目的评价多层螺旋CT胸部健康 体检图像对肺部以外病变的诊断价值。方 法 回顾性分析1866例徐州医科大学及徐 州医科大学附属医院在职及离退休职工胸 部健康体检人员，由两名放射科医师按 肺部以外病变所发生的部位对病变进行 统计。对肺部以外病变的行临床意义评 分：1分：没有临床意义，即不需要进一 步检查或随访的病变；2分：需要临床重 视，即需要进一步检查明确诊断或随访 的病变；3分：可能危及患者生命，即需 临床采取积极有效治理措施的病变。不 相关的病变(如颈椎、胸椎退行性改变) 未纳入统计。1分被认为无临床意义组， 2分、3分被认为有临床意义组。结果 在 1856例体检人员中，发现660例(33.6%)有 941个肺部以外病变。17.9%(118/660)患 者有多部位病变，其中5.8%(55/941)发生 于乳腺，41.6%(391/941)发生于纵隔， 2.0%(19/941)发生于骨，6.6%(62/941) 发生于甲状腺，44.0%(414/941)是腹 部。在腹部病变中，肝囊肿、肝内钙 化灶、脂肪肝、胆囊结石、肾上腺结 节发生率分别为47.3%(196/414)、 25.6%(106/414)、19.1%(79/414)、 6.3%(26/414)、2.2%(9/414)。临床意义 评价结果，1、2、3分病变的发生率分 别为8.5%(36/941)、81.15(344/941)和 10.4%(44/941)。结论 多层螺旋CT胸部健 康体检中图像具有重要的临床诊断价值， 可提示对临床有重要价值的肺部以外病 变。观察源图像时调节不同窗宽窗位对肺 部以外病变的检出具有重要意义。

Objective To assess the clinical value of multi-detector computed tomography(MDCT) source image on detecting extrapulmonary abnormalities in a large cohort of physical examination patients. Methods MDCT source images from 1866 consecutive physical examination patients(mean 51.2 years) were reviewed retrospectively by 2 readers. Extra-pulmonary findings were classified according to involved organ and level of clinical significance. Clinical relevance of extracoronary findings was considered as either "non-significant" or "significant". "Non-significant" findings were subclassified as score 1: findings without clinical implication findings necessitating immediate therapeutic actions. "Significant" findings were assigned to score 2: findings with uncertain clinical or prognostic relevance, requiring clinical awareness, follow-up or further investigations(non-urgent), or score 3: findings necessitating immediate therapeutic actions. The irrelevant incidental findings (C-spinal or T-spinal degenerative changes) were not analyzed. Results Extrapulmonary findings was evidenced in 660 patients with 941 abnormalities. 17.9%(118/660) patients had multiple lesions, 5.8%(55/941) lesions were located in the breast, 44.0%(414/941)lesions found in the upper abdomen, 41.6%(391/941)lesions evidenced in the mediastinum, 2.0%(19/941)lesions seen in the spine, 6.6%(62/941)lesions located in the thyroid. The clinical significance score 1-3 was 8.5%(36/941), 81.1%(344/941) and 10.4%(44/941) respectively. Conclusion Our data show that there is clinical value to observe and report extrapulmonary findings with source image of pulmonary MDCT.