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目的探讨HRCT与PET/CT相结合对孤立性肺癌结节和结核球的鉴别诊断价值。方法回顾性分析经病理或临床证实的孤立性肺癌结节和结核球共60例,全部病例均行PET/CT显像和胸部HRCT检查。PET/CT用目测法结合半定量法判断良恶性,HRCT根据病灶的形态学特征判断良恶性,统计PET/CT诊断结果和HRCT与PET/CT相结合诊断结果。结果病理或临床证实的孤立性肺癌结节和结核球分别为38例和22例,单纯PET/CT正确诊断36例肺癌和14例结核球,2例肺癌PET/CT显像为阴性,其中1例经HRCT和PET/CT联合诊断为恶性;8例结核球PET/CT显像为阳性,其中7例经HRCT和PET/CT结合后正确诊断。单纯PET/CT诊断和联合诊断对孤立性肺癌结节和结核球鉴别的敏感性、特异性和准确性分别为94.74%、63.64%、83.33%和97.37%、95.45%、96.67%。结论 HRCT与PET/CT相结合能大大降低孤立性结核球良恶性判断的假阳性率,可明显提高孤立性肺癌结节和结核球的鉴别的准确性。
Objective To investigate the value of HRCT combined with PET / CT in the differential diagnosis of solitary pulmonary nodules and tuberculomas. Methods A total of 60 cases of solitary pulmonary nodules and tuberculomas confirmed by pathology or clinic were retrospectively analyzed. PET / CT imaging and chest CT were performed in all cases. PET / CT with visual method combined with semi-quantitative method to determine benign and malignant, HRCT according to the morphological features of lesions to determine the benign and malignant, statistical PET / CT diagnosis and HRCT and PET / CT combined diagnostic results. Results Pathologically or clinically confirmed solitary pulmonary nodules and tuberculomas were 38 and 22, respectively. PET / CT was used to correctly diagnose 36 cases of lung cancer and 14 cases of tuberculoma. PET / CT imaging was negative in 2 cases of lung cancer Cases were diagnosed as malignant by HRCT and PET / CT; 8 cases of PET / CT scans were positive, of which 7 cases were correctly diagnosed by HRCT and PET / CT. The sensitivity, specificity and accuracy of simple PET / CT diagnosis and combined diagnosis of nodular and tuberculous solitary pulmonary nodules were 94.74%, 63.64%, 83.33% and 97.37%, 95.45% and 96.67% respectively. Conclusion The combination of HRCT and PET / CT can greatly reduce the false-positive rate of benign and malignant solitary tuberculoma and can significantly improve the accuracy of identification of solitary pulmonary tuberculosis and tuberculoma.