多探测器计算机断层仪动态增强扫描对孤立性肺部肿块诊断价值.docVIP

多探测器计算机断层仪动态增强扫描对孤立性肺部肿块诊断价值 　 作者：陈韵彬, 蔡林峰, 林孔起, 林春浩 【摘要】 目的 比较良性和恶性孤立性肺部结节或肿块多探测器计算机断层动态增强扫描(MDCTDE)的特点。 方法 对98例直径lt;4 cm的肺部肿块患者行MDCTDE扫描;92例病理诊断,6例临床随访gt;1年诊断为良性。平扫后,以4 mL/s的速度静脉注入对比剂进行动态增强扫描,连续扫描45 s后,每20 s扫描一次至205 s。测量平扫CT值、强化峰值、到达峰值时间、净强化值、最大相对强化率及强化斜率。 结果 肺癌的到达峰值时间(35.95±3.18)s短于肺部良性病变［(80.31±47.95)s,Plt;0.01］;肺癌的净强化值(38.00±15.52)Hu小于肺部良性病变［(44.92±10.37)Hu,Plt;0.05］。将到达峰值时间43 s定为诊断肺癌的阈值,其敏感性100%,特异性80.77%,阴性预测值100%,阳性预测值93.51%,准确率94.90%。 结论 MDCTDE扫描对肺部孤立性肿块的定性诊断有一定的价值。 【关键词】 体层摄影术,X线计算机; 肺肿瘤; 诊断 ABSTRACT: Objective To compare characteristics of malignant and benign pulmonary nodules or masses with multiple detectors computed tomography dynamic enhanced(MDCTDE) scan. Methods Ninety-eight patient with solitary pulmonary masses(diameter 1~4 cm) were enrolled. Pathologic diagnosis were made in 92 lesions and follow-up images showed benignancy in 6 lesions. After unenhanced CT scans were obtained, MDCTDE were performed after intravenous injection of contrast with a rate of 4 mL/s, successive scan for 45 s, subsequently scan at 65, 85, 105, 125, 145, 165, 185 and 205 s. Results The time to peak enhancement of lung cancer (35.95±3.18)s was shorter than benign leisions(80.31±47.95)s (Plt;0.01). The net enhancement (38.00±15.52)Hu and the maximum relative enhancement ratio (average 0.96) of lung cancer were smaller than benign masses ［average (44.92±10.37)Hu and 1.212 Hu, Plt;0.01］. When 43 s of time to peak enhancement as a cutoff value in differentiation malignant and benign masses, sensitivity for malignant masses was 100%, specificity was 80.77%, negative predictive value was 100%, positive predictive value is 93.51% and accuracy was 94.90%. Conclusion Dynamic enhanced MDCT is valuable in the diagnosis of solitary pulmonary nodule or masses. KEY WORDS: tomography, X-ray computed; lung neoplasm; diagnosis 孤立肺部结节的定性诊断仍然是胸部影像学的研究热点,良性和恶性病变之间的形态学征象有较多的重叠,仅有形态信息是不足的,研究孤立肺部病灶的强化特点、获得的功能信息,能够提高诊断的准确性。笔者2003年1月―2007年3月,连续对152例孤立肺部肿块患者行多探测器计算机断层动态增强扫描(multiple detector