摘要
目的探讨多层螺旋CT灌注扫描对孤立性肺结节(SPN)的诊断价值,从而加强SPN良恶性的鉴别区分,提高定性诊断水平。方法选取笔者收集的经病理证实的SPN患者160例作为研究对象,对其临床资料进行回顾性分析。采用常规16排螺旋CT机对患者行灌注扫描,应用GE ADW 4.3工作站的后处理技术及Perfusion3-body tumor软件对结节进行分析,对所获得的SPN的CT灌注的血流量(BF)、血容量(BV)、平均通过时间(MTT)及表面通透性(PS)等参数进行统计分析,并分析不同检查方法对诊断SPN的效能是否存在差异。结果恶性SPN和炎性SPN的BF、BV和PS值均明显高于良性SPN,良性组与恶性组SPN的BV(P=0.000)、BF(P=0.000)及PS(P=0.000)差异有统计学意义;良性组与炎性组SPN的BV(P=0.027)、BF(P=0.000)及PS(P=0.001)差异有统计学意义,恶性与炎性SPN各项灌注参数差异均无统计学意义(P>0.05)。以BV≥5ml/100g为恶性SPN诊断阈值,其敏感度、特异性、阳性预测值、阴性预测值分别为86.4%、72.2%、79.2%、81.3%。设PS≥15ml/(min·100g)为诊断恶性阈值,其敏感度、特异性、阳性预测值、阴性预测值分别为90.9%、66.7%、80.0%、85.7%。设BV≥5ml/100g且PS≥15ml/(min·100g)为诊断恶性阈值,其敏感度、特异性、阳性预测值、阴性预测值分别为95.5%、72.2%、80.8%、92.9%。结论 CT灌注成像对良恶性SPN的鉴别具有较高诊断价值,但对良恶性的鉴别缺乏特异性。设定BV≥5ml/100g且PS≥15ml/(min·100g)为诊断恶性阈值时,其诊断恶性SPN的敏感度、特异性及阳性预测值均高于设定单个参数的诊断效能。
Objective To investigate the diagnostic value of multi -slice spiral CT perfusion scanning for SPN , and to strengthen the SPN differential diagnosis of benign and malignant distinguish , then to improve the diagnosis level .Methods One hundred and sixty cases of SPN patients were involved as the research object , and the clinical data were retrospectively analyzed .The 16 row spiral CT for patients underwent plain ＋dynamic enhanced scan ＋perfusion scan.The blood flow in nodules was analyze ,using GE ADW 4.3 work-station for post -processing technology and Perfusion 3 -body tumor software .CT perfusion on acquired SPN′s （ BF ） , blood volume （BV）, the mean through time （MTT）and permeability surface （PS） were analyzed, and whether there were differences between the ef-fectiveness of different examination methods for the diagnosis of SPN was analyzed .Results BF, BV and PS values in Malignant nodules and inflammatory nodules were significantly higher than that of benign nodules .BV （P=0.000）, BF （P=0.000） and PS （P=0.000） between the benign group and the malignant group had statistical significance .BV （P=0.027）, BF （P=0.000） and PS （P=0.001） between the benign and inflammatory group had statistical significance .There was no significant difference between malignant nodules and inflammatory nodules perfusion value （P〉0.05）.With BV≥5ml/100g for diagnosis of malignant SPN threshold , the sensitivity, speci-ficity, positive predictive value, and negative predictive values were 87.5% （21/24）, 72.2% （13/18）, 80.7% （21/26）, 81.3%（13/16）.PS =15ml/（min· 100g） for the diagnosis of malignant threshold , the sensitivity, specificity, positive predictive value, and negative predictive values were 91.8%（22/24）, 66.7%（12/18）, 78.6%（22/29）, 85.7%（12/14）.BV was more than or equal to 5ml/100g and PS =15ml/（min· 100g） for the diagnosis of malignant threshold, the sensitivity, specificity, positive predictive value, and negative predictive values were 95.8%（23/24）, 83.3% （15/18）, 88.5% （23/26）, 93.8% （15/16）.Conclusion It is of high value in differentiating CT perfusion imaging of benign and malignant SPN , with BV greater than 5ml/100g and PS =15ml/（min· 100g） for the diagnosis of malignant threshold .The positive predictive value of SPN for diagnosis of malignant in 88.5%, but the differen-tial diagnosis of malignant and inflammatory SPN lackes of specificity .
出处
《医学研究杂志》
2015年第10期76-79,共4页
Journal of Medical Research
基金
河南省教育厅2011年度自然科学研究计划项目(2011A340002)
