肺混杂密度磨玻璃结节的薄层CT特征对微浸润性肺腺癌和浸润性肺腺癌的鉴别价值  

Differential value of thin-slice CT features of lung mixed ground glass nodules between minimally invasive adenocarcinomas and invasive adenocarcinoma

作　　者：叶圣利 许顺良[2] 郑小平 胡文超 蒋家康 杨莉[4] YE Shengli;XU Shunliang;ZHENG Xiaoping;HU Wenchao;JIANG Jiakang;YANG Li(Department of Radiology,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310000,China;Department of Radiology,the First Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Pathology,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310000,China;Department of Respiratory Medicine,Shulan(Hangzhou)Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College,Hangzhou 310000,China)

机构地区：[1]浙江树人大学树兰国际医学院附属树兰杭州医院放射科,浙江杭州310000 [2]浙江大学医学院附属第一医院放射科,浙江杭州310003 [3]浙江树人大学树兰国际医学院附属树兰杭州医院病理科,浙江杭州310000 [4]浙江树人大学树兰国际医学院附属树兰杭州医院呼吸科,浙江杭州310000

出　　处：《温州医科大学学报》2020年第7期547-552,共6页Journal of Wenzhou Medical University

基　　金：浙江省自然科学基金资助项目(LY15H010005)。

摘　　要：目的:分析表现为肺混杂密度磨玻璃结节(MGGN)的微浸润性腺癌和浸润性腺癌的薄层CT影像学特征,为选择合理的手术方式提供参考。方法:选取2017年1月至2018年12月在浙江大学医学院附属第一医院经手术病理证实的200例肺腺癌患者,包含216个MGGN,分为微浸润性腺癌(MIA)组(n=107)和浸润性腺癌(IAC)组(n=109)。比较2组影像学特征,通过多因素logistic回归分析浸润性的危险因素,ROC曲线分析影像学特征的诊断效能。结果:MIA组与IAC组在边界清楚、分叶征、结节CT值、磨玻璃成分直径、实性成分直径、结节直径等影像学特征上差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,边界清楚(OR=0.063,95%CI=0.008~0.507,P=0.009)、分叶征(OR=0.383,95%CI=0.147~0.993,P=0.048)为提示其浸润性的危险因素,结节CT值(OR=1.007,95%CI=1.001~1.014,P=0.029)、磨玻璃成分CT值(OR=1.007,95%CI=1.001~1.013,P=0.030)、实性成分直径(OR=337.004,95%CI=17.431~6515.579,P<0.001)、结节直径(OR=3.528,95%CI=1.146~10.862,P=0.028)越大,MGGN病理证实为IAC的可能性更大。ROC曲线分析结果显示:边界清楚、分叶征的敏感度为9.35%、58.88%,特异度为97.85%、59.63%,曲线下面积为0.536、0.593;结节CT值、磨玻璃成分CT值、实性成分直径、结节直径的诊断截断值为-408 Hu、-496Hu、0.4cm、1.1cm;敏感度为77.57%、86.92%、89.72%、57.94%;特异度为84.40%、71.56%、99.08%、82.57%;曲线下面积为0.881、0.835、0.954、0.756。结论:在MGGN患者中,MIA组边界清楚更少,有更少的分叶征,更小的实性成分直径(≤4 mm)和结节直径(≤11 mm),更低的结节CT值(≤-408 Hu)和磨玻璃成分CT值(≤-496 Hu)。薄层CT影像学特征能为表现为MGGN的MIA和IAC的鉴别诊断提供一定的帮助。Objective:To explore the differential value between lung minimally invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC)manifesting as mixed ground-glass nodule(MGGN)by analyzing the imaging features of thin section computed tomography(TSCT),so as to help thoracic surgeons to choose a reasonable surgical method for patients.Methods:There were 200 patients with 216 pathologically diagnosed MGGN(107 MIA and 109 IAC)from the First Affiliated Hospital of Zhejiang University School of Medicine included in this study.By comparing the imaging features of the two groups,the invasive risk factors were analyzed by multivariate logistic regression,and the diagnostic efficiency of the imaging features was analyzed by ROC curve.Results:There were statistical differences between MIA group and IAC group in clear border,lobulation sign,nodule diameter,the diameter of the solid component,the CT values of nodule and ground-glass components(P<0.05).The results of multivariate logistic regression analysis showed clear border(OR=0.063,95%CI=0.008-0.507,P=0.009)and lobulation sign(OR=0.383,95%CI=0.147-0.993,P=0.048)were the risk factors for their invasion.However,the greater the CT values of nodule(OR=1.007,95%CI=1.001-1.014,P=0.029),the CT values of ground-glass components(OR=1.007,95%CI=1.001-1.013,P=0.030),the diameter of the solid component(OR=337.004,95%CI=17.431-6515.57,P<0.001)and the diameter of the nodule(OR=3.528,95%CI=1.146-10.862,P=0.028),the more likely it was for MGGN to be pathologically confirmed as IAC.The corresponding diagnostic sensitivity,specificity,areas under the ROC curve(AUC)of clear border were 9.35%,97.85%and 0.536,respectively;lobulation sign was 58.88%,59.63%and 0.593,respectively.The corresponding diagnostic cut-off value,sensitivity,specificity,AUC of CT values of nodule were-408 Hu,77.57%,84.40%and 0.881%,respectively;CT values of ground-glass components were:-496 Hu,86.92%,71.56%and 0.835,respectively;the solid component was 0.4 cm,89.72%,99.08%and 0.954%respectively in diameter;the nodule was

关 键 词：薄层CT 微浸润腺癌 浸润性腺癌 混杂密度磨玻璃结节 

分 类 号：R655.3[医药卫生—外科学]