Gross B H, Glazer G M, Bookstein F L
J Comput Assist Tomogr. 1985 Sep-Oct;9(5):880-5. doi: 10.1097/00004728-198509000-00007.
Prior to the advent of CT, the radiographic demonstration of multiple nonmiliary lung nodules usually indicated the presence of metastases or, less likely, granulomas. The increased sensitivity of CT at detecting small parenchymal pulmonary densities is accompanied by loss of specificity, creating uncertainty as to the significance of nodules detected at CT in any individual patient. During a 1 year period we reviewed all CT scans in our institution demonstrating three or more focal lung densities, noting these parameters: number of densities, maximum lesion size, presence of calcification as determined visually, and lesion morphology (linear or nodular). Of 137 patients with three or more focal lung densities at CT, nodule diagnosis was established on pathologic or clinical grounds in 114. Metastases accounted for 73%, with primary colon and lung malignancies and lymphoma the most common causes. Malignant nodules were statistically significantly larger, more numerous, and more rounded, whereas calcification was significantly associated with benign disease. However, no single criterion or combination of criteria was foolproof. Based on our results, we offer recommendations for further evaluation of nodules in several common clinical settings.
在CT出现之前，多个非粟粒性肺结节的X线表现通常提示转移瘤的存在，或者较少见的肉芽肿。CT检测小的肺实质密度的敏感性增加，但特异性降低，这使得在任何个体患者中CT检测到的结节的意义变得不确定。在1年的时间里，我们回顾了本机构所有显示三个或更多局灶性肺密度的CT扫描，记录了以下参数：密度数量、最大病变大小、肉眼确定的钙化情况以及病变形态（线性或结节状）。在137例CT显示三个或更多局灶性肺密度的患者中，114例通过病理或临床依据确诊了结节。转移瘤占73%，原发性结肠癌、肺癌和淋巴瘤是最常见的病因。恶性结节在统计学上显著更大、更多且更圆，而钙化与良性疾病显著相关。然而，没有单一标准或标准组合是万无一失的。基于我们的结果，我们针对几种常见临床情况中结节的进一步评估提供了建议。
