胸部CT胸膜区病变征象在鉴别良恶性胸腔积液中的价值

目的:探讨胸膜区CT病变征象在鉴别良恶性胸腔积液中的价值。方法:收集比较良恶性胸腔积液的胸部 CT平扫图像，观察胸膜区病变征象，包括胸膜结节、纵隔胸膜增厚、病变突入胸膜外脂肪间隙、胸膜与胸膜外脂肪交界面不光整、肋间淋巴结肿大、胸内筋膜及最内肋间肌增厚、肋间血管增粗、单侧胸腔积液，胸膜外脂肪间隙密度增高。单因素分析应用χ2检验，并将单因素分析差异有统计学意义的因素纳入Logistic回归进行多因素分析，并绘制受试者工作特征曲线（ROC），通过计算曲线下面积（AUC）判断诊断效能。结果:单因素分析中胸膜结节、纵隔胸膜增厚、病变突入胸膜外脂肪间隙、胸膜与胸膜外脂肪交界面不光整、肋间淋巴结肿大、单侧胸腔积液这些因素在良恶性胸腔积液间的差异有统计学意义（P＜0.05）。纳入多因素分析的变量包括胸膜结节、纵隔胸膜增厚、病变突入胸膜外脂肪间隙、胸膜与胸膜外脂肪交界面不光整、单侧胸腔积液，其联合诊断恶性胸腔积液的灵敏度为85.4%，特异度为97.7%，ROC曲线下面积（AUC）为0.961。结论:胸膜区的病变征象对于胸腔积液良恶性诊断有较高价值，综合应用这些征象可为良恶性胸腔积液的鉴别诊断提供一种简便高效的方法。

The value of chest CT pleural lesions in differentiating benign and malignant pleural effusions

Objective:To explore the value of pleural CT lesions in the differential diagnosis of benign and malignant pleural effusions.Methods:The plain CT images of benign pleural effusion and malignant pleural effusion were collected and compared.The signs of pleural lesions were observed,including pleural nodules,mediastinal pleural involvement,protruding into extrapleural fat space,uneven interface between pleura and extrapleural fat,enlarged intercostal lymph nodes,thickening of intrathoracic fascia and innermost intercostal muscle,thickening of intercostal vessels,unilateral pleural effusion and increased density of extrapleural fat space.Univariate analysis was carried out by using χ2 test,and the factors with statistically significant differences in univariate analysis were included in Logistic regression for multivariate analysis,and the receiver operating characteristic curve(ROC)of the subjects was drawn.The diagnostic efficiency was judged by calculating the area under the curve(AUC).Results:In univariate analysis,pleural nodules,mediastinal pleural involvement,lesion protruding into extrapleural fat space,uneven interface between pleura and extrapleural fat,enlarged intercostal lymph nodes and unilateral pleural effusion were statistically different between benign and malignant pleural effusions(P＜0.05).The variables included pleural nodule,mediastinal pleural thickening,lesion protruding into extrapleural fat space,pleural and extrapleural fat interface and unilateral pleural effusion.The sensitivity and specificity for the combined diagnosis of malignant pleural effusion were 85.4% and 97.7%,respective.The AUC was 0.961.Conclusion:The signs of pleural lesions are of high value in the diagnosis of benign and malignant pleural effusions.The combined application of these signs can provide a simple and efficient method for the differential diagnosis of benign and malignant pleural effusions.