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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2~4cm,平均2·7cm。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。
Objective To analyze the limitations of computed tomography (CT) and positron emission computed tomography (PET) in the diagnosis of solitary pulmonary nodules (SPN) and their synergistic diagnostic effects. Methods A retrospective analysis of pathologically confirmed single pulmonary nodules in 118 cases. All cases CT and PET examination interval <2 weeks. Lesion diameter 2 ~ 4cm, an average of 2.7cm. There were 87 malignant tumors in 118 SPN cases, including 85 lung cancer patients and 2 lung cancer patients with colon adenocarcinoma; 31 patients were benign, of which 8 were tuberculomas, 6 were hamartomas, 6 were inflammatory pseudotumors, and 6 were non-specific chronic inflammation 4 cases, inflammatory granuloma in 3 cases, cryptococcal infection in 2 cases, abscess and spherical atelectasis in 1 case. Results In 118 cases of SPN, CT was correctly diagnosed in 93 cases, 25 cases were misdiagnosed, and the misdiagnosis rate was 21.2%. 12 cases of lung cancer misdiagnosed as benign, 13 cases of benign misdiagnosed as lung cancer. In PET, 96 cases were correctly diagnosed, 22 cases were misdiagnosed, and the rate of misdiagnosis was 18.6%. Among them, 9 cases of lung cancer and 1 case of colon cancer were misdiagnosed as benign pulmonary metastases and 12 cases were misdiagnosed as malignant. CT and PET synergistic diagnosis, 108 cases were correctly diagnosed, 10 cases were misdiagnosed, the misdiagnosis rate was 8.5%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CT and PET in diagnosing and co-diagnosing were 86.2%, 58.1%, 85.2%, 60.0% and 78.8 %, 88.5%, 61.3%, 86.5%, 65.5%, 81.4% and 97.7%, 74.2%, 91.4%, 92.0%, 91.5% %. The accuracy of CT and PET in the diagnosis of SPN alone was not statistically significant (χ2 = 0.625, P = 0.239). The accuracy of CT and PET alone in diagnosing SPN was statistically significant (χ2 = 7.762 and 5 · 318, P = 0 · 005 and 0 · 021). Conclusion Both CT and PET images of benign and malignant SPN have some overlap. The value of using CT or PET alone to diagnose pulmonary nodules is comparable, and the diagnostic accuracy of CT and PET is higher than that of CT or PET alone.