CT动态增强与三维血管重建对孤立性肺结节的定性诊断价值

目的 评价CT动态增强与三维血管重建对孤立性肺结节的定性诊断价值.方法 对26例肺部孤立性结节患者,采用动态增强扫描,计算病灶最大CT净增值,绘制时间-密度曲线,并利用随机工作站,行肺结节的三维血管重建.根据肺结节增强后的最大CT净增值、时间-密度曲线及其周围的血管特征,对病变进行定性分析.结果 (1)孤立性肺结节动态增强、三维血管重建对病变定性诊断的敏感性、特异性及准确性无显著性差异(P＞0.05).(2)孤立性肺结节动态增强和三维血管重建相结合,其定性诊断的敏感性、特异性、准确性分别为89%、71%、84%.结论 动态CT增强与三维血管重建相结合可明显提高对孤立性肺结节诊断的准确性.     

螺旋CT靶扫描与三期增强扫描联合应用对肺结节的诊断及临床应用价值

目的 探讨靶扫描与三期增强联合应用对肺结节的定性诊断价值.方法 搜集55例肺结节性病变患者,在常规扫描基础上,先行螺旋CT靶扫描,然后依据血流动力学特点,进行三期增强扫描,根据靶扫描肺结节形态学特点、增强后的最大CT净增值,对病变进行定性分析.结果 肺结节靶扫描、三期增强扫描对病变定性诊断的敏感性、特异性、准确性均无显著性差异(P>0.05);靶扫描与三期增强扫描相结合,对肺结节定性诊断的敏感度、特异度和诊断符合率分别为97.3%、83.3%和80.6%.结论 靶扫描与三期增强扫描联合应用可明显提高诊断的敏感性和准确性.     

SSD血管成像在肺结节性病变中的应用

目的　探讨SSD(shadedsurfacedisplay)血管成像在肺结节性病变中的应用价值。方法　对 47例患者、50个肺结节性病变增强后行结节处血管的SSD成像,分析结节处血管表现及与定性的关系。结果　50个肺结节中, 38个SSD重建后图像显示清晰,其中 31个为恶性结节, 7个为良性结节。恶性结节中, 20例出现结节处血管增粗、增多, 4例仅见单根血管增粗, 1例出现结节处血管增多、未见增粗, 6例可见血管穿过结节(3例同时发现合并血管增多、增粗 ), 3例结节处血管未见明显异常;良性结节中, 1例见血管增粗、增多, 1例仅见血管增粗, 3例出现结节处血管增多、未见增粗, 2例结节处血管未见明显异常。结论　①SSD重建后示结节处血管增粗或穿过结节提示恶性结节可能性大。②SSD血管成像对位于中外带肺野的肺结节性病变的定性诊断更有帮助。     

动态CT增强扫描对肺结节的定性价值研究

目的　研究动态CT增强扫描对孤立性肺结节 (SPN)的定性价值。资料与方法　随机选择 72例SPN患者 ,先行薄层 (3～ 5mm)平扫 ,再静脉注射对比剂 (优维显 ) 10 0ml后 ,对选定的结节中心行动态CT增强扫描 ,测量其增强前后的CT值 ,并对其中 36例行三维表面重建。结果　肺炎性结节以重度强化为主 ,净增值 >6 0HU ,动态曲线呈持续上升型 ;肺癌性结节以轻～中度强化为主 ,净增值为 2 0～ 6 0HU ,动态曲线呈缓慢持续升高型 ;肺结核结节以轻度强化为主 ,净增值 <2 0HU ,动态曲线呈平坦型。三维重建成像显示 :恶性肺结节以Ⅰ、Ⅱ型血管异常为主 ;良性肺结节以Ⅳ型血管异常为主。结论　 (1)动态CT增强扫描对SPN的鉴别诊断有较高价值。 (2 )动态CT增强中追加三维重建 ,亦有利于SPN的定性诊断。     

