Ribeiro Sergio Marrone, Ruiz Raul Lopes, Yoo Hugo Hyung Bok, Cataneo Daniele Cristina, Cataneo Antonio José Maria
Department of Tropical Diseases and Diagnostic Imaging, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Sao Paulo.
Acta Radiol. 2013 Sep;54(7):757-64. doi: 10.1177/0284185113481695. Epub 2013 Apr 30.
The problem of diagnosing whether a solitary pulmonary nodule is benign or malignant is even greater in developing countries due to a higher prevalence of infectious diseases. These infections generate a large number of patients who are generally asymptomatic and with a pulmonary nodule that cannot be accurately defined as having benign or malignant etiology.
To verify the percentages of benign versus malignant non-calcified nodules, the length of time after contrast agent injection is spiral computed tomography (CT) most sensitive and specific, and whether three postcontrast phases are necessary.
We studied 23 patients with solitary pulmonary nodules identified on chest radiographs or CT. Spiral scans were obtained with Swensen protocol, but at 3, 4, and 5 min after contrast injection onset. Nodules were classified as benign or malignant by histopathological examination or by an absence or presence of growth after 2 years of follow-up CT.
Of the 23 patients studied, 18 (78.2%) showed a final diagnosis of benign and five (21.7%) malignant nodules. Despite the small sample size, we obtained results similar to those of Swensen et al., with 80.0% sensitivity, 55.5% specificity, and 60.8% accuracy. Four minutes gave the greatest mean enhancement in both malignant and benign lesions.
Small non-calcified benign nodules were much more frequent than malignant nodules. The best time for dynamic contrast-enhanced CT density analysis was 4 min postcontrast. As well as saving time and money, this simplified Swensen protocol with only precontrast and 4 min postcontrast phases also reduces patient exposure to ionizing radiation.
由于发展中国家传染病患病率较高，诊断孤立性肺结节是良性还是恶性的问题更为突出。这些感染导致大量患者通常无症状，且肺部有结节，其病因无法准确界定为良性或恶性。
验证非钙化结节中良性与恶性的比例、注射造影剂后螺旋计算机断层扫描（CT）最敏感和特异的时间长度，以及是否需要三个造影后阶段。
我们研究了23例在胸部X线片或CT上发现孤立性肺结节的患者。采用斯文森方案进行螺旋扫描，但在注射造影剂开始后3、4和5分钟进行。通过组织病理学检查或随访CT 2年后结节有无生长情况将结节分为良性或恶性。
在研究的23例患者中，18例（78.2%）最终诊断为良性结节，5例（21.7%）为恶性结节。尽管样本量较小，但我们得到的结果与斯文森等人的相似，敏感性为80.0%，特异性为55.5%，准确性为60.8%。4分钟时恶性和良性病变的平均强化程度最高。
非钙化的小良性结节比恶性结节更为常见。动态对比增强CT密度分析的最佳时间是造影后４分钟。这种仅包括造影前和造影后4分钟阶段的简化斯文森方案不仅节省了时间和金钱，还减少了患者接受的电离辐射。
