计算机辅助诊断的三维体积测量技术在实性肺结节CT随诊中的价值  

Diagnostic value of computer-aided diagnosis with three-dimensional volumetric measurement in solid pulmonary nodules on follow-up CT

作　　者：刘瑛[1] 吴宁[1] 唐威[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院影像诊断科,100021

出　　处：《中华放射学杂志》2009年第4期351-355,共5页Chinese Journal of Radiology

基　　金：国家“十一五”科技支撑计划课题（2006BA102A01）;国家科技支撑计划课题（2007BA105B05）;首都医学发展科研基金（2005-1039）

摘　　要：目的评价计算机辅助诊断的三维体积测量技术在实性肺结节随诊中的价值。方法行2次或2次以上胸部CT扫描的实性肺结节患者46例，共计58个结节。在CT工作站上用三维体积测量软件计算结节的体积、倍增时间（DTs）和体积增长率（VGRs）。用非参数检验评价DTs在良恶性结节之间的差异有无统计学意义；用χ^2检验评价DTs阈值在良恶性结节之间的差异有无统计学意义。所有结果均经组织学、诊断性治疗或临床随诊证实。结果（1）恶性结节13个。DTs为45～465d（中位159d），12个〈400d。VGRs为8％～329％（中位30．0％）。（2）良性结节45个。VGRs为-38％～24％（中位0）。①24个体积增大或不变的结节，DTs为302～55158d（中位2704d），22个〉400d，VGRs为0～24％（中位6．5％）。②21个体积缩小的结节，无法计算DTs，VGRs为-38％～-4％（中位-16．0％）。（3）DTs在良恶性结节之间的差异有统计学意义（P〈0．05）。（4）以DTs≤500、400和300d分别作为恶性结节的诊断阈值，各阈值在良恶性结节之间的差异均有统计学意义（P均〈0．01），其敏感性分别为100．0％、92．3％、76．9％，特异性分别为87．5％、91．7％、100．0％，准确性分别为91．9％、94．6％、91．9％，阳性似然比分别为8、11、0。结论（1）以DTs≤400d作为恶性结节的诊断阈值，具有很高的诊断价值。（2）计算机辅助诊断的三维体积测χ量技术在实性肺结节的随诊中叮早期发现病变大小的变化，对鉴别结节良恶性具有重要价值，可作为难以定性的实性肺结节随诊的常规方法。Objective To evaluate the diagnostic value of computer-aided diagnosis with threedimensional volumetric measurement in solid pulmonary nodules on follow-up CT. Methods Forty-six patients with 58 solid nodules were evaluated. Each patient underwent chest CT at least twice. The volume, doubling times（DTs） and volumetric growth rates（VGRs） of nodules were calculated with three-dimensional volumetric measurement software. If there were significant statistical differences in DTs between malignant and benign nodules, Nonparametric test was used to make the analysis. If there were significant statistical differences in upper DTs＇values between malignant and benign nodules, χ^2 test was used to make the analysis. Final diagnosis of all nodule were confirmed by pathology or by response to diagnostic therapy or by clinical follow-up. Results The DTs of 13 malignant nodules were 〈400 days in 12 nodules, with a range from 45 to 465 days （median, 159 days） ; the VGRs ranged from 8% to 329% （median, 30. 0% ）. The VGRs of 45 benign nodules ranged from -38% to 24% （median, 0% ）. The DTs of 24 benign nodules that increased or not changed in size were 〉400 days in 22 nodules, with a range from 302 days to 55 158 days （median, 2 704 days）; the VGRs ranged from 0 to 24% （median, 6. 5%. Twenty-one nodules that decreased in size had the VGRs ranging from -38% to -4% （median, - 16. 0% ） , and the DTs of these nodules could not be calculated by software. There were significant statistical differences in DTs between malignant and benign nodules （P 〈 0. 05 ）. Taking 500 days, 400 days and 300 days as the upper value for malignancies there were statistically significant differences in these values between malignant and benign nodules（P 〈 0. 01 ）. Their sensitivities were 100. 0% , 92. 3% , 76. 9% respectively and specificities were 87.5% , 91.7%, 100. 0% respectively. Accuracies were 91.9%, 94. 6% ,91.9% respectively and positive predictive values were 8,11,0. Conclusions Taking 400 days as

关 键 词：硬币病变 肺 肺肿瘤 体层摄影术 X线计算机 图像处理 计算机辅助 

分 类 号：R686[医药卫生—骨科学]