高分辨螺旋CT增强扫描诊断肺内孤立小结节

目的 :评价高分辨螺旋CT增强扫描诊断肺内孤立小结节的价值。材料和方法 :直径小于 3cm的肺内孤立小结节患者 40例 ,其中周围性肺癌 2 9例 ,转移瘤 1例 ,肺炎性肿块 5例 ,结核瘤 2例 ,肺错构瘤、肺囊肿及肺血管瘤各 1例。40例患者先行常规CT扫描 ,发现病变后局部行高分辨螺旋CT扫描 ,仍不能定性诊断时行高分辨螺旋CT增强扫描。 40例病例均行前瞻性对比研究。结果 :高分辨螺旋CT增强扫描诊断肺内孤立性小结节的正确率为 81% ,肺内恶性结节大多均匀增强且增强CT值大于 2 0Hu ,平均增强CT值为 3 6Hu。良性结节多周边增强且增强CT值小于 10Hu。结论 :高分辨螺旋CT增强扫描有助于肺内孤立性小结节定性诊断 ,同时强调必须结合病变的基本形态特征综合考虑。     

多层螺旋CT对孤立性肺结节的诊断价值

目的 探讨多层螺旋CT鉴别孤立性肺良恶性结节的诊断价值.方法 回顾性分析2005-10-2007-12在本院接受治疗的临床与病理资料完整的肺孤立性结节(SPN)患者76例,以手术或穿刺活组织检查的病理结果作为诊断金标准.以动态扫描中增强值＞20 HU为界值计算出CT诊断SPN的敏感性、特异性、准确性、阳性预测值和阴性预测值.结果 多层螺旋CT对良性孤立性肺结节诊断的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为92.6%,89.8%,90.8%,83.3%,95.7%.对恶性孤立性肺结节诊断的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为83.7%,80.5%,82.9%,89.1%,73.3%.结论 多层螺旋CT诊断良恶性孤立性肺结节具有较高的敏感性、特异性和准确性,可作为诊断孤立性肺结节首选的非侵入性检查方法.     

多排螺旋CT动态增强扫描对肺孤立性结节鉴别诊断价值

目的探讨多排螺旋CT动态增强扫描在肺孤立性结节病变的良、恶性鉴别与诊断中的应用价值。方法对收治的肺孤立性结节病变患者病理诊断结果进行多排螺旋CT动态增强扫描对比统计,分析其敏感性、特异性及准确性。结果 CT动态增强扫描对肺孤立性结节病变的良、恶性鉴别诊断的敏感性为93.10%,特异性为88.46%,准确性为90.91%。炎性结节组和恶性结节组患者在动态增强扫描期间,在各时间点的CT值均明显高于良性结节组,且差异具有统计学意义。对比炎性结节组和恶性结节组的不同时间点动态增强CT值可以发现炎性结节组在30s、90s、180s的动态增强CT值均升高,但是两组无差异(P0.05);而在300s和480s,炎性结节组的动态增强CT值明显下降,而恶性结节组则下降不明显,而且炎性结节组在300s和480s的动态增强CT值明显低于恶性结节组,且差异具有统计学意义。恶性结节组和炎性结节组患者的PH、SPH/PPH等CT动态增强扫描特征参数值均明显高于良性结节组,且差异具有统计学意义。结论多排螺旋CT动态增强扫描可以为鉴别和诊断良、恶性肺孤立性结节病变提供有利证据,在临床诊断过程中,结合结节的形态学特征对于孤立性肺结节的良恶性鉴别具有较高的临床价值。     

