目的：评价直方图像素分析法对乏脂肪肺错构瘤CT负值成分及脂肪成分显示能力及对肺内孤立性结节鉴别能力。材料与方法：回顾性分析经手术及穿刺病理证实的90例肺内孤立性结节病灶，其中肺错构瘤28例、肺癌36例、肺结核球26例，HRCT病灶均无明显脂肪及钙化成分显示，采用直方图像素分析法对病变感兴趣区内全部像素进行分析并绘制直方图，统计负值像素百分比并比较各组间差异，利用受试者工作特征（ROC）曲线选择最适于鉴别肺孤立性结节病灶的负值像素百分比最佳临界值。结果：肺错构瘤组平均CT值、最低CT值低于肺癌组及肺结核球组（P＜0.05）、负值像素百分比及各像素区间百分比明显高于其余两组（P＜0.05）。ROC曲线结果显示以负值像素百分比为15.7%作为诊断肺错构瘤最佳临界值可以获得较高的灵敏度及特异度。结论：对HRCT无明显脂肪及钙化成分显示的肺错构瘤的诊断中，直方图像素分析法明显提高了CT负值成分及脂肪成分检出率，显著提高肺错构瘤诊断鉴别能力。
Abstract
Objective: To evaluate the ability of histogram analysis method in lipid-poor pulmonary hamartoma in differential diagnosis. Materials and Methods: We retrospectively analyzed 90 cases of solitary pulmonary nodules confirmed pathologically by operation and puncture, including 28 cases of pulmonary hamartoma, 36 cases of lung cancer and 26 cases of pulmonary tuberculoma. There was not obvious fat and calcification components on HRCT. We used histogram analysis method to analysis lesions and the receiver operator characteristic curve to choose the optimal cut-off value to differentiate lipid-poor pulmonary hamartoma with other solitary pulmonary nodule. Results: The average CT attenuation and the lowest CT attenuation of the pulmonary hamartoma group is lower than that in the group of lung cancer and tuberculoma group(P＜0.05), the percentage of negative pixels, each pixels interval was significantly higher than that of the other two groups(P＜0.05). ROC curve showed the percentage of negative pixels was 15.7% is the optimal cut-off value in differential diagnosis. Conclusion: Histogram analysis method can significantly improve the detection of lipid-poor pulmonary hamartoma without visible fat at HRCT.
关键词
肺肿瘤 /
错构瘤 /
硬币病变 /
肺 /
诊断 /
鉴别 /
体层摄影术 /
螺旋计算机
Key words
Lung neoplasms /
Hamartoma /
Coin lesion, pulmonary /
Diagnosis, differential /
Tomography, spiral computed
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1]刘士远，肖湘生. 孤立性肺结节的处理策略[J]. 中华放射学杂志，2005，39（1）：6-8.
[2]De Cicco C, Bellomi M, Bartolomei M, et al. Imaging of lung hamartomas by multidetector computed tomography and positron emission tomography[J]. Ann Thorac Surg, 2008, 86(6): 1769-1772.
[3]Heuschmid M, Küttner A, Schr?觟der S, et al. Left ventricular functional parameters using ECG-gated multidetector spiral CT in comparison with invasive ventriculography[J]. RoFo: Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin, 2003, 175(10): 1349-1354.
[4]金哲. 23例肺错构瘤的诊治分析[J]. 中国医药指南，2008，6（5）：63-64.
[5]Siegelman SS, Khouri NF, Leo FP, et al. Solitary pulmonary nodules: CT assessment[J]. Radiology, 1986, 160(2): 307-312.
[6]Travis WD, Brambilla E, Nicholson AG, et al. The 2015 World Health Organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification[J]. J Thorac Oncol, 2015, 10(9): 1243-1260.
[7]尚延海，崔允峰，任德印. 呼吸系统疾病影像诊断[M]. 济南：山东科学技术出版社，1996：82-84.
[8]Gjevre JA, Myers JL, Prakash UBS. Pulmonary hamartomas[J]. Mayo Clin Proc, 1996, 71(1): 14-20.
[9]王淼淼，张丽芝，李智勇，等. 肺错构瘤的影像学诊断[J]. 中国临床医学影像杂志，2002，13（Suppl）：48-50.
[10]Chow BJ, Hoffmann U, Nieman K. Computed tomographic coronary angiography: an alternative to invasive coronary angiography[J]. Can J Cardiol, 2005, 21(4): 933-940.
[11]Ge F, Tong F, Li Z. Diagnosis and treatment of pulmonary hamartomas[J]. Chin Med Sci J, 1998, 13(1): 61-66.
[12]Siegelman SS, Khouri NF, Scott WW Jr, et al. Pulmonary hamartoma CT findings[J]. Radiology, 1886, 160(2): 313-317.
[13]高治庆，毕聪珍，马佳华. 肺错构瘤的CT诊断与鉴别[J]. 临床肺科杂志，2008，13（9）：500-502.
[14]夏宇，刘进康，周飞，等. 无钙化及脂肪密度的肺错构瘤的CT诊断[J]. 中国临床医学影像杂志，2004，15（8）：434-436.
[15]伍建林，王园园. 周围型肺错构瘤的HRCT表现与病理对照研究[J]. 中国医学计算机成像杂志，2000，6（5）：313-315.
[16]Bae KT, Fuangtharnthip P, Prasad SR, et al. Adrenal Masses: CT Characterization with Histogram Analysis Method[J]. Radiology, 2003, 228(3): 735-742.
[17]Kim JY, Kim JK, Kim N, et al. CT Histogram Analysis: Differentiation of Angiomyolipoma without Visible Fat from Renal Cell Carcinoma at CT Imaging[J]. Radiology, 2008, 246(2): 472-479.
