CT 和正电子发射计算机体层摄影术诊断

CT 和正电子发射计算机体层摄影术诊断
孤立性肺结节的局限性和协同作用
张金娥 梁长虹 赵振军 王淑侠 乔穗宪 何晖 张佳 茹光腾
【摘要】 目的 分析CT 和正电子发射计算机体层摄影术( PET) 诊断孤立性肺结节( SPN) 的局
限性和二者的协同诊断作用。方法 回顾性分析有病理证实的单个肺结节118 例。所有病例CT 和
PET 检查间隔时间< 2 周。病灶直径2 ～4 cm, 平均2. 7 cm。118 例SPN 中, 恶性肿瘤87 例, 其中肺
癌85 例, 结肠腺癌肺转移2 例; 良性31 例, 其中结核球8 例, 错构瘤6 例, 炎性假瘤6 例, 慢性非特异
性炎症4 例, 炎性肉芽肿3 例, 隐球菌感染2 例, 脓肿和球形肺不张各1 例。结果 118 例SPN 中, CT
诊断正确93 例, 误诊25 例, 误诊率21. 2% 。其中12 例肺癌误诊为良性, 13 例良性误诊为肺癌。PET
诊断正确96 例, 误诊22 例, 误诊率18. 6% 。其中9 例肺癌、1 例结肠癌肺转移误诊为良性, 12 例良性
误诊为恶性。CT 和PET 协同诊断, 108 例诊断正确, 10 例误诊, 误诊率8. 5% 。CT、PET 单独诊断和
协同诊断的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为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 单独诊断SPN 的准确性无统计学意义(χ2 = 0. 625, P = 0. 239) , 协同诊断与CT、PET 单独
诊断SPN 的准确性有统计学意义( χ2 = 7. 762 和5. 318, P = 0. 005 和0. 021 ) 。结论 良、恶性SPN 的
CT 和PET 影像特征均有一定的重叠。单独采用CT 或PET 诊断肺结节的价值相当, CT 和PET 协同
诊断的准确性高于CT 或PET 单独诊断。
【关键词】 硬币病变, 肺; 体层摄影术, 发射型计算机; 体层摄影术, X 线计算机
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 和正电子发射计算机体层摄影术诊断--胸部.rar