64排螺旋CT低剂量检查肺孤立小结节临床价值分析

目的探讨64排螺旋CT低剂量扫描在肺孤立小结节的良恶性病变的鉴别与诊断价值。方法对收治的肺孤立性小结节病变56例患者进行64排螺旋CT低剂量扫描复查,并与穿刺活检或手术病理确诊结果进行对比研究。结果64排螺旋CT低剂量扫描对肺孤立性小结节病变的良、恶性鉴别诊断的敏感性为93.10%,特异性为88.46%,准确性为90.91%。恶性病变患者的CT影像学表现与良性病变比较存在明显差异,其中恶性病变患者的边缘大部分呈现不规则或分叶,而良性病变患者的边缘则呈现清楚的状态,且差异具有统计学意义。另外,良性病变患者的内部结构表现为钙化的例数明显多于恶性病变患者,且差异具有统计学意义。炎性结节组和恶性结节组患者在动态增强扫描期间,在各时间点的CT值均明显高于良性结节组,且差异具有统计学意义。对比炎性结节组和恶性结节组的不同时间点动态增强CT值可以发现炎性结节组在30s、90s、180s的动态增强CT值均升高,但是两组无差异(P>0.05);而在300s和480s,炎性结节组的动态增强CT值明显下降,而恶性结节组则下降不明显,而且炎性结节组在300s和480s的动态增强CT值明显低于恶性结节组,且差异具有统计学意义)。结论 64排螺旋CT低剂量扫描可以为鉴别和诊断良、恶性肺孤立性小结节病变提供有利证据。     

孤立性肺结节的影像学诊断和处理

胸部CT,尤其HRCT作为检测和诊断肺结节的首选方法,主要通过形态学评价肺结节,但其也具有一定的局限性。近年来,随着MDCT广泛应用,利用计算机辅助CT三维体积测量技术能较准确地评价结节倍增时间,并且动态增强CT、CT灌注成像也可提供较优良的功能性成像,为进一步准确诊断肺结节提供了更多手段。动态增强MRI及磁共振扩散加权成像也初步应用于肺结节的检测、定性和分期。PET/CT是反映肺结节代谢水平的功能性成像技术,主要应用于肿瘤分期。从形态学和功能性方面对CT、MRI、PET/CT等技术诊断肺结节的优缺点进行综述。     

肺部结节性病变穿刺活检中辅助引导定位技术的临床运用新进展

肺结节是肺部常见病变,它的定性诊断一直是临床诊断的难点,近些年随着高分辨率螺旋计算机断层扫描（computer tomography, CT）、灌注成像、双源CT双能量技术及正电子发射计算机断层显像（positron emission tomography,PET/CT）的深入研究,肺结节的诊断与鉴别诊断明显提高,但仍有少部分病变诊断困难,尤其是良恶性的鉴别。肺结节性病变穿刺活检术是临床获得病理的常用方法,其成功的关键是辅助定位技术的选择,现对各种辅助引导定位技术的进展予以综述。     

螺旋CT三维重建对肺占位性病变的诊断及与病理相关性

目的探讨肺占位性病变64排螺旋CT三维重建特点及与其病理类型、良恶性肿瘤的关系。方法回顾性分析2016年3月~2018年3月在本院就诊的肺占位性病变患者103例。均进行常规64排螺旋CT检查,并进行三维重建后处理技术,以病理结果为金标准,分析64排螺旋CT三维重建的临床应用价值。结果64排螺旋CT三维重建对肺占位性病变结节检出率显著高于常规CT(P<0.05)。恶性肿瘤分叶征,小气道改变,胸膜凹陷征,毛刺征,血管纠集征出现比例显著高于非肿瘤患者(P<0.05)。64排螺旋CT三维重建对肺癌诊断的灵敏度,准确度和特异度均显著高于常规CT(P<0.05)。且64排螺旋CT三维重建对肺癌的诊断结果与病理诊断结果具有极好的一致性(Kappa=0.858)。结论肺占位性病变64排螺旋CT三维重建特点与其病理类型、良恶性肿瘤具有一定的相关性,可用于临床诊断肺癌,具有较高的临床价值。     

Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT.

