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目的 探讨肺内结节CT血管集束征与强化值的关系.方法 收集2010年1月至2012年1月在中南大学湘雅医院行肺部双源CT平扫增强的连续原发孤立性肺内结节病例708例.将所有病例分成有血管集束征组与无血管集束征组,再依据病灶与血管连接数量将有血管集束征组分为4个亚组,分析强化值与血管集束征的关系.结果有血管集束征组强化值明显高于无血管集束征组[(27.6±10.5)比(3.2 ±2.8)HU,P=0.000],随着与病灶相连血管数目的增加,病灶强化值有增加趋势,但各亚组之间无明显差异(均P＞0.05)；分别以强化值≥15、20、25 HU为标准判别肺内恶性结节的准确度分别为84.9％、70.6％、60.3％；以有血管集束征为标准判别肺内病灶为恶性结节的敏感度、特异度、准确度分别为97.2％、68.8％、93.7％；以有血管集束征判断病灶强化程度≥15 HU的准确度为88.1％.结论 在缺乏增强图像时,血管集束征的有无可作为判断肺内结节有无强化的简易指标.

Objective To explore the correlation between computed tomographic (CT) vascular convergence sign and enhancement value in patients with pulmonary nodules.Methods A total of 708 consecutive patients with pulmonary nodule received dual-source CT scan from January 2010 to January 2012.They were divided into vascular convergence sign group (including 4 subgroups) and non-vascular convergence sign group.Then the correlation between CT vascular convergence sign and enhancement values was analyzed.Results The enhancement values in vascular convergence sign group were significantly higher than those in non-vascular convergence sign group ((27.6 ± 10.5) vs (3.2 ± 2.8) HU,P =0.000).The CT enhancement values in lesions tended to increase with the number of connecting blood vessels.However,no significant differences existed among the subgroups (P ＞ 0.05).The accuracy of vascular convergence sign for detection of pulmonary malignant nodules was 84.9％,70.6％ and 60.3％ according to the standards of CT enhancement values ≥ 15,20,25 HU respectively.The sensibility,specificity and accuracy of determining pulmonary malignant nodules were 97.2％,68.8％ and 93.7％ according to the standard of vascular convergence sign.The accuracy of determining pulmonary nodules' CT enhancement values ≥ 15 HU was 88.1％ according to the standard of vascular convergence sign.Conclusion Vascular convergence sign may be used to indicate the enhancement of pulmonary nodules when CT enhancement images are not available.