肺内恶性孤立性小结节的CT征像特征分析与诊断

目的通过对肺内恶性孤立性小结节CT影像特征的分析,不断提高CT对恶性孤立性肺结节的检出率。方法全面、系统地回顾、分析134例肺内孤立性小结节患者的临床资料。结果 134例肺内孤立性小结节患者中,病检恶性80例(59.70%);病检和CT均诊断为恶性者78例,CT与病检符合率为97.5%,病检确诊为恶性而CT征像不支持者2例(2.50%),CT诊断为恶性,而首次病检不支持,再次病检支持者1例(1.25%);81例结节≥2.0 cm者,恶性75例(92.59%);53例结节2 cm者,恶性3例(5.66%);右肺结节恶性率为73.21%,明显高于左肺的43.59%(P0.05);恶性结节CT影像表现中胸膜凹陷征、引流线征、血管集束征、毛刺征、棘突征、分叶征、空泡和细支气管充气征,征像所占比例明显高于良性结节(P0.05);85.90%的恶性结节病例表现为3种以上基本影像征像并存。结论肺内孤立性结节恶性率高,其发病的部位和影像表现均具有其一定的特征性,CT诊断具有较高的检出率,在CT诊断过程中,要紧紧围绕结节的部位和影像征像进行仔细分析鉴别,对一时难以定论的结节要积极开展动态观察,以提高恶性孤立性肺结节的检出率,减少误诊和漏诊。

Analysis and diagnosis of CT syndrome characteristics of solitary pulmonary nodules

Objective To improve the detection rate of CT in malignant solitary pulmonary nodules by analy-zing the CT image features of small solitary pulmonary nodules.Methods The clinical data of 134 cases of small solitary pulmonary nodules were reviewed and analyzed comprehensively and systematically.Results 80 cases were pathologically malignant (59.70%),and 78 cases were malignant by pathological examination and CT.The coinci-dence of CT and pathological was 97.5%.There were 2 malignant cases by pathological diagnosis without CT support (2.50%)and 1 malignant case by CT diagnosis without pathological examination (1.25%).There were 75 malig-nant cases in 81 cases of nodes larger than 2 cm and 3 malignant cases in 53 cases of nodes less than 2 cm (5.66%).The rate of malignant right pulmonary nodules was 73.21%,which was significantly higher than that of left lung (43.59%)(P <0.05).The CT manifestations of malignant nodes included pleural indentation,drainage line sign,vascular convergence sign,spinous process,glitch syndrome,lobulation,cavitation and air bronchogram sign.85.90% cases of malignant nodules showed more than 3 kinds of basic image sign.Conclusion The malig-nant rate of solitary pulmonary nodules is high,the location and imaging features of the disease have a certain charac-teristic,and CT has a high detection rate.In the process of CT diagnosis,it should be closely around the nodules.