肺亚实性结节CT图像定量变化对浸润的判断  

Quantitative Feature Change of Pulmonary Subsolid Nodule on CT Image to Determine Its Invasiveness

作　　者：施丽萍 张亚平 解学乾[1] 蒋蓓蓓 陈安[1] SHI Liping;ZHANG Yaping;XIE Xueqian;JIANG Beibei;CHEN An(Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Radiology department,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院放射科

出　　处：《CT理论与应用研究（中英文）》2019年第5期541-548,共8页Computerized Tomography Theory and Applications

基　　金：上海市科学技术委员会项目（16411968500;16410722300）;科技部国际合作项目（2016YFE0103000）;上海交通大学医学院高峰学科—临床医学研究型医师（20181814）

摘　　要：目的:定量评估肺亚实性结节(SSN)内非实性成分从基线到随访CT扫描之间的变化,以鉴别诊断有浸润表现的SSN,即微浸润性腺癌(MIA)和浸润性腺癌(IAC)。材料与方法:回顾性纳入有基线和复查CT,并有组织学结果的SSN。测量指标为SSN整体最大直径,非实性成分CT值均值、最大CT值、最小CT值和CT值标准差。以时间为因变量,用线性回归评估SSN测量值从基线到复查扫描的进展。采用受检者工作特征曲线(ROC)和曲线下面积(AUC)评价测量值年化改变对有浸润表现SSN的诊断能力。结果:71名患者(男32,女39)中纳入78个SSN,其中良性19个,原位腺癌10个,微浸润腺癌36个,浸润腺癌13个。所有SSN分类的直径均与时间呈显著正相关(P<0.05)。有浸润表现SSN的非实性成分CT值标准差与时间显著正相关(P=0.037)。良性和原位腺癌中,所有4个CT值指标与时间无相关性(P>0.05)。ROC分析提示CT值标准差年化改变可以明显诊断有浸润表现的SSN(P=0.014),诊断敏感性、特异性和AUC分别为68.7%,77.8%和0.747。结论:在SSN的复查过程中,良性、原位腺癌、MIA和IAC的直径都有增加,评估CT值标准差的变化能够鉴别诊断有浸润表现的SSN(MIA和IAC)。Aim:To quantitatively evaluate the changes of the non-solid components in pulmonary subsolid nodules(SSN)between baseline and follow-up CT scan in order to identity SSN with invasive manifestations,i.e.,minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).Materials and methods:Patients with baseline and follow-up CT scans,who had one or more SSNs and histological results,were retrospectively included.The measurement parameters were the maximum diameter of the whole SSN,the mean,the maximum and the minimum CT value,and the standard deviation of CT value of the non-solid component.Time dependent linear regression were used to evaluate the progression of nodule measurements from the baseline to follow-up scan.The diagnostic performance for SSN with invasive manifestations was evaluated by using the receiver operating characteristic curve and the area under the curve(AUC).Results:71 patients(32 males and 39 females)with 78 SSNs were included.Nineteen SSNs were benign,ten adenocarcinoma in situ(AIS),36 MIA and 13 IAC.The diameter of all SSNs positively correlated with time(all P<0.05).The standard deviation of CT values of the non-solid components with invasive manifestations positively correlated with time(P=0.37),but the other three CT values did not correlate with time(all P>0.05).In benign and AIS,all four CT value parameters had no correlation with time(all P>0.05).Annual changes of the standard deviation of CT value significantly determined invasive SSN(P=0.014).The sensitivity,specificity and AUC were 68.7%,77.8%and 0.747,respectively.Conclusion:The diameter of benign,AIS,MIA and IAC increases during follow-up.The changes of the standard deviation of CT value may be used to differentiate and diagnose SSN with invasive manifestations(MIA and IAC).

关 键 词：CT 肺亚实性结节 肺腺癌 量化 

分 类 号：R812[医药卫生—放射医学] R445.5[医药卫生—临床医学]