| Objective:To study CT diagnosis and differential diagnosis of SPN. To detect serum tumor markers'concentration of SPN. To investigate the clinic diagnosis value of CT scan combined with the determination of serum tumor markers for SPN. It was designed to improve the diagnostic accuracy of benign and malignant SPN.Methods:72 cases of SPN,25 cases were performed with GE Lightspeed VCT 64MSCT.20 cases were performed with GE Lightspeed VCT 16MSCT.17 cases were performed with SIEMEN EMOTION helical scanner and 10 were cases performed with PLUS 4 helical scanner. Scanning range was from the lungs pointed to bilateral renal door level, end-inspiratory hold, slice thickness and interval were 5～8mm.50 patients were performed enhanced scan.80-100 ml iopromide (300mg/ml) contrast material in antecubital vein from high pressure injector, and rate was 3.0 ml/s. SPN location, size, edge characteristics, density, internal characteristics, surrounding performance and CT enhancement were observed, measured and recorded in 5mm CT images with pulmonary window (WW 750 to 1500. WL-700--650) and mediastinal window (WW 350. WL 50). The size of the SPN was measured in lung window; the plain and maximum strengthening CT value were measured in mediastinum window.ΔCT was the maximum strengthening CT value subtraction plain CT. to 30HU CT value for threshold.> 30HU for malignant (except the vascular sample strengthened nodules),<30HU for benign. To make the diagnose of CT combined with the patient's clinical data such as age. smoking history, clinical manifestation, malignant tumor history. The serum tumor markers'concentration was detected, containing CEA,CA125,CA199,SCC-Ag,CYFRA21-1,NSE and ProGRP.The positive result was more than its normal diagnostic criteria of at least one tumor marker (diagnosed to be malignant SPN), the negative result was all normal of seven tumor markers(diagnosed to be benign SPN). Statistical analysis was executed by SPSS 17.0 software. It was compared the main CT signs between malignant and benign SPN. and calculated CT. seven tumor markers and combining two methods" sensitivity, specificity and consistency for SPN.Result:1. There were 40 cases of malignant SPN, including 21 adenocarcinomas.11 squamous cell carcinomas.2 large cell lung cancers,3 small cell lung cancers,3 metastatic carcinomas and there were 32 cases of benign SPN, including 9 tuberculosis lesions,7 cases hamartomas.5 inflammatory pseudotumors,2 bronchial cysts,2 pulmonary AVMs,2 fungal infections,1 hematoma organization,1 sclerosing angioma and 3 follow-up with imaging studies. Using CT scan alone, the sensitivity was 67.5%, the specificity was 75.0%, and the consistency was 70.8%. Using seven tumor markers alone, the sensitivity was 55.0%, the specificity was 84.3%, and the consistency was 68.1%. With combination of CT scan and seven tumor markers, the diagnostic sensitivity was 75.0%, the specificity was 71.8%, and the consistency was 73.6%.Conclusion:1. CT, especially multi-slice spiral CT was the most effective, sensitive, widely used, noninvasive way to diagnose SPN.2. SPNs'desity, edge, calcification and blood vessel of CT had significant differences between benign and malignant SPN.3. Tumor markers detection was a convenient and easy to popularize method. Tumor markers detection should be as routine examination to diagnose SPN.4. CT examination combined with tumor markers detection could improve the diagnostic accuracy of the SPN. |
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