Yin Yue-Hui, Qi Yuan-Gang, Wang Bing
Department of Radiology, Weifang People's Hospital, Weifang, China.
Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
J Thorac Dis. 2022 Apr;14(4):1225-1231. doi: 10.21037/jtd-22-372.
Pulmonary nodular mucinous adenocarcinoma (PNMA) tends to be easily misdiagnosed as tuberculoma in practice. In this study, we aimed to discriminate PNMA from tuberculoma with dynamic computed tomography (CT).
In this study, 38 consecutive pathologically confirmed cases of PNMA and 23 cases of tuberculoma from January 2015 to December 2019 were retrospectively collected. The mean CT attenuations of each lesion were examined. The values on the plain scan, the venous scan, and the enhanced values (CT attenuation of lesion of venous scan minus that of the plain scan) were tested with an independent -test pair-wisely. Receiver operating characteristic (ROC) curve analyses were performed to test the differential diagnosis values. The presence of satellite lesions was determined with the chi-square test.
The mean CT attenuation of tuberculoma shown on the plain scan was significantly higher than that of PNMA (35.15±16.00 24.00±12.67 HU; P<0.01). The enhanced value of tuberculoma on venous scan was significantly lower than that of PNMA (13.44±13.40 22.52±14.00 HU; P=0.02). The optimum CT attenuation of the plain scan and the enhanced value for differential diagnosis were 28.80 and 14.25 HU [area under the curve (AUC) =0.72, 95% confidence interval (CI): 0.58-0.86; and AUC =0.70, 95% CI: 0.59-0.84], with sensitivity (78.3% 71.1%) and specificity (63.8% 69.6%) respectively. The satellite lesions were more often observed in the tuberculoma group (P<0.01).
The CT attenuation of the plain scan, the enhanced value after enhancement, and the presence of satellite lesions might be useful in differentiating PNMA from tuberculoma.
在实际临床中，肺结节状黏液腺癌（PNMA）容易被误诊为结核瘤。在本研究中，我们旨在通过动态计算机断层扫描（CT）鉴别PNMA与结核瘤。
本研究回顾性收集了2015年1月至2019年12月期间38例经病理证实的连续PNMA病例和23例结核瘤病例。检测每个病变的平均CT衰减值。对平扫、静脉期扫描的值以及强化值（静脉期扫描病变的CT衰减值减去平扫的CT衰减值）进行独立样本t检验。进行受试者操作特征（ROC）曲线分析以检验鉴别诊断价值。采用卡方检验确定卫星灶的存在情况。
结核瘤平扫显示的平均CT衰减值显著高于PNMA（35.15±16.00对24.00±12.67HU；P<0.01）。结核瘤静脉期扫描的强化值显著低于PNMA（13.44±13.40对22.52±14.00HU；P=0.02）。平扫的最佳CT衰减值和用于鉴别诊断的强化值分别为28.80和14.25HU[曲线下面积（AUC）=0.72，95%置信区间（CI）：0.58 - 0.86；以及AUC =0.70，95%CI：0.59 - 0.84]，敏感性分别为（78.3%对71.1%）和特异性分别为（63.8%对69.6%）。卫星灶在结核瘤组中更常被观察到（P<0.01）。
平扫的CT衰减值、强化后的强化值以及卫星灶的存在情况可能有助于鉴别PNMA与结核瘤。
