CT增强扫描与MRI扫描对周围型肺肿块的临床鉴别诊断价值研究(1)
[摘要] 目的 探讨CT增强扫描与MRI扫描对周围型肺肿块的鉴别诊断价值。 方法 选择2012年1月～2013年12月我院收治的周围型肺肿块患者66例，分别进行CT增强扫描、MRI检查及增强CT联合MRI检查，对比分析三种检查方法的诊断鉴别特异度及灵敏度。 结果 CT增强扫描对周围型肺肿块诊断特异度为56.52%，灵敏度为81.39%；MRI特异度为52.38%，灵敏度为73.33%；增强CT联合MRI的特异度为78.26%，灵敏度为93.02%，MRI与CT增强扫描的特异度以及灵敏度比较无明显差异(P>0.05)；CT增强联合MRI检查的特异度与灵敏度均显著高于CT增强扫描及MRI扫描(P<0.05)。 结论 CT增强扫描与MRI扫描对周围型肺肿块的鉴别诊断均各具优势，将两者联合应用能够提高临床鉴别诊断特异度与灵敏度，提高肿块良恶性判断准确性。
[关键词] CT增强扫描；核磁共振成像；周围型肺肿块；鉴别诊断
[中图分类号] R734.2 [文献标识码] B [文章编号] 1673-9701(2015)04-0088-04
, 百拇医药
[Abstract] Objective To evaluate the differential diagnosis value of enhanced CT scanning and MRI scanning for peripheral pulmonary nodules. Methods A total of 66 cases of patients with peripheral pulmonary nodules in our hospital from January 2012 and December 2013 were collected， all received enhanced CT scan， MRI and enhanced CT combined MRI scan， the differential diagnosis specificity and sensitivity of the three methods were comparative analyzed. Results The specificity of enhanced CT scan for peripheral pulmonary nodules was 56.52%， the sensitivity was 81.39%； the specificity of MRI was 52.38%， the sensitivity was 73.33%； the specificity of enhanced CT combined MRI was 78.26%， and the sensitivity was 93.02%. The specificity and sensitivity between enhanced CT and MRI had no significant difference (P>0.05)； the specificity and sensitivity of enhanced CT combined MRI were significantly higher than those of simple enhanced CT scan and MRI scan (P<0.05). Conclusion Enhanced CT scanning and MRI scanning for peripheral pulmonary nodules each has advantages， the combination of the two applications can improve the clinical differential diagnosis specificity and sensitivity， and improve the accuracy of judgment of benign and malignant tumors.
, 百拇医药
[Key words] Enhanced CT scan； Magnetic resonance imaging； Peripheral pulmonary nodules； Differential diagnosis
肺部肿块是临床常见的肺部病变，主要由肺部炎症、结核或恶性肿瘤等所致，早期准确诊断与及时有效的治疗是控制病情进展、改善临床预后的关键[1]。既往对肺部肿块的诊断多依靠痰液及纤维支气管镜检查等，但这类方法对干咳无痰型或纤支镜无法达到的周围型肺肿块，敏感性仅为25%～78%左右，临床应用具有局限性[2]。由于肺部属于含气组织，应用超声检查往往难以通过，且难以进行定性诊断。近年来，临床多应用CT及MRI检查进行诊断。本研究对比分析了CT增强扫描、MRI扫描与CT增强联合MRI扫描对周围型肺肿块的鉴别诊断价值，旨在提高临床对周围型肺肿块的诊断水平，现报道如下。
1 资料与方法
, http://www.100md.com 1.1 一般资料
选择2012年1月～2013年12月我院收治的周围型肺肿块患者66例，其中，男45例，女21例，年龄35～76岁，平均(59.2±4.1)岁；肿块直径1.5～6.5 cm，平均(3.5±0.6)cm。患者均接受手术治疗，均经手术病理检查确诊。其中，21例为鳞癌，19例为腺癌，6例为小细胞癌，20例为炎症肿块。患者均自愿并知情，均签署知情同意书，均能够配合CT增强扫描及MRI扫描。除外人工心脏瓣膜、心脏起搏器、幽闭恐怖症以及体内金属异物者。
1.2 方法
