Mustafa Fatih ERKOÇ, Hakan İMAMOĞLU, İsa DÖNGEL, Ertuğrul MAVİLİ, Mustafa GÜLEÇ

Soliter pulmoner nodüllerin değerlendirilmesinde kontrastlı dinamik bilgisayarlı tomografi tetkiki (Klinik çalışma)

Amaç: Malign ve benign soliter pulmoner nodüllerin ayrımında kontrastlı dinamik bilgisayarlı tomografi (BT) tetkikinin değerinin araştırılması. Yöntem ve Gereçler Klinik ve radyolojik bulgularla olası malign olarak değerlendirilen olgulara kontrastlı dinamik BT tetkikini yapıldı. Olgulardan kontrast öncesi ve kontrast verildikten sonra 1.,2., 3. ve 4.dakikalarda aynı düzeyden kesitler alındı. Her bir nodül için nodülün 1-2 mm periferini içermeyen ve santralini kapsayan bir alandan BT dansiteleri ölçüldü. Pre ve post kontrast görüntüler arasında herhangi bir dakikada hesaplanan maksimum kontrastlanma farkı maksimum atenüasyon değeri olarak kaydedildi. Benign malign ayrımında 20 HÜ değeri eşik değer kabul edildi. Seçilen eşik değere göre maksimum atenüasyon değerinin sensitivite, spesivite, pozitif ve negatif prediktivite değerleri hesaplandı. Bulgular: 30 olgu malign, yedi olgu benign lezyon tanısı aldı. Malign nodüllerin maksimum atenüasyon değerleri benign nodüllerden istatistiksel olarak farklıydı (p=0.003). Maksimum atenüasyonun 20 HÜ ve üzerinde olmasının malignite için sensitivitesi %96.6, spesivitesi %42,9, pozitif prediktif değeri %87.9, negatif prediktif değeri %75 olarak hesaplandı. Sonuç: Kontrastlı dinamik BT malign soliter pulmoner nodüllerin erken dönemde teşhisinde kullanılabilir.

Evaluating contrast dynamic computed tomography of solitary pulmonary nodules (Experimental study)

Aim: To evaluate the effectivenes of contrast enhanced dynamic CT for differentiating malign from benign lesions. Material and Methods: The lesions that were classified as probable malign according to radiological and clinical findings were included in the study. Precontrast ,and postcontrast images at 1,2,3, and 4th minutes from the same levels were obtained. CT densities were calculated from a region which constituted of the central part excluding the peripheral 1-2 mm of the lesion. The maximum enhancement at any time was accepted as maximum attenuation value. The cut-off level for malign and benign lesions was accepted as 20 HU maximum attenuation value. The sensitivity, spesifity, positive predictive and negative predictive value for this cut-off level was calculated. Results: 30 of the lesions were malign, and seven of the lesions were benign. The maximum attenuation value of the malign lesions were statistically different (p=0.003) from benign lesions. The sensitivity, spesivity, positive predictive, and negative predictive value for the cut-off level was found as 96.6%, 42,9%, 87.9%, and 75% respectively. Conclusion: Contrast enhanced dynamic CT may be used for early diagnosis of malign solitary pulmonary nodules.

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