结节组(P<0.05)。结论 低剂量螺旋CT在显著降低辐射剂量的同时，可维持与常规CT相当的孤立性肺结节良恶性鉴别准确率，支持低剂量CT用于筛查及随访以减少辐射风险；同时混合磨玻璃结节、血管集束征可作为恶性结节的辅助影像学指标。更多还原

【Abstract】 Objective To investigate the application of low dose spiral computed tomography(CT) in the diagnosis and evaluation of isolated pulmonary nodules. Methods From January 2022 to January 2025, 145 patients with solitary pulmonary nodules were retrospectively included in our hospital. All patients received standard and low-dose spiral CT scan. The subjective score of scan quality, image noise, radiation dose(dose length product, effective tubule dose, CT volume dose index) were compared between the two spiral CT scans. At the same time, pathological diagnosis was used as the gold standard to compare the results and efficacy of two spiral CT scans in the differential diagnosis of benign and malignant solitary pulmonary nodules. In addition, different low-dose spiral CT signs of benign and malignant nodules were compared. Results Pathological diagnosis was used as the gold standard. The results showed that 69 benign nodules were detected in 145 patients with solitary pulmonary nodules(benign nodules group). There were 76 malignant nodules(malignant nodules group). The subjective scores of noise and quality of the two spiral CT images were similar(P>0.05). Compared with standard dose spiral CT scan, CT volume dose index, dose length product and effective tubule dose of low-dose spiral CT scan were lower(P<0.05). There were 74 malignant nodules(51.03%, 74/145) and 71 benign nodules(48.97%, 71/145) by low-dose spiral CT. There were 72 malignant nodules(49.66%, 72/145) and 73 benign nodules(50.34%, 73/145) by standard dose spiral CT. There was no significant difference in the diagnostic efficacy and kappa value of spiral CT in the diagnosis of benign and malignant solitary pulmonary nodules(P>0.05). The proportion of pure ground glass nodule and vascular cluster in benign nodule group was lower than that in malignant nodule group(P<0.05). Conclusion Low-dose spiral CT can significantly reduce the radiation dose and maintain the same accuracy in distinguishing benign and malignant isolated pulmonary nodules as conventional CT, which supports the use of low-dose CT for screening and follow-up to reduce the radiation risk. At the same time, pure ground glass nodules and vascular cluster signs can be used as auxiliary imaging indicators of malignant nodules.更多还原