肺实质性附壁结节（SPANs）不常被检测到，因此研究和理解不足。本研究旨在确定鉴别良性和恶性SPANs的临床和CT特征。从2017年1月至2023年3月，共纳入了295名患者的300例SPAN（良性128例，恶性172例）进行回顾性分析。良性和恶性SPAN之间在患者年龄、吸烟史、临床症状、CT特征、结节-胸膜界面、相邻胸膜变化、外围伴发病灶和淋巴结肿大方面存在显著差异。多变量分析显示，吸烟史（奥尔斯比比率[OR] 2.016；95%置信区间[CI] 1.037-3.919；p = 0.039）、毗邻纵隔胸膜（OR 3.325；95% CI 1.235-8.949；p = 0.017）、结节直径（＞15.6mm）（OR 2.266；95% CI 1.161-4.423；p = 0.016）、裂隙状（OR 8.922；95% CI 4.567-17.431；p ＜ 0.001）、狭窄基底对胸膜（OR 6.035；95% CI 2.847-12.795；p ＜ 0.001）和同时伴发纵隔和纵膈淋巴结肿大（OR 4.971；95% CI 1.526-16.198；p = 0.008）是恶性SPANs的独立预测因素，该模型的曲线下面积（AUC）为0.890（敏感性82.0%，特异性77.3%）（p ＜ 0.001）。在有吸烟史的患者中，毗邻纵隔胸膜的SPANs、较大尺寸（直径＞15.6mm）、裂隙状、狭窄基底或同时伴发纵膈和纵隔淋巴结肿大的SPANs更有可能为恶性。良性和恶性SPANs在临床和CT特征上有显著差异。了解良性和恶性SPANs之间的差异有助于选择高风险病例，并避免不必要的手术切除。·实质性附壁结节（SPANs）与胸膜密切相关。·结节与胸膜的关系和胸膜变化对区分SPANs至关重要。·良性SPANs通常具有广泛的胸膜增厚或埋在增厚的胸膜中。·吸烟史和边缘毗邻纵隔胸膜的病变是恶性SPANs的指标。·恶性SPANs通常具有较大的直径、裂隙征象、狭窄基底和淋巴结增大。©2023. 欧洲放射学协会（ESR）。

Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs.From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001).In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant.The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection.• The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.© 2023. European Society of Radiology (ESR).