CT征象在预测肺纯磨玻璃结节侵袭风险中的价值  

The value of CT features in predicting the invasiveness of PGGN

作　　者：张磊[1] 谢晓东[1] 沈文荣[1] 康铮[1] ZHANG Lei;XIE Xiaodong;SHEN Wenrong;KANG Zheng(CT/MRI Room,Jiangsu Cancer Hospital,Nanjing 210009,China)

机构地区：[1]江苏省肿瘤医院CT/MRI室,江苏南京210009

出　　处：《实用放射学杂志》2020年第2期207-210,213,共5页Journal of Practical Radiology

基　　金：江苏省卫生和计划生育委员会科学研究项目(H201509)。

摘　　要：目的探讨CT征象在预测肺纯磨玻璃结节(PGGN)侵袭风险中的价值.方法选取CT发现肺部持续存在的PGGN并经手术病理证实为早期肺腺癌158例患者共170个病灶,分析其CT征象,行单因素及多因素Logistic回归分析明确PGGN侵袭性的预测因素.结果170个病灶按病理结果分为2组:侵袭前组与侵袭组,其中侵袭前组共92例(54.11%),包括原位腺癌(AIS)30例,微浸润性腺癌(MIA)62例;侵袭组浸润性腺癌(IA)78例(35.79%);单因素分析显示2组在最长直径、CT值增加值、形状、分叶、毛刺、支气管充气征、肿瘤微血管CT成像征间差异有统计学意义(P<0.05);而在瘤肺界面、空泡、胸膜凹陷方面差异无统计学意义(P>0.05);在ROC曲线分析中CT值增加值预测IA侵袭性的临界值为256 HU,敏感性和特异性分别为83.33%和60.9%,AUC为0.737;大小预测IA侵袭性的临界值为1.35 cm,敏感性和特异性分别为48.7%和82.6%,AUC为0.706.多因素二元Logistic回归分析显示病灶的最长直径(OR=5.4,P<0.05)和CT值增加值(OR=1.101,P<0.05)可以作为IA的独立预测因素.结论PGGN侵袭前组与侵袭组在最长直径、CT值增加值、形状、分叶、毛刺、支气管充气征、肿瘤微血管CT成像征间差异有统计学意义;病灶的最长直径和CT值增加值是IA的独立预测因素.Objective To explore the value of CT features in predicting the invasiveness of pure ground-glass nodule(PGGN).Methods CT features of 170 persistent PGGN which were conformed to be early lung carcinomas by surgery in 158 patients were analyzed retrospectively.Univariate and multivariate Logistic regression analysis were also conducted to determine the risk factors in predicting invasiveness of PGGN.Results 170 PGGN were divided into two groups:pre-invasive group(92 cases)including 30 adenocarcinoma in situ(AIS)and 62 minimally invasive adenocarcinoma(MIA),and invasive group invasive adenocarcinoma(IA)(78 cases).Univariate analysis showed that there were significant differences between the two groups in the longest diameter,CT VAL-plus,shape,lobulation,burr,air bronchogram and CT microangiogram sign(P<0.05).There were no significant differences in tumor-lung interface,bubblelucency and pleural retraction(P>0.05).The ROC analysis for the CT VAL-plus conformed a cut-off value of 256 HU which yielded the sensitivity(83.33%)and specificity(60.9%),and the AUC was 0.737.The cut-off value for the longest diameter was 1.35 cm,with sensitivity and specificity of 48.7%and 82.6%,and the AUC was 0.706.Multivariate Logistic regression analysis revealed that the longest diameter(OR=5.4,P<0.05)and the CT VAL-plus(OR=1.101,P<0.05)were the independent risk factors of IA.Conclusion The longest diameter,CT VAL plus,shape,lobulation,burr,air bronchogram and CT microangiogram sign are significantly different between the invasive group and pre-invasive group of the PGGN.The longest diameter and the CT VAL-plus can independently predict IA.

关 键 词：肺肿瘤 侵润性腺癌 计算机体层成像 支气管充气征 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]