标题：MSCT联合MR-DWI用于诊断肺部实性结节良恶性的临床价值

      作者：陈松 1，杨守珍 2，杨如武 1    1.西电集团医院影像科，陕西 西安 710077；2.中航工业西安医院影像科，陕西 西安 710077

      卷次： 2022年33卷5期

      【摘要】 目的 探讨多层螺旋CT (MSCT)联合磁共振扩散加权成像(MR-DWI)对肺部实性结节良恶性的鉴别价值。方法 回顾性分析西电集团医院2019年5月至2020年7月通过病理确诊为孤立性肺结节的120例患者的临床资料，其中良性结节51例，恶性结节69例，以病理结果为金标准，分别计算并比较MSCT、MR-DWI单独或联合检测鉴别诊断肺部实性结节的准确度、敏感度、特异度。结果 恶性结节MSCT鉴别征象中圆形/类圆形、毛刺征、分叶征、棘状突起征、病灶-肺界面清晰、支气管征、血管集束征、胸膜凹陷征比例明显高于良性结节，结节直径明显大于良性结节，差异均有统计学意义(P<0.05)；恶性结节磁共振参数T2WI平均信号值高于良性结节(P<0.05)；b值=500 s/mm2、700 s/mm2、900 s/mm2时，恶性结节检测ADC值低于良性结节，差异有统计学意义(P<0.05)；MSCT联合MR-DWI共正确检测良性结节45例，恶性结节67例；单独MSCT共正确检测良性结节45例，恶性结节54例，单独MR-DWI共正确检测良性结节46例，恶性结节58例；MSCT联合MR-DWI对良恶性结节诊断准确度、灵敏度、特异度分别为 93.33%、97.10%、88.24%，MSCT单独检测分别为 80.83%、75.36%、88.24%，MR-DWI分别为 85.00%、81.16%、90.20%，MSCT联合MR-DWI检测准确度、灵敏度明显高于单独检测，差异均有统计学意义(P<0.05)。结论 MSCT显示良恶性结节病灶边缘特征，MR-DWI显示病灶内部状态，两者联合诊断有助于提高诊断灵敏度。
      【关键词】 肺部实性结节；良恶性；多层螺旋CT；磁共振扩散加权成像；诊断价值
      【中图分类号】 R563 【文献标识码】 A 【文章编号】 1003—6350（2022）05—0613—04

Clinical value of multi-slice spiral CT combined with magnetic resonance diffusion weighted imaging in thediagnosis of benign and malignant solid pulmonary nodules.
CHEN Song 1, YANG Shou-zhen 2, YANG Ru-wu 1. 1.Imaging Department, Xi'an XD Group Hospital, Xi'an 710077, Shaanxi, CHINA; 2. Imaging Department, AICC Xi'anHospital, Xi'an 710077, Shaanxi, CHINA
【Abstract】 Objective To explore the value of multi-slice spiral CT (MSCT) combined with magnetic reso-nance diffusion weighted imaging (MR-DWI) in the differential diagnosis of benign and malignant solid pulmonary nod-ules. Methods A retrospective analysis was performed on the clinical data of 120 patients confirmed with solitary pul-monary nodules by pathology in Xi'an XD Group Hospital between May 2019 and July 2020, including 51 cases with be-nign nodules and 69 cases with malignant nodules. Taking pathological results as the golden standard, the accuracy, sen-sitivity and specificity of MSCT, MR-DWI and combined detection were calculated and compared. Results In MSCT im-ages, proportions of round/quasi-circular sign, spicule sign, lobular sign, spiculate protuberance sign, clear focus-pulmo-nary interface, bronchial sign, vessel convergence sign, and pleural indentation in malignant nodules were significantlyhigher than those in benign nodules, and nodules diameter was significantly longer than that in benign nodules (P<0.05).The average signal value of magnetic resonance parameter (T2WI) in malignant nodules was greater than that in benignnodules (P<0.05). When meeting the following conditions (b=500 s/mm2, 700 s/mm2, 900 s/mm2), ADC values in malig-nant nodules were lower than those in benign nodules (P<0.05). MSCT combined with MR-DWI showed that there were45 cases with benign nodules and 67 cases with malignant nodules detected. MSCT showed that there were 45 cases withbenign nodules and 54 cases with malignant nodules. MR-DWI showed that there were 46 cases with benign nodules and58 cases with malignant nodules. The diagnostic accuracy, sensitivity and specificity were 93.33%, 97.10%, 88.24% forcombined detection, 80.83%, 75.36%, 88.24% for MSCT, and 85.00%, 81.16%, 90.20% for MR-DWI, respectively. Theaccuracy and sensitivity of combined detection were higher than those of single index (P<0.05). Conclusion MSCT candisplay the edge characteristics of benign and malignant nodules, and MR-DWI can display internal status of lesions.The combined diagnosis of the two indexes is beneficial to improve diagnostic sensitivity.
      【Key words】 Solid pulmonary nodule; Benign and malignant; Multi-slice spiral CT; Magnetic resonance diffu-sion weighted imaging; Diagnostic value