1.2.1 CT检查方法 CT扫描仪器选择西门子多层螺旋CT机，扫描参数：电流=100 mA，电压=120 kV，视野(field of view，FOV)=300 mm，层厚=5 mm，层间距=5 mm。扫描时患者常规取仰卧位，自肺尖向下扫描直至肺底部，嘱患者深呼吸并屏气以后进行全胸扫描。然后进行增强扫描，对比剂为300 mg/mL碘普罗胺，采用高压注射器经右肘静脉前注入，流率为4.0 mL/s。完成造影剂注射后25 s、45 s以及60 s进行三期增强扫描。以70%肿瘤最大直径作为感兴趣区(region of intrest，ROI)直径，并注意ROI应避开空洞、钙化区以及部分溶剂效应区。所有患者均应用肺窗以及纵隔窗，肺窗窗宽、窗位分别为1600 HU、-600 HU，纵隔窗分别为350 HU、45 HU。, 百拇医药(余小君 程斌)
[关键词] CT增强扫描；核磁共振成像；周围型肺肿块；鉴别诊断
[中图分类号] R734.2 [文献标识码] B [文章编号] 1673-9701(2015)04-0088-04
, 百拇医药
[Abstract] Objective To evaluate the differential diagnosis value of enhanced CT scanning and MRI scanning for peripheral pulmonary nodules. Methods A total of 66 cases of patients with peripheral pulmonary nodules in our hospital from January 2012 and December 2013 were collected， all received enhanced CT scan， MRI and enhanced CT combined MRI scan， the differential diagnosis specificity and sensitivity of the three methods were comparative analyzed. Results The specificity of enhanced CT scan for peripheral pulmonary nodules was 56.52%， the sensitivity was 81.39%； the specificity of MRI was 52.38%， the sensitivity was 73.33%； the specificity of enhanced CT combined MRI was 78.26%， and the sensitivity was 93.02%. The specificity and sensitivity between enhanced CT and MRI had no significant difference (P>0.05)； the specificity and sensitivity of enhanced CT combined MRI were significantly higher than those of simple enhanced CT scan and MRI scan (P<0.05). Conclusion Enhanced CT scanning and MRI scanning for peripheral pulmonary nodules each has advantages， the combination of the two applications can improve the clinical differential diagnosis specificity and sensitivity， and improve the accuracy of judgment of benign and malignant tumors.
, 百拇医药
[Key words] Enhanced CT scan； Magnetic resonance imaging； Peripheral pulmonary nodules； Differential diagnosis
肺部肿块是临床常见的肺部病变，主要由肺部炎症、结核或恶性肿瘤等所致，早期准确诊断与及时有效的治疗是控制病情进展、改善临床预后的关键[1]。既往对肺部肿块的诊断多依靠痰液及纤维支气管镜检查等，但这类方法对干咳无痰型或纤支镜无法达到的周围型肺肿块，敏感性仅为25%～78%左右，临床应用具有局限性[2]。由于肺部属于含气组织，应用超声检查往往难以通过，且难以进行定性诊断。近年来，临床多应用CT及MRI检查进行诊断。本研究对比分析了CT增强扫描、MRI扫描与CT增强联合MRI扫描对周围型肺肿块的鉴别诊断价值，旨在提高临床对周围型肺肿块的诊断水平，现报道如下。
1 资料与方法
, http://www.100md.com 1.1 一般资料
选择2012年1月～2013年12月我院收治的周围型肺肿块患者66例，其中，男45例，女21例，年龄35～76岁，平均(59.2±4.1)岁；肿块直径1.5～6.5 cm，平均(3.5±0.6)cm。患者均接受手术治疗，均经手术病理检查确诊。其中，21例为鳞癌，19例为腺癌，6例为小细胞癌，20例为炎症肿块。患者均自愿并知情，均签署知情同意书，均能够配合CT增强扫描及MRI扫描。除外人工心脏瓣膜、心脏起搏器、幽闭恐怖症以及体内金属异物者。
1.2 方法
1.2.1 CT检查方法 CT扫描仪器选择西门子多层螺旋CT机，扫描参数：电流=100 mA，电压=120 kV，视野(field of view，FOV)=300 mm，层厚=5 mm，层间距=5 mm。扫描时患者常规取仰卧位，自肺尖向下扫描直至肺底部，嘱患者深呼吸并屏气以后进行全胸扫描。然后进行增强扫描，对比剂为300 mg/mL碘普罗胺，采用高压注射器经右肘静脉前注入，流率为4.0 mL/s。完成造影剂注射后25 s、45 s以及60 s进行三期增强扫描。以70%肿瘤最大直径作为感兴趣区(region of intrest，ROI)直径，并注意ROI应避开空洞、钙化区以及部分溶剂效应区。所有患者均应用肺窗以及纵隔窗，肺窗窗宽、窗位分别为1600 HU、-600 HU，纵隔窗分别为350 HU、45 HU。, 百拇医药(余小君 程斌)