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1. 重庆医科大学附属第一医院 放射科,重庆市,400016
2. 綦江区人民医院 放射科,重庆市,401420
纸质出版日期:2022,
网络出版日期:2022-9-20,
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林芮羽, 刘元兵, 吕发金, 等. 良恶性亚厘米肺实性结节的CT特征[J]. 西南医科大学学报, 2022,45(5):425-430.
LIN Ruiyu, LIU Yuanbing, LV Fajin, et al. CT Features of Benign and Malignant Sub-centimeter Solid pulmonary Nodules[J]. Journal of Southwest Medical University, 2022,45(5):425-430.
林芮羽, 刘元兵, 吕发金, 等. 良恶性亚厘米肺实性结节的CT特征[J]. 西南医科大学学报, 2022,45(5):425-430. DOI: 10.3969/j.issn.2096-3351.2022.05.012.
LIN Ruiyu, LIU Yuanbing, LV Fajin, et al. CT Features of Benign and Malignant Sub-centimeter Solid pulmonary Nodules[J]. Journal of Southwest Medical University, 2022,45(5):425-430. DOI: 10.3969/j.issn.2096-3351.2022.05.012.
目的总结良恶性亚厘米(<1cm)肺实性结节的CT表现特征,提高对良恶性亚厘米肺实性结节二者的影像诊断及鉴别诊断水平。方法回顾性分析2012年1月至2020年6月经手术切除病理确诊的亚厘米肺实性结节174例(良性病变104例,恶性肿瘤70例)病人的临床及CT资料。分析结节的分布位置、形态、密度、结节-肺界面、周围伴随征象及其邻近结构改变等特征。通过单因素分析和Logistic回归分析,并对部分具体特征对比,揭示对良恶性二者鉴别诊断最有意义的征象。结果良恶性结节病人的年龄及病灶密度、结节-肺界面、分叶征等差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示病人年龄较大(OR:1.065;95%CI:1.025~1.107;P<0.001)、结节密度不均(OR:9.388;95%CI:3.015~29.237;P<0.001)、结节-肺界面毛糙(OR:9.060;95%CI:1.504~54.556;P=0.016)和分叶征(OR:7.125;95%CI:2.741~18.522;P<0.001)是恶性结节的重要预测指标。此外,良恶性结节之间在病灶密度不均、毛刺征、分叶征及周围伴随磨玻璃影等方面的具体表现形式均具有较大差别。少数伴钙化、卫星灶或以宽基底与胸膜相连的结节均为良性病变,而引起叶间裂局限皱缩伴或不伴增厚者均为恶性病变。结论对于CT显示的亚厘米肺实性结节,当病人年龄较大、结节密度不均、结节-肺界面毛糙、伴有分叶征时为恶性肿瘤的可能性大,需引起重视,并对其征象做进一步检查与鉴别,以确定其肿瘤的性质。
Objective To summarize the differences in CT findings of benign and malignant sub-centimeter((1cm)pulmonary solid nodules with the aim of improving their diagnosis and differential diagnosis. Methods From January 2012 to June 2020,the clinical and CT data of 174 patients with sub-centimeter pulmonary solid nodules(104 benign lesions and 70 malignant tumors)con⁃firmed by postoperative pathological examination were retrospectively analyzed. The CT manifestations of nodules,including distribu⁃tion,morphology,density,nodule-lung interface and the changes of adjacent structures,were analyzed. Univariate and logistic regres⁃sion analysis as well as comparison of different CT features were used to reveal the most valuable signs for differentiating benign and ma⁃lignant.nodules. Results There were significant differences in age,density,nodule-lung interface and lobular sign between the be⁃nign and malignant lesions(P<0.05). Multivariate logistic regression analysis showed that older patient(OR:1.065;95% CI:1.025~1.107;P<0.001),nodule with mixed density(OR:9.388;95% CI:3.015~29.237;P<0.001),coarse nodule-lung interface(OR:9.060;95% CI:1.504~54.556;P=0.016 )and lobulation(OR:7.125;95% CI:2.741~18.522;P<0.001)were important indicators of malignancies. In addition,there were significant differences in the specific manifestations of mixed density,spiculation,lobulation and peri-nodular ground-glass opacity between these two groups. A few nodules with calcification,satellite lesions or broad base con⁃nected to the pleura were benign. However,those nodules that caused locally shrinkage of the interlobular fissure with or without pleu⁃ral thickening were malignant. Conclusion For sub-centimeter solid pulmonary nodules shown on CT,if the patients were older,the density of nodules were uneven,the nodule-lung interface were rough,or accompanied by lobulation sign,it is more likely to be ma⁃lignant tumor. Attention should be paid and further examinations and differentiation should be done to determine the nature of the tumor.
亚厘米实性肺结节诊断鉴别诊断计算机体层摄影技术
Sub-centimeterSolidPulmonary nodulesDiagnosisDifferential diagnosisComputed Tomography
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