Recent advances in the technology of helical multidetector CT allow precise evaluations of nodule hemodynamics. In addition, the efficacy of tissue characterization has improved, and now sensitivity and specificity of >90% are achieved. Moreover, the efficacy of PET for the tissue characterization of solitary pulmonary nodules (SPNs) has also become of importance. The purpose of this study was to compare the diagnostic accuracy of helical dynamic (HD) CT (HDCT) and integrated PET/CT for pulmonary nodule characterization. METHODS: One hundred nineteen patients with an SPN underwent both HDCT (unenhanced scans, followed by series of images at 30, 60, 90, 120 s and at 5 and 15 min after intravenous injection of contrast medium) and integrated PET/CT. On HDCT, a nodule was regarded as malignant with a net enhancement of > or =25 Hounsfield units (HU) and a washout of 5-31 HU. On integrated PET/CT, nodules were considered malignant with a > or =3.5 maximum standardized uptake value and an 18F-FDG uptake greater than that of mediastinal structures. The sensitivity, specificity, and accuracy of the 2 modalities for malignancy were compared using the McNemar test. RESULTS: There were 79 malignant and 40 benign nodules. The sensitivity, specificity, and accuracy for malignancy on HDCT were 81% (64/79 nodules), 93% (37/40), and 85% (101/119), respectively, whereas those on integrated PET/CT were 96% (76/79), 88% (35/40), and 93% (111/119), respectively (P = 0.008, 0.727, and 0.011, respectively). All malignant nodules were interpreted correctly on either HDCT or PET/CT. CONCLUSION: Integrated PET/CT is more sensitive and accurate than HDCT for the malignant nodule characterization; therefore, PET/CT may be performed as the first-line evaluation tool for SPN characterization. Because HDCT has high specificity and acceptable sensitivity and accuracy, it may be a reasonable alternative for nodule characterization when PET/CT is unavailable.     

Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease.

OBJECTIVE: The purpose of our study was to determine the value of three-dimensional reconstructed helical CT in the assessment of the pulmonary arteries in infants and children with complex congenital heart disease. MATERIALS AND METHODS: Twenty patients were examined with contrast-enhanced helical CT. Three-dimensional reconstructions were performed with multiplanar reformations, maximum intensity projection, and shaded-surface display. Correlation was made with 19 echocardiograms and 14 cineangiocardiograms. All imaging studies were reviewed independently for the following parameters: the caliber of the main and branch pulmonary arteries and their confluence, the presence of stenosis, the number and caliber of aortopulmonary collaterals, and the patency of vascular shunts and conduits. Surgical confirmation, which was used as the reference standard, was available in all patients. RESULTS: Helical CT was as accurate as angiocardiography in revealing stenotic and nonconfluent central pulmonary arteries and in revealing aortopulmonary collaterals (overall CT test parameters: sensitivity, 90%; specificity, 100%; accuracy, 93%).Three-dimensional rendition did not improve the accuracy of CT. The patency of shunts was shown equally well with CT as with angiography, but CT showed thrombosis more directly. Echocardiography was the least accurate technique in revealing pulmonary artery anatomy (accuracy, 65%), primarily because a relatively large number of studies were technically unsatisfactory to assess the study parameters. CONCLUSION: Helical CT angiocardiography with three-dimensional reconstruction is superior to echocardiography for the noninvasive assessment of pulmonary artery anatomy in patients with complex congenital heart disease. Helical CT may be used as a complementary technique and occasionally as a substitute for the diagnostic imaging portion of cardiac catheterization with cineangiocardiography.     

螺旋CT薄层扫描并MPVR重建对孤立性肺结节的诊断价值

目的:探讨螺旋CT肺薄层扫描并多层面重建对孤立性肺结节的诊断价值。方法:对86例SPN患者进行螺旋CT规范化检查,并使用多层面重建(MPVR)技术重建观察。病灶结节直径选在0.8~3.0cm,病历均经临床手术或肺穿刺活检病理证实。其中恶性59例,均为原发性肺癌,包括腺癌25例、鳞癌17例、细支气管肺泡癌10例、小细胞未分化癌7例;良性病变27例,包括结核灶13例、炎性假瘤9例、错构瘤5例。结果:86例SPN的CT征象中,分叶征和棘突或毛刺征多出现于恶性结节,与病理和随访结果对比,螺旋CT薄层扫描并MPVR重建判断肺小结节良恶性的准确率、灵敏度、特异性、阳性预测值和阴性预测值分别为75.6%、76.3%、74.1%、86.5%、58.8%。结论:SCT肺薄层扫描并MPVR重建能显示更多的SPNCT征象,对SPN的良恶性诊断有较高的诊断价值。     

