Multi-slice spiral CT enhancement examination in the diagnosis and differential diagnosis of peripheral lung cancer
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摘要:
目的 探讨多排螺旋CT增强检查在周围型肺癌诊断及鉴别诊断中的意义。 方法 选择65例肺癌患者为病例组，分析并比较肺癌组CT平扫+增强检查的边缘和内容征象以及CT值的变化，探讨CT增强扫描对于平扫检查的意义；选择32例肺结核患者为对照组，测量病灶的CT强化峰值（最大强化CT值的平均值），计算强化增值（最大强化CT值-平扫CT值）及SPH/PPH（病灶强化峰值与主动脉强化CT值的比），分析并比较他们的CT值在增强检查前后的变化，探讨CT增强检查对周围性肺癌的鉴别诊断价值。 结果 在肺癌组CT平扫+增强对比中，短毛刺征征与高密度点条征同层面比较差异有统计学意义（P<0.01）；周围型肺癌CT平扫+增强检查的诊断准确度比较中，CT平扫的灵敏度、特异度、诊断指数及准确率均低于增强检查，其中CT增强检查诊断指数>150%，有诊断意义。肺癌与肺结核平扫CT值比较差异无统计学意义（P>0.05）。肺癌与肺结核增强比较，强化峰值分别是60.35±21.56、40.09±14.41，强化增值分别是41.03±13.72、12.42±15.04，SPH/PPH分别是（22.01±1.93）%、（4.53±1.08）%，t分别是20.71、18.47、3.78，差异有统计学意义（P<0.05）。 结论 与平扫相比，CT增强检查能够显著提高肺癌的诊断准确率，且增强检查在肺癌与肺结核的诊断及鉴别诊断中有一定临床意义。 Abstract:Objective To explore the significance of multi-slice spiral CT enhancement examination in the diagnosis and differential diagnosis of peripheral lung cancer. Methods Sixty-five patients with lung cancer were selected as the case group and received CT plain and contrast-enhanced scan. The edge and content signs of CT findings and CT value changes were analyzed and compared, and the significance of CT contrast-enhanced scan for CT plain scan was investigated. 32 patients with pulmonary tuberculosis were selected as the control group and underwent the same examinations. The CT enhanced peak of the lesions (the mean value of the maximum CT value) was measured, and the CT enhanced increment (maximum enhanced CT value - flat scan CT value) and the SPH/PPH (the ratio of the focal point of the lesion and that of the aortic enhanced CT) were calculated. The CT value variations of aforementioned factors before and after the enhancement were analyzed and compared. Results IIn the CT plain and contrast-enhanced scan of the lung cancer group, there were significant differences between short spicule signs and high-density points (P<0.01). in the comparison of the diagnosis accuracy of peripheral lung cancer CT scan and contrast-enhanced examination, the sensitivity, specificity, diagnostic index and accuracy of CT scan were lower than that of enhanced inspection, among which the CT enhanced screening diagnostic index was over 150%, thus having certain diagnostic significance. There was no significant difference in CT scan between lung cancer and tuberculosis (P>0.05). In the comparison of the enhanced CT examination findings of lung cancer and tuberculosis, the peaks of enhancement were 60.35±21.56 and 40.09±14.41, and the increments of enhancement were 41.03±13.72 and 12.42±15.04, the SPH/PPH were 22.01±1.93% and 4.53±1.08%, and thet values were 20.71, 18.47, and 3.78, all of which have statistical significance (P=0.000). Conclusion Compared to the CT plain scan, the CT contrast-enhanced scan can significantly improve the diagnostic accuracy of lung cancer; therefore, it has clinical significance in the diagnosis and differential diagnosis of lung cancer and tuberculosis. -
表 1 肺癌组CT平扫+增强扫描边缘征象比较
征象 平扫 增强 χ2 P 高密度点条征 0 35 47.895 0.000 无高密度点条征 65 30 短毛刺征 43 8 39.526 0.000 无短毛刺征 22 57 
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表 2 周围型肺癌CT平扫与增强检查准确度四格表
CT增强 病理结果 合计 CT平扫 病理结果 合计 阳性 阴性 阳性 阴性 阳性 58 4 62 阳性 45 11 56 阴性 7 28 35 阴性 20 21 41 合计 65 32 97 合计 65 32 97
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表 3 周围型肺癌CT平扫与增强检查诊断准确度比较（n=65，%）
CT 灵敏度 特异度 诊断指数 准确率 平扫 69.2（45/65） 65.6（21/32） 134.8 68.1 增强 89.2（58/65）# 87.5（28/32）# 176.7*# 88.6# *诊断指数>150%, 诊断效能大;#P<0.05vs 平扫.
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表 4 两组病灶平扫CT值、强化峰值及强化增值的比较（Mean±SD）
肺内病灶 例数（n） 平扫CT值（Hu） 强化峰值（Hu） 强化增值（Hu） SPH/PPH（%） 肺癌 65 32.02±13.21 60.35±21.56 41.03±13.72 22.01±1.93 肺结核 32 28.54±14.26 40.09±14.41 12.42±15.04 4.53±1.08 t - 1.35 20.71 18.47 3.78 P - 0.181 0.000 0.000 0.000 SPH/PPH: 病灶强化峰值与同层主动脉强化CT值的比.
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