CT 和正電子發(fā)射計(jì)算機(jī)體層攝影術(shù)診斷
孤立性肺結(jié)節(jié)的局限性和協(xié)同作用
張金娥 梁長(zhǎng)虹 趙振軍 王淑俠 喬穗憲 何暉 張佳 茹光騰
【摘要】 目的 分析CT 和正電子發(fā)射計(jì)算機(jī)體層攝影術(shù)( PET) 診斷孤立性肺結(jié)節(jié)( SPN) 的局
限性和二者的協(xié)同診斷作用。方法 回顧性分析有病理證實(shí)的單個(gè)肺結(jié)節(jié)118 例。所有病例CT 和
PET 檢查間隔時(shí)間< 2 周。病灶直徑2 ～4 cm, 平均2. 7 cm。118 例SPN 中, 惡性腫瘤87 例, 其中肺
癌85 例, 結(jié)腸腺癌肺轉(zhuǎn)移2 例; 良性31 例, 其中結(jié)核球8 例, 錯(cuò)構(gòu)瘤6 例, 炎性假瘤6 例, 慢性非特異
性炎癥4 例, 炎性肉芽腫3 例, 隱球菌感染2 例, 膿腫和球形肺不張各1 例。結(jié)果 118 例SPN 中, CT
診斷正確93 例, 誤診25 例, 誤診率21. 2% 。其中12 例肺癌誤診為良性, 13 例良性誤診為肺癌。PET
診斷正確96 例, 誤診22 例, 誤診率18. 6% 。其中9 例肺癌、1 例結(jié)腸癌肺轉(zhuǎn)移誤診為良性, 12 例良性
誤診為惡性。CT 和PET 協(xié)同診斷, 108 例診斷正確, 10 例誤診, 誤診率8. 5% 。CT、PET 單獨(dú)診斷和
協(xié)同診斷的敏感性、特異性、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值和準(zhǔn)確性分別為86. 2% 、58. 1% 、85. 2% 、
60. 0% 、78. 8% ; 88. 5% 、61. 3% 、86. 5% 、65. 5% 、81. 4% 和97. 7%、74. 2% 、91. 4% 、92. 0% 、91. 5% 。
CT 和PET 單獨(dú)診斷SPN 的準(zhǔn)確性無(wú)統(tǒng)計(jì)學(xué)意義(χ2 = 0. 625, P = 0. 239) , 協(xié)同診斷與CT、PET 單獨(dú)
診斷SPN 的準(zhǔn)確性有統(tǒng)計(jì)學(xué)意義( χ2 = 7. 762 和5. 318, P = 0. 005 和0. 021 ) 。結(jié)論 良、惡性SPN 的
CT 和PET 影像特征均有一定的重疊。單獨(dú)采用CT 或PET 診斷肺結(jié)節(jié)的價(jià)值相當(dāng), CT 和PET 協(xié)同
診斷的準(zhǔn)確性高于CT 或PET 單獨(dú)診斷。
【關(guān)鍵詞】 硬幣病變, 肺; 體層攝影術(shù), 發(fā)射型計(jì)算機(jī); 體層攝影術(shù), X 線計(jì)算機(jī)
The limita tion and coordination of CT and posit ron emission tomography in the diagnosis of
pulmona ry nodules ZHANG J in-e, LIANG Chang-hong, ZHAO Zhen-jun, WANG Shu-xia , QIAO Suixia
n, HE Hui, ZHANG Jia, RU Guang-teng. Department of Imaging, Guangdong Provincial People′s
Hospital, Gua ngzhou 510080, China
【Abstra ct 】 Objective To Analyze the limitation and coordination of CT and positron emission
tomography ( PET) in the diagnosis of pulmonary nodules. Methods A retrospective study was undertaken
in 118 patients with pulmonary nodules which had CT and PET scan. The interval between examinations of
various imaging equipment was less than 2 weeks. The diameter of nodules ranged from 2 cm to 4 cm with an
average of 2. 7 cm. The nodules were proved as lung cancer by pathology in 85 cases and metastatic tumor in
2 cases , benign nodules in 31 cases, including 8 cases of tuberculosis, 6 cases of hamartoma, 6 cases of
inflammatory pseudotumor, 4 cases of chronic nonspecific inflammation, 3 cases of inflammation granuloma,
2 cases of mycosis , 1 case of abscess, and 1 case of globular atelectasis. Results 93 cases were correctly
diagnosed and 25 cases were misdiagnosed with CT in 118 cases of pulmonary nodules. The misdiagnosis rate
of CT was 21. 2%. 12 cases of lung cancer were misdiagnosed as benign and 13 cases of benign nodules were
misdiagnosed as lung cancer. 96 cases were correctly diagnosed and 22 cases were misdiagnosed with PET.
The misdiagnosis rate of PET was 18. 6%. 10 cases of malignant nodules were misdiagnosed as benign and
12 cases of benign nodules were misdiagnosed as lung cancer. 108 cases were correctly diagnosed and
10 cases were misdiagnosed with CT coordinated with PET. The misdiagnosis rate was 8. 5% . The
sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT, PET, and
CT coordinated with PET were 86. 2% , 58. 1% , 85. 2% , 60. 0% , 78. 8% and 88. 5% , 61. 3% , 86. 5% ,
65. 5% , 81. 4% , and 97. 7% , 74. 2% , 91. 4% , 92. 0% , 91. 5% respectively. The accuracy showed no
significant difference between CT and PET ( χ2 = 0. 625, P = 0. 239) , but there were significant difference
between CT coordinated with PET and CT or PET ( χ2 = 7. 762 and 5. 318, P = 0. 005 and 0. 021 ) .
Conclusion The features of CT and PET in benign and malignant pulmonary nodules are partly overlapped.
The diagnostic accuracy is equivalent between CT and PET, but the accuracy is higher when using CT in
coordination with PET.
【Key wor ds】 Coin lesion, pulmonary; Tomography, emission computed; Tomography, X-ray
computed

CT 和正電子發(fā)射計(jì)算機(jī)體層攝影術(shù)診斷--胸部.rar