摘要
目的:对比分析低浓度对比剂结合低剂量宝石CT灌注及增强成像在孤立性肺结节(SPN)良恶性鉴别诊断中的应用价值。方法:对46例孤立性肺结节患者行宝石CT低剂量增强加灌注扫描,其中恶性34例(A组),良性12例(B组)。比较两组结节血流量(BF)、血容量(BV)、平均通过时间(MTT)、表面通透性(PS)以及增强前后的结节强化值、结节-主动脉强化值比(S/A)的差异。结果:良、恶性SPN的BV值及PS值的差异均有统计学意义(P值分别为0.009和0.003),BF值及MTT值的差异无统计学意义(P值分别为0.889和0.149);以BV≥7ml/100g联合PS≥7ml/100g/min较单独以BV或PS作为诊断恶性结节的阈值时的敏感性、特异性、阳性预测值、阴性预测值和诊断符合率均增高,分别为96.6%、64.7%、82.4%、91.7%、84.8%。良、恶性SPN的结节强化值及结节-主动脉强化值比的差异有统计学意义(t值分别为0.004和0.022);以结节强化值≥15HU、结节-动脉强化值比≥10%作为恶性结节的诊断阈值,灵敏度、特异度、阳性预测值、阴性预测值依次为94.1%、91.7%、96.97%和84.6%。结论:以PS≥7ml/100g/min联合结节强化值≥15HU、结节-动脉强化值比≥10%作为恶性结节诊断阈值时,有利于SPN良、恶性的鉴别,在CT灌注及增强成像诊断恶性SPN的准确性相近时,应选择诊断敏感度较高的BV值。
Purpose： To compare the diagnostic value of Low-dose CT perfusion with dynamic contrast- enhanced imaging of solitary pulmonary nodule. Methods： All 46 patients with solitary pulmonary nodule underwent perfusion imaging and contrast-enhanced imaging using a 64-slice spiral CT scanner. There were 34 malignant nodules and 12 benign nodules. The parameters of CT perfusion imaging were analyzed, including blood volume （BV）, blood flow （BF）, mean transit time （MTT）, and permeability surface （PS）; the CT values of the nodules before and after contrast enhancement, enhancement value and nodule-to-aorta enhanced ratio were measured. Results： The values of BV and PS were higher in malignant nodules than that in benign nodules, which were with significant differences （P=0.009 and P=0.003）; while the values of BF and MTT were with no significant differences （P=0.889and P=0.149）. Combined BV≥7 mI/100g with PS≥7ml/lOOg/min as the threshold value for the diagnosis of malignant nodules, the sensitivity, specificity,positive predictive value, negative predictive value, and the diagnosis coincidence rate was 96.6%, 64.7%, 82.4%, 91.7%, 84.8%. The value of nodular enhancement and nodule-to-aorta enhanced ratio in malignant nodule was higher than that in benign nodule, and there was significant difference between malignant and benign nodules （P =0.004 and P=0.022）. Use the value of nodular enhancement ≥ISHU, nodule-to- aorta enhanced ratio ≥10 % as the threshold value for the diagnosis of malignant nodules, the sensitivity, specificity, positive predictive value, and negative predictive value was 94.1%, 91.7%, 96.97% and 84.6%. Conclusion： Combine PS≥7ml/100g/min with the value of nodular enhancement ≥15HU, nodule-to-aorta enhanced ratio ≥10 % is helpful for the diagnosis of benign and malignant solitary pulmonary nodules.
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2015年第1期30-33,共4页
Chinese Computed Medical Imaging
基金
河南省杰出人才基金项目No.14420051008~~
