The Research Of Solitary Pulmonary Nodules By Using Single-location Dynamic Enhanced CT

Solitary pulmonary nodules(SPNs) already became a kind ofcommon diseases. At present SPNs' qualitative diagnosis isimportant in the clinic, because it is related with referral andprognosis. Medically differential diagnosis between malignant andbenign SPNs is difficult. Using traditional X-ray computed chesttomography and routine computed tomography(CT) we can onlydistinguish the morphological difference of malignant and benignSPNs, but a great degree of overlap exists among malignant andbenign SPNs. Following medicinal technique developing andimaging equipment updating, the study of dynamic enhanced CT hasgrown from simple dynamic enhancement to perfusion imaging.Now the study of dynamic enhanced CT has become a hotspot. CTdynamic enhanced scan not only is an important guide line todifferentiate malignant and benign nodules, but also reflects nodules'blood stream status. Through discussing the relations of increment ofCT value,SPNs' enhanced character,time-density curve and noduleblood stream dynamics, analysing the different imaging characters ofmalignant and benign nodules ,we gain a kind of new crediblemethod to differentiate malignant and benign SPNs.39 cases of having pathologic information were scanned byusing single-location dynamic enhanced CT and described the SPNs'enhanced character,increment of CT value and time-density curve todifferentiate the malignant and benign nodules. SPNs is solitaryrounded or elliptical lesion ,and it's diameter is less than or equal to4cm, and there is not atelectasis,satellitic punctuate lesions andpartial-lymphocyte intumesce. By using Hispeed CT/I multiscalecomputed tomography(MSCT) all patients were scanned. Scanlay-deep is 3-5cm;scan mode is cine;scan space-time is15s,10s,20s,20s,55s respectively. First before enhanced patientswere scanned commonly for choosing to the best lay. Then the laywas studied by using single-location dynamic enhanced CT scan.Before scanning we should tell patient to hold his breath to assurethe same deep of breath every time. The nodule's region of interest(ROI) is 60% of pathological changes. In the ROI there are notputrescence, calcify, blood vessel, rib and so on. In the ROI CTvalue before enhanced and peak height were measured, theincrement of CT value was accounted, the results were mean +/-SD,SPSS11.5 annalysis software was used to analyze the differenceamong three data of lung cancer, tuberculomas and pulmonaryinflammatory nodules. Finally, the time-density curve was drawn byusing the Functool software.Result: 1.In 21 cases of lung cancer, the increment of CTvalue(peak height-CT value before enhanced) of 20 lung cancercases is about 41.9±2.8Hu, the increment of CT value is up to 20Hu;only one case enhanced indistinctively, the increment of CT value islower than 15Hu. The increment of CT value of tuberculomas isabout 11.7±7.85Hu, in the 10 cases it of 9 cases is lower than 15Huand it of one case is 20Hu. The increment of CT value of pulmonaryinflammatory nodules of 7 cases is 43.6±7.7Hu, it is up to 20Hu.One case the increment of CT value of hamartoma don't enhance, itis lower than 15Hu. Statistic study found that the different incrementof CT value of pulmonary carcinomas and tuberculomas had statisticmeaning(P < 0.01),the difference of pulmonary carcinoma andpulmonary inflammatory nodules had no statistic meaning(P>0.10),the difference of pulmonary inflammatory nodules and tuberculomashad statistic meaning(P < 0.01). 2. The enhanced character ofpulmonary carcinomas consisted of symmetrical aggrandizement,asymmetrical aggrandizement and circumambient aggrandizement.In 21 cases of pulmonary carcinomas aggrandizement of 10 casesassumes equably, it of 7 cases is asymmetrical and it of 4 cases iscircumambient. In the circumambient and asymmetricalaggrandizement cases there are 9 cases that the diameter of nodulesis up to 3cm, 2 cases that the diameter is 2cm. In the symmetricalaggrandizement cases there are 9 cases that the diameter is lowerthan 3cm, one case is 3.5cm. The enhanced character oftuberculomas is featheredged and non-enhanced. In the 10 casesaggrandizement of 7 cases is featheredged and aggrandizement of 3cases is non-enhanced. The enhanced character of 7 pulmonaryinflammatory cases is symmetrical. 3. The curve of tuberculomas isplacid, the peak height is low. Malignant SPNs tend to achieve rapidenhancement-to-peak attenuation and eventually reach a plateau.Inflammatory SPNs show gradual enhancement without obviousattenuation. 4. There is high relativity between results from CTdynamic enhancement and pathology, positive match rate is 85%.Conclusion: 1. The increment of CT value of malignant andinflammatory SPNs is higher than it of benign SPNs. But theincrement of CT value of malignant and inflammatory has nostatistic meaning. The use of a threshold value of enhancement of upto 15Hu, as determined by subtracting the pre-enhancement densityfrom peak enhancement density, has yielded a sensitivity, specificity,and artificial masculine rate of 95%, 56%, and 44% respectively, fordifferentiating the malignant and benign SPNs. 2. Malignant andbenign SPNs have different enhanced character, but the enhancedcharacter of pulmonary inflammatory SPNs is ruleless. Theenhanced character of malignant SPNs is related to the nodule's size.The biggers are likely to asymmetrical aggrandizement, and thesmallers are likely to symmetrical aggrandizement. The phenomenaof blood vessel mass around the nodule is found usually inadenocarcinoma, bronchiole alveolarcarcinoma, singularly in theelse style of carcinoma and benign lesion. Featheredgedenhancement is a credible proof of tuberculomas. 3. Thetime-density curve reflect current of CT enhanced value and it isdetermined by blood stream dynamics. The time-density curve maydifferentiate the malignant and inflammatory SPNs. The peak heightof time-density curve of inflammatory nodules appears latter thanthat of malignant nodules, the upper enhanced degree ofinflammatory nodules is clearer than malignant nodules. The curveof benign nodules is placid, the peak height is low.CT single-location dynamic enhanced scan is new check technique.Comparing with pathology, this study confirmed the accuracy,dependability and practical value of CT single-location dynamicenhanced scan to differentiate malignant and benign nodules.Comparing with the other techniques, because CT single-locationdynamic enhanced scan has the character noninvasively, lowerdangerous, lower charge and nonpainful, this technique has beenaccepted easily by patients. Because CT single-location dynamicenhanced scan has higher resolution, can collect more data, andobserve the lesion dynamic, the technique has more clinicalapplication value. Because there was higher relativity betweenresults from CT single-location dynamic enhanced scan andpathology, CT single-location dynamic enhanced scan has highaccuracy in clinical diagnosing of malignant and benign SPNs. CTsingle-location dynamic enhanced scan reflects the blood streamdynamics of nodules, so it has important meaning in clinicaldiagnosing and treatment. Along with development of CTequipments and technical renew, this technique will become animportant check item.