本文選題：孤立性肺結(jié)節(jié)(SPN) + 多層螺旋CT��； 參考：《新疆醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討多層螺旋CT篩查的影像學(xué)單一特征及組合特征在孤立性肺結(jié)(SPN)診斷過(guò)程中的作用。方法:選取經(jīng)臨床手術(shù)切除或穿刺活檢等獲得病理證實(shí)的SPN患者397例作為研究對(duì)象,對(duì)其臨床資料進(jìn)行回顧性分析。采用Philips 64排螺旋CT機(jī)對(duì)患者從胸廓入口水平到肋膈角層面,包括所有肺實(shí)質(zhì)進(jìn)行掃描,統(tǒng)計(jì)分析影像學(xué)平掃特征,篩選出對(duì)孤立性肺結(jié)節(jié)良惡性鑒別診斷具有統(tǒng)計(jì)學(xué)意義的單個(gè)特征及組合特征,評(píng)判各自的診斷效能。結(jié)果:397例SPN患者行多層螺旋CT平掃,以經(jīng)臨床手術(shù)切除或穿刺活檢等獲得的病理結(jié)果為診斷標(biāo)準(zhǔn),差異有統(tǒng)計(jì)學(xué)意義的單個(gè)特征有6種,分別為分葉征(P=0.000)、毛刺征(P=0.000)、胸膜凹陷征(P=0.000)、邊緣不光滑(P=0.000)、血管集束征(P=0.000)及結(jié)節(jié)大小(2cm≤D3cm)(P=0.000),診斷效能最高的前三種分別是分葉征、毛刺征和胸膜凹陷征。其中敏感性和陽(yáng)性預(yù)測(cè)值都最高的特征為胸膜凹陷征。多種特征結(jié)對(duì)出現(xiàn)的可能性較單一特征單獨(dú)出現(xiàn)大幅降低,而在惡性SPN中,同時(shí)呈現(xiàn)分葉征、短毛刺征及胸膜凹陷征三種現(xiàn)象的概率最低。結(jié)論:多層螺旋CT篩查在對(duì)SPN的良惡性鑒別診斷中具有較高的應(yīng)用價(jià)值,它對(duì)大多數(shù)(準(zhǔn)確性58.7%-77.8%)SPN的良惡性能做出準(zhǔn)確診斷。單一和組合征象對(duì)于SPN的診斷效能無(wú)明顯統(tǒng)計(jì)學(xué)意義,但影像學(xué)圖像具有的典型特征愈多,其確診SPN惡性病變的可信度和陽(yáng)性預(yù)測(cè)值愈高。
[Abstract]:Objective: to investigate the role of single and combined features of multislice spiral CT in the diagnosis of solitary pulmonary nodule (SPN). Methods: the clinical data of 397 patients with SPN confirmed by clinical operation or biopsy were retrospectively analyzed. Philips 64-slice spiral CT was used to scan the patients from the level of thoracic entrance to the angle of costal diaphragm, including all pulmonary parenchyma. The single and combined features of the differential diagnosis of benign and malignant solitary pulmonary nodules were selected and their diagnostic efficacy was evaluated. Results one hundred and ninety-seven patients with SPN underwent multislice spiral CT scan. The diagnostic criteria were based on the pathological results obtained by clinical surgical resection or puncture biopsy. There were 6 single features with statistical significance. The results were as follows: lobulation sign (P = 0.000), burr sign (P = 0.000), pleural depression (n = 0.000), non-smooth margin (P ~ (0.000), vascular bundle sign (n = 0.000) and nodule size (n = 2cm 鈮，

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