肋骨抑制成像技术在胸片检测不同密度、大小及位置肺结节中的应用  

Bone Suppression Images Improve Radiologists’ Performance on Detection of Lung Nodules with Different Size,Density and Location on Chest Radiographs

作　　者：王云龙[1] 范丽[1] 望云[1] 管宇[1] 夏艺[1] 李琼[1] 刘士远[1] WANG Yunlong;FAN Li;WANG Yun;et al(Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, P. R. Chin)

机构地区：[1]第二军医大学长征医院影像诊断科

出　　处：《临床放射学杂志》2018年第3期509-513,共5页Journal of Clinical Radiology

基　　金：国家自然科学基金重点项目(编号:81230030);国家自然科学基金面上项目(编号:81370035);上海市科委重大生物医药专项(编号:13411950100);浦江上海人才项目(编号:15PJD002);国家重点研发计划政府间科技合作项目(编号:2016YFE0103000)

摘　　要：目的评价肋骨抑制成像技术在胸片检测不同密度、大小和分布位置的肺结节中的应用价值。方法回顾性分析128例经CT证实存在肺单发结节的胸部后前位X线片和130名正常健康体检者胸片。将肺结节根据密度（实性,混杂磨玻璃,纯磨玻璃）、最长径（D）（3≤D〈10 mm,10≤D〈20 mm,20≤D〈30 mm）及分布（肺周边区,肺门区,肺尖区）分组,分别进行分析。两名高年资与两名低年资放射科医师分别独立阅读所有胸部后前位X线片和经肋骨抑制成像技术处理后的胸部后前位X线片。阅读、记录结节的部位、大小并对结节存在的肯定度进行评分。观察的结果采用受试者工作特征（ROC）曲线进行分析。结果四名放射科医师使用去肋骨图像前后的平均ROC曲线下面积（AUC）由0.722提高到0.764,两者有统计学差异（t=-13.282,P〈0.01）,肺结节检出率由51.6%（66/128）提高到58.2%（74.5/128）,且对分布在肺周边区的实性或者亚实性中等大小（10≤D〈20 mm）的结节效果最好。结论肋骨抑制成像技术可以显著提高放射科医师对胸部后前位X片中肺结节的检出率,其效能与结节的密度、大小和分布有关。Objective To evaluate the difference of the performance of bone suppression imaging（ BSI） on the detection of lung nodules with different size,density and location. Methods There were 258 Standard posteroanterior（ PA） digitalchest radiographs,which included 128 patients with a solitary nodule and 130 controls in this observer study. All the lung nodules were devided into groups based on density,size and distribution to analyse respectively. In the observer study,4 observers which included 2 radiologists and 2 residents,indicated their confidence level regarding the presence of a nodule for each lung,first by use of standard images,then with the addition of bone suppression images. Receiver operating characteristic（ ROC） curve analysis was used to evaluate the observers＇ performance. Results The mean value of the area under the ROC curve（ AUC） of four observers without and with temporal subtraction images were 0. 722 and 0. 764,respectively（ P 0. 01）. Average sensitivity for detection of lung nodules was improved from 51. 6%（ 66/128） to 58. 2%（ 74. 5/128）by using BSI. Increase of detection performance was highest for medium-sized（ 10≤D 20 mm） solid or subsolid nodules located on peripheral lung area. Conclusion The use of bone suppression images can improve radiologists＇ performance on detection of lung nodules on chest radiographs.

关 键 词：硬币病变 肺 肺肿瘤图像处理 计算机辅助 

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