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目的探讨低剂量螺旋CT(LDCT)扫描对肺内结节的诊断价值。方法前瞻性随诊分析2002～2010年在我院行LDCT的302例患者的临床资料,胸部X线、常规剂量CT(SDCT)及LDCT的结果。结果行LDCT检查者分两组:肺内结节待查组:共230例,男性120例(52.2%),女性110例(47.8%),中位年龄为65岁,>40岁216例(94.0%),符合肺癌高危因素史112例(48.7%),无临床症状95例(41.3%),LDCT检出的结节是胸部X线的2.4倍。SDCT及LDCT比较,两者在结节检出及其影像学特征上相似。LDCT共检出结节587个,直径≤1 cm达93.2%,给临床诊断带来一定困难。明确病理20例,肺癌12例(5.2%),其中8例手术(87.5%为Ⅰ期),肺内良性疾病8例;恶性肿瘤患者疗后随访组:共72例,其中26例诊断肺内转移或第二恶性肿瘤。结论 LDCT检出肺内结节明显优于胸部X线;与SDCT比较,可明显降低受检者辐射剂量,但影像学表现无明显差异;LDCT对良、恶性结节的检出有一定意义;LDCT将有利于提高肺癌的早期诊断,提高手术切除率,延长生存期。能否作为肺癌筛查的方法尚需进一步探讨;部分恶性肿瘤患者疗后定期行LDCT,可早期发现肺内转移及第二肺恶性肿瘤,安全性更好;对国人的肺内结节应积极考虑除外结核及慢性感染性疾病。
Objective To investigate the diagnostic value of low-dose spiral CT (LDCT) in pulmonary nodules. Methods The clinical data of 302 patients with LDCT in our hospital from 2002 to 2010 were prospectively followed up. The results of X-ray, routine CT and SDCT were analyzed. Results The LDCT examiners were divided into two groups: a total of 230 cases of pulmonary nodules to be investigated group, 120 cases (52.2%) were male, 110 cases (47.8%) were female, the median age was 65 years old, 94.0%). There were 112 patients (48.7%) with history of high risk of lung cancer and 95 patients (41.3%) without clinical symptoms. The nodules detected by LDCT were 2.4 times of chest X-ray. Comparison of both SDCT and LDCT showed similarities in nodule detection and imaging features. LDCT detected a total of 587 nodules, diameter ≤ 1 cm up to 93.2%, to bring some clinical diagnosis. Clear pathology in 20 cases, lung cancer in 12 cases (5.2%), of which 8 cases of surgery (87.5% for stage Ⅰ), benign lung disease in 8 cases; cancer patients after treatment follow-up group: a total of 72 cases, of which 26 cases of lung Metastasis or second malignancy. Conclusions LDCT is superior to chest X-ray in detecting pulmonary nodules. Comparing with SDCT, it can significantly reduce the radiation dose of the subjects, but there is no significant difference in imaging findings. LDCT has certain significance in the detection of benign and malignant nodules. LDCT will help improve the early diagnosis of lung cancer, improve the surgical resection rate and prolong survival. Whether lung cancer screening can be further explored; some patients with malignant tumors after regular LDCT line, early detection of lung metastases and second lung cancer, better safety; on the lungs of people should be positive Consider excluding tuberculosis and chronic infectious diseases.