| 阮俊峰,吴 芳,饶钦盼,等.高分辨率CT靶向增强扫描对肺磨玻璃小结节良恶性的鉴别诊断价值[J].肿瘤学杂志,2024,30(9):727-732. |
| 高分辨率CT靶向增强扫描对肺磨玻璃小结节良恶性的鉴别诊断价值 |
| High Resolution CT Targeted Contrast-Enhanced Scan in Diffe-rential Diagnosis of Benign and Malignant Pulmonary Small Ground-Glass Nodules |
| 投稿时间：2024-06-11 |
| DOI：10.11735/j.issn.1671-170X.2024.09.B003 |
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| 中文关键词: 肺 磨玻璃结节 计算机体层成像 高分辨率 鉴别诊断 |
| 英文关键词:pulmonary ground glass nodules computed tomography high resolution differential diagnosis |
| 基金项目:浙江省中医药科技计划项目（2020ZB117） |
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| 中文摘要: |
| 摘 要：［目的］ 探讨高分辨率CT（high resolution computed tomography，HRCT）靶向增强扫描对于肺磨玻璃小结节（6 mm≤最大径≤10 mm）良恶性的鉴别诊断价值。［方法］ 回顾性分析浙江中医药大学附属第二医院自2018年1月至2023年6月收治的经常规CT检查发现肺磨玻璃小结节患者89例，行HRCT靶向增强扫描检查。根据手术、穿刺或随访结果分成良性组（n=47例）和恶性组（n=42例），评估每个病灶的影像特征，通过单因素及多因素 Logistic 回归分析确定恶性结节的独立预测因素，并构建预测模型；采用受试者工作特征（receiver operating characteristic，ROC）曲线和曲线下面积（area under the curve，AUC）评估诊断效能。两名医师现场阅片，通过 Kappa 检验分析医师诊断结果与术后病理结果的一致性。 ［结果］ 多因素Logistic分析显示，血管集束征和内部血管增粗为恶性肺磨玻璃小结节的独立预测因素。联合上述特征构建预测模型用于鉴别良恶性肺磨玻璃小结节的AUC为0.868（95%CI：0.794~0.942），灵敏度为80.1%（95%CI：65.2%~91.7%），特异度为91.5% （95%CI：79.6%~97.6%）。对照病理结果，住院医生的常规CT诊断肺磨玻璃小结节的Kappa值为0.63，HRCT靶向增强扫描的Kappa值为0.72；主治医师的常规CT和HRCT靶向增强扫描的Kappa值分别为0.72和0.82。［结论］ HRCT靶向增强扫描有利于对肺磨玻璃小结节的良恶性鉴别诊断，指导临床决策，减少不必要的随访。 |
| 英文摘要: |
| Abstract： ［Objective］ To evaluate the application of high resolution CT (HRCT) targeted contrast-enhanced scan in differential diagnosis of benign and malignant pulmonary ground-glass nodules (6 mm≤maximum diameter≤ 10 mm). ［Methods］ Eighty nine patients with pulmonary ground-glass nodules found by routine CT scan who underwent HRCT targeted enhanced scanning from January 2018 to June 2023 were enrolled in the study. Based on surgical pathology， puncture biopsy or follow-up， the nodules were confirmed as benign in 47 cases and malignant in 42 cases. The imaging features of each lesion were evaluated. The independent predictors of malignant nodules were determined by univariate and multivariate Logistic regression analysis. The value of HRCT in differentiating between benign and malignant nodules was analyzed by receiver operating characteristic (ROC) curve and area under the curve (AUC). The Kappa test was used to analyze the consistency between imaging and pathological results. ［Results］ Multivariate Logistic analysis showed that vascular convergence sign and internal vascular thickening were independent predictors of malignant pulmonary small ground-glass nodules. The AUC of the combination of above signs for diagnosing benign and malignant pulmonary nodules was 0.868 (95%CI： 0.794~0.942) with a sensitivity of 80.1% (95%CI： 65.2%~91.7%)， and specificity of 91.5% (95%CI： 79.6%~97.6%). Compared with the pathological results of 50 cases， the Kappa value of conventional CT and HRCT read by a resident doctor was 0.63 and 0.72， and the Kappa value of conventional CT and HRCT read by a senior doctor was 0.72 and 0.82， respectively. ［Conclusion] Targeted enhanced HRCT scan can be conducive to differentiating benign from malignant pulmonary small ground glass nodules， to guide clinical decision and reduce unnecessary follow-up. |
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