| Objective:To evaluate the value of contrast-enhanced CT,99mTc-MIBI-SPECT/CT fusion imaging and Lung-RADS grading system version 1.1 in the differential diagnosis of benign and malignant Solitary pulmonary nodule（SPN）.Methods:From March 2018 to October 2019,169 cases of SPN were diagnosed by our hospital.All the SPNS were examined by pathology after operation or puncture biopsy,and the chest enhanced CT and 99mTc-MIBI-SPECT/CT scanning data of all cases were collected one week before the operation.Among them,there were 88 male and 81 female patients with an average age of（58.44±10.97）years,ranging from 25to 80 years old.With pathological results as the gold standard,SPN was divided into benign and malignant groups,and the receiver operating characteristic curve（ROC curve）was drawn to analyze the sensitivity,specificity,diagnostic coincidence rate,positive predictive value,and negative predictive value of contrast-enhanced CT and99mTc-MIBI-SPECT/CT.The Chi-square test was used to analyze the difference between the two methods in diagnosing benign and malignant SPN.The Chi-square test was also applied in counting data,and an independent sample t-test was used to measure the differences between benign and malignant groups in terms of age,sex,basic morphological characteristics of CT,and SPECT/CT uptake ratio in early and delayed stages.Logistic regression analysis was used to screen out independent risk factors for predicting benign and malignant SPN.ROC method was used to evaluate the efficacy of enhanced CT,99mTc-MIBI-SPECT/CT,and Lung-RADS in differentiating benign and malignant SPN,and the critical value of99mTc-MIBI uptake ratio in early and delayed SPECT/CT was calculated.Results:（1）The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic coincidence rate of enhanced CT and99mTc-MIBI-SPECT/CT in the diagnosis of benign and malignant SPN were 95.9%,54.20%,84.1%,83.9%,84.0%and 87.6%,52.1%,82.2%,62.5%,77.5%respectively.The accuracy of combined diagnosis was higher than that of enhanced CT alone（x2=57.44,P<0.05）and 99mTc-MIBI-SPECT/CT（x2=29.96,P<0.05）.（2）Age,mean diameter,air bronchus sign,spiculation sign,pleural indentation sign,vacuole sign,lobulation sign,enhancement sign,and tumor microvascular sign were significantly different in benign and malignant SPN（P<0.05）,Logistic regression analysis showed that age,mean diameter of nodules,and tumor microvascular sign were independent risk factors for predicting benign and malignant SPN,and the odds ratio was 1.041,0.081,and 1.131 respectively.（3）ROC curve showed that the AUC value of enhanced CT in the diagnosis of benign and malignant SPN was 0.75,and the AUC value of99mTc-MIBI-SPECT/CT was 0.70.The diagnostic efficiency of the combination of the two methods was higher than that of a single examination（AUC=0.77）.（4）The uptake ratio（T/NT）of benign and malignant SPN at early stage and delayed stage had no significant difference（t=-0.45,t=-1.97;P>0.05）;ROC showed that Youden index was the highest when T/NT>1.4 in early stage and T/NT>1.6 in delayed stage of benign and malignant SPN,and AUC values were 0.59 and 0.68 respectively.（5）According to the ROC curve,the AUC=0.77,of solid nodules diagnosed by Lung-RADS grade was higher than that of subsolid nodules（AUC=0.71）and total nodules（AUC=0.68）,and the difference was statistically significant.（6）The mean CT value of malignant SPN was higher than that of benign SPN,and ROC showed that the mean CT value of subsolid ROC was>-398,which is an evidence of malignant SPN（AUC=0.715,P<0.05）.Conclusion:（1）Enhanced CT combined with 99mTc-MIBI-SPECT/CT scanning can improve the diagnostic efficiency of benign and malignant SPN.（2）Age,mean diameter of nodules and tumor microvascular sign were independent influencing factors for predicting malignant SPN.（3）The diagnostic efficiency of solid SPN Lung-RADS classification was higher than that of subsolid nodules and total nodules,and the average CT value of subsolid SPN was higher in malignant nodules than in benign nodules. |
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