多层螺旋CT三维肺血管重建在肺血管相关疾病中的临床应用

目的：评价多层螺旋CT(MSCT)三维肺血管成像在肺血管相关疾病中的临床应用价值。材料和方法：对12例中心型肺癌、11例肺动脉栓塞、3例肺动静脉畸型的患者行MSCT造影增强检查，采用螺旋薄层CT扫描，在独立工作站上进行三维肺血管重建，使用不同的旋转轴观察肺血管的空间解剖细节。结果：全部病例三维肺血管图像均能充分显示肺动、静脉的空间关系与解剖细节，能准确、直观地观察肺血管与肿瘤的空间解剖关系，可以对肺动脉栓塞与肺动静脉畸型患者提出明确诊断。结论：MSCT三维肺血管成像能够准确、直观地显示肺血管的立体解剖特点，为胸部血管性疾病和中心型肺癌的诊断与治疗提供重要依据。     

多层螺旋CT及重建技术对肺动静脉畸形的诊断价值

目的：评价多层螺旋CT及重建技术对肺动静脉畸形诊断的价值。材料和方法：对9例肺动静脉畸形的病人行MSCT检查，然后进行三维肺血管重建，并与DSA检查进行对照分析。结果：全部病例的MSCT检查及重建诊断结果与PADSA诊断相符，MSCT及三维肺血管重建均能充分显示供血肺动脉、引流静脉的空间关系与解剖细节，能准确、直观地观察畸形血管的走行、数目、直径。结论：MSCT及重建技术对肺动静脉畸形的诊断具有重要价值，并能为治疗提供重要依据。     

Dynamic computed tomography in solitary pulmonary nodules

OBJECTIVE: To evaluate the utility of dynamic computed tomography (CT) imaging in the management of solitary pulmonary nodules. METHODS: We examined solitary pulmonary nodules in 45 patients. The nodules included in the study were solid, homogenous, and spherical or oval-shaped in precontrast images. Nodules that had calcification or fat density were excluded from the study. We were not able to obtain clinical or pathological diagnosis of the nodules in 23 patients, and we excluded these patients from statistical analysis. Patients were examined with 2-mm collimation and 1-mm reconstruction interval. Computed tomography examinations were done before and after injection of contrast material. Computed tomography scans of the nodule were obtained in the first, second, third, fourth, and fifth minutes after contrast injection. RESULTS: The malignancy prevalence was 40%. The mean enhancement of malignant nodules were significantly higher than the benign ones. Also, the peak attenuation value obtained after the administration of contrast material was 82.44 +/- 19.56 HU in malignant lesions and 54 +/- 23.10 HU in benign ones, with statistical significance (P = 0.006). Using enhancement values greater than 15 HU as a threshold for malignancy, the calculated sensitivity, specificity, positive and negative predictive values, and accuracy of the dynamic CT examination were 100%, 69.2%, 69.2%, 100%, and 81%, respectively. CONCLUSION: Dynamic CT imaging demonstrates significantly greater enhancement in malignant nodules than in benign ones. Lung nodule enhancement of 15 HU or less strongly indicates benignity.     

Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT

PURPOSE: To prospectively assess the accuracy of combined wash-in and washout characteristics at dynamic contrast material-enhanced multi-detector row computed tomography (CT) in distinguishing benign from malignant solitary pulmonary nodules. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The study included 107 patients (62 men, 45 women; mean age, 55 years; range, 22-81 years) with a solitary pulmonary nodule. After unenhanced CT (2.5-mm collimation) scans were obtained, dynamic CT was performed by using a helical technique (series of images obtained throughout the nodule, with 2.5-mm collimation, at 30, 60, 90, and 120 seconds and 4, 5, 9, 12, and 15 minutes) after intravenous injection of contrast medium (120 mL). Tissue diagnosis was made in 70 nodules, and follow-up images showed benignancy in the remaining 37 (no change in size, n = 32; decrease in size, n = 5). CT findings were analyzed in terms of wash-in and washout of contrast medium. Sensitivity, specificity, and accuracy for malignant nodules were calculated by considering both the wash-in and washout characteristics at dynamic CT. RESULTS: There were 49 malignant and 58 benign nodules. When diagnostic criteria for malignancy of both wash-in of 25 HU or greater and washout of 5-31 HU were applied, sensitivity, specificity, and accuracy for malignancy were 94% (46 of 49 nodules), 90% (52 of 58 nodules), and 92% (98 of 107 nodules), respectively. Of 58 benign nodules, 27 showed less than 25 HU wash-in, 14 showed persistent contrast enhancement without washout and with wash-in of 25 HU or greater, and 11 showed washout greater than 31 HU and wash-in of 25 HU or greater. CONCLUSION: Evaluation of solitary pulmonary nodules by analyzing combined wash-in and washout characteristics at dynamic contrast-enhanced multi-detector row CT showed 92% accuracy for distinguishing benign nodules from malignant nodules.     

Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density

PURPOSE: To evaluate enhancement dynamics of solitary pulmonary nodules at multi-detector row computed tomography (CT) and to correlate results with extent of tumor angiogenesis in pathologic specimens. MATERIALS AND METHODS: One hundred thirty-one patients with solitary pulmonary nodules underwent unenhanced thin-section CT, followed by dynamic helical CT (throughout the nodule for 30 mm along the z-axis [13 images] and at 20-second intervals for 3 minutes [130 images total]) after intravenous injection of 120 mL of contrast medium. Diagnosis of malignancy or benignancy was assigned in 109 patients, and follow-up imaging suggested benignancy in the remaining 22. CT findings were analyzed for peak attenuation, net enhancement, and enhancement dynamics. In 54 patients with surgical diagnoses, Pearson correlation coefficient was used to correlate enhancement pattern with extent of microvessel density and vascular endothelial growth factor (VEGF) staining. RESULTS: With 30 HU or more of net enhancement as a cutoff value in differentiation of malignant and benign nodules, sensitivity for malignant nodules was 99% (69 of 70 malignant nodules), specificity was 54% (33 of 61 benign nodules), positive predictive value was 71% (69 of 97 malignant readings), negative predictive value was 97% (33 of 34 benign readings), and accuracy was 78% (102 of 131 nodules). Peak attenuation was correlated positively with extent of microvessel density (r = 0.369, P =.006) and VEGF staining (r = 0.277, P =.042). Malignant nodules showed significantly higher VEGF expression (P =.009) than that of benign nodules. CONCLUSION: Dynamic enhancement with multi-detector row CT shows high sensitivity and negative predictive values for diagnosis of malignant nodules but low specificity because of highly enhancing benign nodules. Extent of enhancement reflects underlying nodule angiogenesis.     

高级肺分析软件在肺孤立结节诊断中的应用

 目的 评价高级肺分析软件(ALA)测量肺孤立结节体积的准确性及其在肺小结节诊断中的作用.方法 对87例肺孤立结节采用ALA进行分析,每例至少进行2次检查,所有检查采用GE LighhtSpeed Plus多层面CT扫描机,将图像传输至工作站,由ALA自动测量结节的体积.结果 87例孤立结节患者中75例为良性,其中有31例结节体积较前减小,有38例结节体积与前次比较略有增大,增加最大值小于50mm3;6例结节体积增加大于50mm3.12例为恶性,9例结节增加大于50mm3,1例结节增大18 mm3,2例结节体积减小.以结节体积增加大于50mm3作为阈值,ALA诊断恶性肺结节的敏感性为60%,特异性为96%,准确性为89%.结论 ALA可准确测量肺孤立结节的体积并敏感地评价肺小结节大小随时间的改变,有助于肺小结节的定性诊断.