HRCT上界面影像在肺内孤立性结节鉴别诊断中的意义

目的:探讨高分辨率CT(HRCT)上界面影像在肺内孤立性结节(SPN)鉴别诊断中的意义。方法:回顾性分析98例SPN的界面影像表现,其中经手术病理证实的85例,经抗炎治疗后病变消失的6例,诊断为良性肿瘤随访2年以上病变无变化的7例。所有病例均具常规螺旋CT(SCT)及HRCT资料。结果:良恶性结节界面模糊出现率分别为31%(13/42)和12.5%(7/56)(P<0.05);界面清楚分别为61.9%(26/42)和78.6%(44/56)(P>0.05);光滑锐利分别为26.2%(11/42)和1.8%(1/56)(P<0.001);细短毛刺分别为23.8%(10/42)和57.1%(32/56)(P<0.001);粗长毛刺出现率分别为23.8%(10/42)和8.9%(5/56)(P<0.05);索条征分别为19%(8/42)和3.8%(2/56)(P<0.05);锯齿征9例全部为恶性结节。结论:界面影像在不同性质的SPN中出现率不同,具有重要的鉴别诊断意义,HRCT有助于显示这些征象,应列为SPN的常规检查手段。

The value of interface imaging on HRCT in differentiating of solitary pulmonary nodules

Objective:To evaluate the value of interface findings in differentiating of solitary pulmonary nodules (SPN).Methods:Spiral CT(SCT) and high resolution CT(HRCT) findings of the interface in 98 SPN with pathologically-proved (n=85),diagnostic inflammatory therapy(n=6) or a flow-up observation over two years(n=7) were retrospectively analyzed.Results:Cloudy sign appeared in 31%(13/42)benignancy nodules and 12.5%(7/56)malignancy nodules(P<0.05).Well-defined sign appeared in 61.9%(26/42)benignancy nodules and 78.6%(44/56)malignancy nodules (P>0.05).Sharp margin appeared in 26.2%(11/42)benignancy nodules and 1.8%(1/56)malignancy nodule(P<0.001).Fine-short spiculated appeared in 23.8%(10/42)benignancy nodules and 57.1%(32/56)malignancy nodules(P<0.001).Long spiculated appeared in 23.8%(10/42)benignancy nodules and 8.9%(5/56)malignancy nodules(P<0.05).Thickened stripes appeared in 19%(8/42) benignancy nodules and 3.8%(2/56)malignancy nodules(P<0.05).Serrated sign appeared in malignancy nodules only (n=9).Conclusion:Interface imaging was useful and pivotal in improving accuracy of diagnosis and differential diagnosis of SPN.