CT对正电子发射计算机断层显像阳性肺结节诊断价值的回顾性研究

目的 探寻CT影像学特征能否帮助鉴别正电子发射计算机断层显像(PET)阳性肺部恶性病变及良性肉芽肿性病变.方法 2005年1月至2012年2月间93例手术切除、术后病理学证实为支气管肺癌及肉芽肿患者,对其术前的CT及PET影像学特征进行回顾性分析,得出对结节的印象性诊断,并对结节的影像学特征行多元Logistic回归分析.结果 67.7％ (65/96)患者被切除的肺结节是癌性的,而32.3％(31/96)的肺结节是肉芽肿性的.CT在64.5％(20/31)肉芽肿性疾病中呈良性表现,在4.6％(3/65)肺癌之中呈良性表现(P＜0.01),阴性预测值为87.0％(20/23),其中非毛刺样边缘、不规则外形及实性密度征对良性结节的阴性预测值可达85.7％(12/14).结论 CT影像学特征可以减少PET阳性肺结节误诊的可能性,但不能完全避免,CT影像学特征中非毛刺样边缘、不规则外形及实性密度征对良性肿块的阴性预测值较高,对于PET阳性肺结节的鉴别诊断有价值.

Retrospective diagnosis study of computed tomography for positron emission tomography-position pulmona- ry nodule

Objective To discuss whether computer tomography （CT） imaging features can help diagnosis of positron emission tomography （PET） positive pulmonary malignant and benign granulomatous lesions. Methods We retrospectively identified 93 consecutive patients between January 2005 and February 2012 who had operation of a pulmonary nodule pathologically diagnosed of bronchogenic carcinoma or granuloma and preoperative feature with CT and PET. Bivariate and logistic regression analyses were finished. Results Totally 67. 7 percent （65/96） of nodules were carcinomas and 32. 3% （31/96） were granulomas. The CT appearance was benign in 64. 5% （20/ 31 ） of granulomas and 4.6% （ 3/65 ） of carcinomas （ P 〈 O. 01 ） ; negative predictive value（NPV） was 87.0% （20/23）. Nonspiculated margin, irregular shape and solid attenuation had a NPV of 85.7% （12/14）. Conclusions CT can reduce but cannot eliminate the possibility that a nodule is malignant. Nonspiculated margin, irregular shape and solid attenuation have a high NPV ,which is the most valuable diagnostic CT imaging method to distinguish be- nign pulmonary nodule.