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形态学特征评分联 合能谱CT参数诊断 孤立性肺结节的临 床研究

作者:练 伟 姚立正 梁志鹏 颜利辉 李 新 李运健

所属单位:东南大学医学院附属盐城医院影像 科 (江苏 盐城 224001)

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摘要

目的 研究形态学特征评分联合 能谱CT参数对孤立性肺结节(SPN)的诊断 价值。方法 以我院2014年6月~2015年7 月经病理结果证实的46例SPN患者为研究 对象,根据病理结果将其分为恶性结节组 与良性结节组,所有患者均接受能谱CT检 查,经专业工作站分析图像并显示肺结节 形态学特征,同时对病灶行能谱分析,有 效结合其形态学特征及能谱参数,评价诊 断敏感度、特异度及准确度。结果 恶性 结节组形态学特征主观评分、综合评分分 别为(4.23±0.12)分、(4.14±0.21)分, 分别显著高于良性结节组的(2.07±0.21) 分、(2.41±0.22)分,差异有统计学意义 (P<0.001)。形态学特征评分结合能谱分 析结果:方案一对SPN诊断敏感度、特异 度、准确度分别为98.4%/91.7%/96.0%, 方案二敏感度、特异度、准确度分别为 96.9%、88.9%、94.0%,方案三敏感度、 特异度、准确度分别为92.2%、80.6%、 88.0%。结论 形态学特征评分联合能谱CT 参数诊断SPN有重要价值,敏感度、特异 度及准确度均较高。

Objective To study the diagnostic value of morphological feature score combined with energy spectrum parameters CT in solitary pulmonary nodules (SPN). Methods 46 patients with SPN confirmed by pathological findings in the hospital during February 2013 to May 2015 were treated as the research objects. According to the pathological findings, the patients were divided into the malignant nodule group and the benign nodule group. All patients underwent CT examination. The images were analyzed by professional workstation and the morphological features of pulmonary nodules were displayed. Meanwhile, the energy spectrum analysis was performed on the energy spectrum browser. The morphological features and energy spectrum parameters were effectively combined to evaluate the sensitivity, specificity and accuracy. Results The subjective score of morphological features and comprehensive score of the malignant nodule group were (4.23±0.12) and (4.14±0.21) points which were significantly higher than(2.07±0.21) and (2.41±0.22) points of the benign nodule group, respectively. The differences were statistically significant (P<0.001). The results of morphological feature score combined with energy spectrum analysis showed that the sensitivity, specificity and accuracy of scheme one in the diagnosis of APN were 98.4%, 91.7% and 96.0%, respectively while those of scheme two were 96.9%, 88.9% and 94.0%, respectively and of scheme three were 92.2%, 80.6% and 88.0% respectively. Conclusion Morphological feature score combined with energy spectrum CT parameters is of significant value in the diagnosis of APN and the sensitivity, specificity and accuracy are relatively high.

【关键词】形态学特征;CT;能谱参数;      孤立性肺结节

【中图分类号】R445.3;R734.2

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.11.019

前言

孤立性肺结节(solitary pulmonary nodules, SPN)具有病灶直径 小(通常3cm及以下)、无钙化或空洞变化、无淋巴结肿大等特点,病灶 单一且隐匿[1],临床影像学诊断缺乏特异性,通常结节直径越小,影 像学诊断越难发现。目前临床诊断SPN常见影像学方法为CT,常规CT检 查虽能准确区别肿块及血管,但对微小病灶或不明显强化难以区别, 在良恶性病灶判断中有一定的难度[2]。宝石能谱CT具有单能量成像、 物质分离双重作用,对肺结节血液供应等情况可清晰显示。另外,临 床发现肺结节不同病灶能谱参数、形态学特征各异,均有利于肺结节 定性诊断,基于此,本研究将形态学特评分与能谱CT参数结合用于SPN 诊断,重点观察其对SPN良恶性的诊断价值,报告如下。