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1、肺内常见的孤立性肺结节鉴别诊断方法的探索研究——应用最大似然法【摘要】目的探讨应用最大似然法鉴别周围性肺癌、肺错构瘤及结核球3种SPN的诊断价值。方法对150例经临床和手术病理证实的SPN（周围性肺癌、肺错构瘤、结核球各50例）的HRCT影像学征象进行分类统计分析，运用最大似然判别法，将其各种征象转化为记分值，以数值的大小来判定肺结节所属的类型。结果最大似然法对周围型肺癌、肺错构瘤及结核球的诊断正确率分别为86%、92%及90%，平均诊断正确率为89.3%，高于常规阅片法的82%，但两组间差异无统计学意义
2、（2=2.434，P>0.05）。最能提示为肺癌的征象依次为空泡征、分叶征、支气管充气征和血管集束征；最能提示为肺错构瘤的征象依次为脂肪、边缘清楚及钙化；最能提示为结核球的征象依次为空洞、卫星灶、钙化及胸膜凹陷征。结论最大似然法对常见SPN的鉴别诊断正确率有所提高，是一种辅助影像学诊断的有价值的方法。【关键词】肺癌,肺孤立结节,结核球,错构瘤,最大似然法，X线计算机[Abstract]ObjectiveToevaluatethediagnosticvalueofthediscriminationme
3、thodoflargelog-likelihoodstudyindifferentiatingthe3kindsofsolitarypulmonarynodule(SPN)amongperipherallungcarcinoma,hamartomaandtuberculoma.11Methods150patientswithperipherallungcarcinomas(n=50),hamartomas(n=50)andtuberculomas(n=50),pathologicallyprovedbyc
4、linicandoperation,werestudiedstatisticallywithHRCTmanifestations.Withthediscriminationmethodoflargelog-likelihood,theCTsignsofthe3kindsofSPNwereanalyzedandthentranslatedintoprobabilityscorestoidentifythenodularcategory.ResultsThediagnosticaccuracywiththed
5、iscriminationmethodoflargelog-likelihoodforperipherallungcarcinoma,hamartomaandtuberculomawere86%,92%and90%respectively.Themeanaccuracy(89.3%)ofthediscriminationmethodoflargelog-likelihoodwashigherthanthat(82%)ofroutinediagnosticmethod,buttherewasnostatis
6、ticaldifferencebetweeneachother(2=2.434，P>0.05).ThemostprobableCTsignsforlungcancerwerevacuolesign,lobulation,bron-chogramandvascularconvergence;themostprobableCTsignsforhamartomawerefat,well-definedmarginandcalcification;themostprobableCTsignsfortuber
7、culomawerecavitation,satellite,calcificationandpleuralindentation.ConclusionThediscriminationmethodoflargelog-likelihoodisakindofvaluablemethodtoassistimagingdiagnosis,andcanimprovethedifferentialdiagnosticaccuracyforcommonSPN.11[KeyWords]lungcarcinoma;so
8、litarypulmonarynodule;tuberculoma,hamartoma;discriminationmethodoflargelog-likelihood;X-raycomputed孤立性肺结节（SPN）是指直径2～30mm的全肺唯一的类圆形孤立性病灶[1]。尽管广大影像学与病理学专家对SPN的影像学特征与病理学基础进行了大量卓有成效的研究，但临床工作中SPN仍有较高的误诊率。因此，越来越多的专家试图利用较为客
