摘要目的:分析多层螺旋CT(MSCT)动脉扫描联合CT薄层靶重建对肺内小结节性质的评估价值。方法:前瞻性纳入2019年1月至2020年6月郑州市第九人民医院收治的84例肺内小结节患者作为研究对象，所有患者均接受MSCT动脉扫描及CT薄层靶重建检查，且在接受检查后2周内CT引导下行肺小结节穿刺活检检查，判断肺内小结节性质，以CT引导下肺小结节穿刺病理活检检查结果作为金标准，分析MSCT动脉扫描、CT薄层靶重建单独及联合诊断肺内小结节性质的价值，并观察两种检查方式的主要影像学特征。结果:84例肺内小结节患者病理活检检查结果示良性31例，恶性53例。MSCT动脉扫描联合CT薄层靶重建的准确度、灵敏度均高于单独使用MSCT动脉扫描、CT薄层靶重建，差异有统计学意义( P<0.05)；MSCT动脉扫描、CT薄层靶重建技术单独与联合检查的特异度、阳性预测值、阴性预测值组间比较差异未见统计学意义( P>0.05)。MSCT动脉扫描恶性小结节多为毛刺征、分叶征、空泡征、胸膜凹陷征，部分良性小结节可见少许毛刺、分叶及胸膜凹陷征；CT薄层靶重建可发现更多细微CT征象，如钙化、棘状突起及脂肪等，良性肺内小结节主要为圆形，且表面光滑。 结论:MSCT动脉扫描与CT薄层靶重建联合评估肺内小结节性质有协同作用，可提升对肺内小结节恶性的诊断效果。

abstractsObjective:To analyze the value of multi-slice spiral computed tomography (MSCT) arterial scan combined with CT thin-layer target reconstruction in evaluating the nature of small intrapulmonary nodules.Methods:A total of 84 patients with small intrapulmonary nodules admitted to Zhengzhou Ninth People’s Hospital from January 2019 to June 2020 were prospectively included as the study subjects. All patients received the examination of MSCT arterial scan and thin-layer target reconstruction, and the examination of CT guided needle biopsy of small intrapulmonary nodules was performed 2 weeks after examination to determine nature of pulmonary nodules. With the results of CT guided needle biopsy of small intrapulmonary nodules as the gold standard, the value of MSCT arterial scan, CT thin-layer target reconstruction alone, and combination of them in the diagnosis of nature of small intrapulmonary nodules was analyzed. The main imaging features of the two examination methods were observed.Results:In 84 patients with small intrapulmonary nodules, CT guided needle biopsy examination showed 31 cases benign nodules and 53 cases malignant nodules. The accuracy and sensitivity of MSCT arterial scan combined with CT thin-layer target reconstruction were higher than those of MSCT arterial scan and CT thin-layer target reconstruction alone ( P<0.05). There was no statistical significant difference in the specificity, positive predictive value and negative predictive value among MSCT arterial scan, CT thin-layer target reconstruction alone, and combined examination ( P>0.05). The malignant nodules of MSCT arterial scan were mostly spiculated, lobulated, vacuolated and pleural indentation, while some benign nodules were slightly spiculated, lobulated and pleural indentation; thin-layer target reconstruction can find more subtle CT signs, such as calcification, spinous process and fat, while benign pulmonary nodules are mainly round and smooth. Conclusions:MSCT arterial scan combined with CT thin-layer target reconstruction has a synergistic effect in evaluating the nature of small intrapulmonary nodules, which can improve the diagnostic effect of malignant small intrapulmonary nodules.