亚实性肺结节CT三维质量分析:观察者内及观察者间差异  

Three-dimensional Mass Measurement of Subsolid Pulmonary Nodules on Chest CT: Intra and Inter-observer Variability

作　　者：刘慧婷[1] 王颖[1] 冯磊[1] 于铁链[1] 

机构地区：[1]天津医科大学总医院放射科,天津300052

出　　处：《中国肺癌杂志》2015年第5期289-294,共6页Chinese Journal of Lung Cancer

基　　金：国家自然科学基金面上项目(No.81171345);中央补助地方公共卫生专项资金肺癌早诊早治项目;2012年高等学校博士学科点专项科研基金(No.20121202110005)资助~~

摘　　要：背景与目的肺内亚实性结节(包括磨玻璃密度结节和部分实性结节)体积增长常较缓慢,但恶性概率比实性结节大,常需随访确定其生长特性。恶性亚实性结节的生长性不仅可以表现为体积的增长,也可以表现为密度的增加或新出现实性成分。计算机断层扫描(computed tomography,CT)质量(Mass)测量能综合评估其体积及密度的变化,在结节随访中量化反映其生长特性。本研究目的是评估亚实性结节质量测量的重复性,并与体积测量重复性比较。方法两名医生盲法应用结节分析软件对44例患者共80个亚实性结节的CT影像资料进行三维体积及质量重复测量,对自动分割效果不佳的结节采用手动调整。应用Bland-Altman法评估质量测量及体积测量的观察者内及观察者间差异,组内相关及Wilcoxon检验评估质量测量与体积测量观察者内、间测量变异度的差异。结果74个(92.5%)亚实性结节分割效果满意纳入研究。结节直径(7.2±2.5)mm(3.2 mm-16.4 mm)。质量测量的观察者内、观察者间95%一致性区间分别为-11.5%-10.4%、-17.4%-19.3%,体积测量的观察者内、观察者间95%一致性区间分别为-8.4%-8.8%、-17.9%-19.4%,观察者内、间质量测量与体积测量变异度的组内相关系数分别为0.95、0.93(P均<0.001),二者之间无统计学差异(P值分别为0.78、0.09)。手动调整结节分割对测量的重复性有一定影响。结论亚实性肺结节的质量测量重复性较好,可作为随访定量评估方法。Background and objective Subsolid pulmonary nodules tend to exhibit considerably slower growth rates than solid lesions, nevertheless, higher malignancy probability. hTe diagnosis of indeterminate nodules largely depends on the growth evaluation during follow-up. hTe growth can manifested as an increase in size or the appearance and/or subsequent increase of solid components. hTe mass relfect the product of volume and density and can be more sensitive in growth evalu-ation. However, the repeatability needs a further validation. hTe purpose of this study is to assess the intra and inter-observer variability of mass measurement for subsolid nodules. Methods 80 subsolid nodules in 44 patients were retrospectively en-rolled. Both the volume and mass were measured by two radiologists using blind method independently. Intra-observer and inter-observer variability were analyzed and compared by Bland-Altman method intra-class correlation test and Wilcoxon test. Results Sotfware achieved satisifed segmentation for 92.5%nodules. Of them, 35%underwent manual modiifcation. hTe 95%limits of agreement for intra-observer variability were-11.5%-10.4%for mass and-8.4%-8.8%for volume. hTe 95%limits of agreement for inter-observer variability were-17.4%-19.3%for mass and-17.9%-19.4%for volume.hTe intra-class correlation foeffcients between volume and mass measument was 0.95 and 0.93 （both P〈0.001） and no signiifcant differences （P=0.78, 0.09） was found for intra-and inter-observer variability. Manual modiifcation of the segmentation caused the worse mass mea-surement repeatability in spite of the reader satisfaction. Conclusion hTe repeatability of mass measurement has no signiifcant difference with that of volume measurement and may act as a reliable method in the follow-up of subsolid nodules.

关 键 词：亚实性结节 质量测量 体积测量 计算机断层扫描 重复性 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]