本文選題：孤立性肺結(jié)節(jié)　切入點(diǎn)：x線(xiàn)計(jì)算機(jī)　出處：《遼寧醫(yī)學(xué)院》2013年碩士論文

【摘要】：目的 通過(guò)對(duì)孤立性肺結(jié)節(jié)的各種影像征象的研究，并運(yùn)用回歸分析的方法，對(duì)孤立性肺結(jié)節(jié)的良惡性進(jìn)行鑒別診斷，并得出相應(yīng)的結(jié)論，以提高CT檢查方法對(duì)良惡性肺結(jié)節(jié)的鑒別診斷，從而給臨床治療提供更加可靠的依據(jù)。 方法 用回顧性方法分析188例經(jīng)病理確證獲得證實(shí)的孤立性肺結(jié)節(jié)的臨床及CT資料。收集各病例臨床資料并分析肺結(jié)節(jié)影像學(xué)征象，結(jié)合臨床和影像的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析來(lái)判定不同影像學(xué)特征對(duì)良惡性結(jié)節(jié)的診斷手段的可靠性。影像學(xué)特征包括結(jié)節(jié)的大小，所在部位，分葉征，，毛刺征，血管集束征，胸膜凹陷征，鈣化和空泡征。良惡性結(jié)果為因變量，影像學(xué)征象為自變量。建立數(shù)據(jù)進(jìn)行多因素回歸分析。從這些自變量中計(jì)算出惡性結(jié)節(jié)的危險(xiǎn)因素，建立估算模型。然后通過(guò)模型方程得到單個(gè)SPN的概率值。并將結(jié)果與臨床實(shí)際診斷結(jié)果進(jìn)行對(duì)比。進(jìn)一步描繪出ROC曲線(xiàn)，并最終判斷邏輯回歸分析對(duì)SPN良惡性診斷的應(yīng)用價(jià)值。 結(jié)果 經(jīng)過(guò)統(tǒng)計(jì)188例孤立性肺結(jié)節(jié)中有惡性結(jié)節(jié)共106例，包括腺癌63例，小細(xì)胞癌20例，鱗癌16例，大細(xì)胞癌5例，細(xì)支氣管癌3例；良性結(jié)節(jié)共82例，包括38例結(jié)核球，35例炎性病變，7例錯(cuò)構(gòu)瘤，2例血管瘤。其中左肺上葉7例，左肺下葉56例，右肺上葉6例，右肺中葉26例，右肺下葉93例。 本文中研究的CT征象統(tǒng)計(jì)比例為；惡性結(jié)節(jié)分葉征69.8%、毛刺征60.4%、胸膜凹陷征67.0%、血管集束征74.5%、空泡征25.5%，鈣化8.5%。在良性肺結(jié)節(jié)組中出現(xiàn)率依次為分葉征20.7%,毛刺征23.2%,胸膜凹陷征17.1%,血管集束征13.4%,空泡征7.3%,鈣化39.0%。 良性結(jié)節(jié)多邊緣光滑，長(zhǎng)毛刺的出現(xiàn)率較高，結(jié)節(jié)內(nèi)鈣化的發(fā)生率等與惡性結(jié)節(jié)組相比較，差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。另外，患者臨床癥狀、發(fā)病年齡及發(fā)病部位對(duì)做出孤立性肺結(jié)節(jié)的診斷和鑒別診斷亦有重要的參考依據(jù)。 結(jié)論 孤立性肺結(jié)節(jié)的CT征象的分析對(duì)良惡性的鑒別診斷具有一定的參考價(jià)值。其中毛刺征，分葉征，血管集束征，胸膜凹陷征，空泡征提示惡性可能性較大。鈣化提示良性結(jié)節(jié)可能性較大。運(yùn)用統(tǒng)計(jì)學(xué)回歸分析計(jì)算出OR值和95%可信區(qū)間并繪出其ROC曲線(xiàn)，可以明確該價(jià)值的臨床意義，為臨床最終做出確切診斷提供可靠的依據(jù)。
[Abstract]:PurposeThrough the study of various imaging signs of solitary pulmonary nodules and the method of regression analysis, the differential diagnosis of benign and malignant solitary pulmonary nodules was carried out, and the corresponding conclusions were drawn.In order to improve the CT diagnosis of benign and malignant pulmonary nodules, and provide a more reliable basis for clinical treatment.MethodThe clinical and CT data of 188 cases of solitary pulmonary nodules confirmed by pathology were analyzed retrospectively.The clinical data of each case were collected and the imaging signs of pulmonary nodules were analyzed. The reliability of different imaging features in the diagnosis of benign and malignant nodules was evaluated by statistical analysis combined with clinical and imaging data.Imaging features include nodule size, location, lobulation, burr, vascular cluster, pleural indentation, calcification and vacuolation.The benign and malignant results were dependent variables and the imaging signs were independent variables.The data were analyzed by multivariate regression analysis.The risk factors of malignant nodules were calculated from these independent variables and an estimation model was established.Then the probabilistic value of a single SPN is obtained by the model equation.The results were compared with the results of clinical diagnosis.The ROC curve was further described, and the value of the logistic regression analysis in the diagnosis of benign and malignant SPN was finally determined.ResultThere were 106 cases of malignant nodules in 188 solitary pulmonary nodules, including 63 cases of adenocarcinoma, 20 cases of small cell carcinoma, 16 cases of squamous cell carcinoma, 5 cases of large cell carcinoma, 3 cases of bronchiolar carcinoma, 82 cases of benign nodules.There were 38 cases of tuberculous bulbus tuberculum 35 cases of inflammatory lesions 7 cases of hamartoma and 2 cases of hemangioma.There were 7 cases of left upper lobe, 56 cases of left lower lobe, 6 cases of right upper lobe, 26 cases of right middle lobe and 93 cases of right lower lobe.The proportion of CT signs studied in this paper is: malignant nodule lobulation sign 69.8, burr sign 60.4, pleural sag sign 67.0, vascular cluster sign 74.5, vacuole 25.5and calcification 8.5.In the benign pulmonary nodule group, the occurrence rates were as follows: lobulation sign 20.7m, burr sign 23.2m, pleural indentation sign 17.1m, vascular cluster sign 13.4m, vacuole sign 7.3g and calcification 39.0.The incidence of calcification in benign nodules was significantly higher than that in malignant nodules (P 0.05).In addition, the clinical symptoms, onset age and location of the patients also have important reference for the diagnosis and differential diagnosis of solitary pulmonary nodules.ConclusionThe analysis of CT findings of solitary pulmonary nodules has certain reference value for differential diagnosis of benign and malignant lung nodules.Among them, burr sign, lobulation sign, vascular cluster sign, pleural indentation sign and vacuole sign suggest that malignancy is more likely.Calcification suggests that benign nodules are more likely.Using statistical regression analysis to calculate OR value and 95% confidence interval and draw its ROC curve can determine the clinical significance of this value and provide a reliable basis for the final diagnosis.
【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R563

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