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目的通过对肺内孤立性结节血管征的出现及其分型以及血管直径测量,探讨其在鉴别诊断中的价值。方法对186例肺内孤立性结节作肺部CT常规容积扫描8mm重建,局部动态增强扫描0.2mm重建,观察病灶及周围血管形态并作分类和测量。结果手术病理证实肺内孤立性结节186例,血管征的总出现率为80.9%(149/186),其中恶性孤立性为结节87.3%(89/102),良性孤立性结节为71.5%(60/84),两者差异有统计学意义(P<0.05)。血管征可分为4种类型,在良、恶性孤立性结节中的出现率差异有统计学意义(P<0.01)。恶性孤立性结节的平均血管总直径为(4.9±1.3)mm,明显大于良性孤立性结节(2.3±0.3)mm,差异有统计学意义(P<0.05)。恶性SPN的单根血管最粗为(3.61±1.21)mm,而良性为(1.70±0.21)mm,差异有统计学意义(P<0.05)。结论 HRCT薄层扫描能很好显示孤立性结节的血管,血管征分型及血管的直径大小对孤立性结节的鉴别诊断有比较大的帮助。
OBJECTIVE: To investigate the differential diagnosis of solitary pulmonary nodules in the lung by the appearance and classification of blood vessels and the diameter of blood vessels. Methods Totally 186 cases of solitary pulmonary nodules were reconstructed by conventional 8-mm CT scan of the lungs. Local dynamic contrast-enhanced scanning was performed on a 0.2-mm reconstruction. The lesions and their peripheral blood vessels were observed for classification and measurement. Results 186 cases of solitary pulmonary nodules were confirmed by operation and pathology. The total appearance of vascular signs was 80.9% (149/186). The malignant isolation was 87.3% (89/102) of nodules and 71.5% of benign solitary nodules % (60/84), the difference was statistically significant (P <0.05). Vascular signs can be divided into four types, the difference was statistically significant in benign and malignant solitary nodules (P <0.01). The average diameter of malignant solitary nodules was (4.9 ± 1.3) mm, which was significantly higher than that of benign solitary nodules (2.3 ± 0.3) mm, the difference was statistically significant (P <0.05). The diameter of the single vessel of malignant SPN was (3.61 ± 1.21) mm and the benignity was (1.70 ± 0.21) mm, the difference was statistically significant (P <0.05). Conclusion HRCT thin-section scanning can well show that solitary nodules of blood vessels, vascular classification and the size of the diameter of the blood vessels on the differential diagnosis of isolated nodules are more helpful.