双层探测器光谱CT平扫定性联合定量参数预测肺纯磨玻璃结节侵袭性的价值  

The value of qualitative and quantitative parameters of dual-layer spectral detector CT plain scan in predicting the invasiveness of pure ground-glass pulmonary nodules

作　　者：李敏 王娅菲 姜文蓁 李琪 王化 叶兆祥 Li Min;Wang Yafei;Jiang Wenzhen;Li Qi;Wang Hua;Ye Zhaoxiang(Department of Radiology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy Tianjin,Tianjin′s Clinical Research Center for Cancer,Tianjin 300060,China;Department of Pathology,Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy Tianjin,Tianjin′s Clinical Research Center for Cancer,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院放射科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津300060 [2]天津医科大学肿瘤医院病理科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津300060

出　　处：《中华放射学杂志》2022年第3期248-253,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(81601492)。

摘　　要：目的探讨双层探测器光谱CT平扫定性联合定量参数预测肺纯磨玻璃结节(pGGN)侵袭性的价值。方法回顾性分析2019年11月至2020年12月天津医科大学肿瘤医院术前接受双层探测器光谱CT胸部平扫,表现为pGGN且病理证实为肺腺癌113例患者(119个pGGN)的临床和影像学资料。根据pGGN的侵袭性,将119个pGGN分为非浸润性腺癌组(非IA组,66个,包括10个不典型腺瘤样增生、26个原位腺癌和30个微浸润腺癌)和浸润性腺癌(IA)组(53个)。纳入分析的定性参数包括结节形状、肺瘤界面、分叶征、毛刺征、胸膜牵拉征、空泡征、支气管充气征和血管异常征;定量参数包括结节大小、有效原子序数(Z_(eff))、120 kVp混合能量图像的CT值(CT_(120 kVp))以及40~200 keV虚拟单能量图像的CT值(CT_(40 keV)~CT_(200 keV))和能谱曲线斜率(λHU)。采用χ^(2)检验、Mann-Whitney U检验和独立样本t检验对非IA组与IA组的定性及定量参数差异进行分析。采用logistic回归分析筛选出pGGN侵袭性的独立预测因素,并以受试者操作特征(ROC)曲线评价单个独立预测因素以及联合独立因素对pGGN侵袭性的预测效能。结果非IA组与IA组结节形状、分叶征、支气管充气征、血管异常征分布及结节大小、Z_(eff)、CT_(120 kVp)及CT_(40 keV)~CT_(200 keV)的差异均具有统计学意义(P<0.05)。多因素logistic回归分析显示结节大小(优势比9.269,95%CI 1.640~52.395,P=0.012)、CT_(200 keV)(优势比1.012,95%CI 1.006~1.019,P<0.001)以及血管异常征(优势比4.940,95%CI 1.358~17.969,P=0.015)是pGGN侵袭性的独立预测因素。对单个独立预测因素以及3个因素联合的ROC曲线分析显示3个因素联合预测pGGN侵袭性的曲线下面积(AUC)显著高于血管异常征(Z=4.01,P<0.001)和CT_(200 keV)(Z=3.25,P=0.001)的AUC,而3个因素联合与结节大小的AUC差异无统计学意义(Z=1.94,P=0.052)。3个独立预测因素联合预测pGGN侵袭性的AUC为0.909,以0.505为阈值,Objective To explore the predictive value of qualitative and quantitative parameters of dual-layer spectral detector CT plain scan on the invasiveness of pure ground-glass pulmonary nodules(pGGNs).Methods Clinical and imaging data of 113 patients(119 pGGNs)with pathology-proven lung adenocarcinoma who underwent preoperative dual-layer spectral detector CT plain scan in Tianjin Medical University Cancer Institute and Hospital from November 2019 to December 2020 were retrospectively analyzed.According to invasiveness,pGGNs were divided into non-invasive adenocarcinoma(non-IA)group(n=66)and IA group(n=53).The non-IA group included atypical adenomatous hyperplasia(n=10),adenocarcinoma in situ(n=26)and minimally invasive adenocarcinoma(n=30).The qualitative parameters were nodule shape,lung-tumor interface,lobulation,spiculation,pleural retraction,bubblelike lucency,air bronchogram and vascular abnormality.The quantitative parameters included nodule size,effective atomic number(Z_(eff)),CT value on 120 kVp images(CT_(120 kVp))and virtual monoenergetic images from 40 keV to 200 keV(CT_(40 keV)-CT_(200 keV)),and slope of energy spectrum curve(λHU).The χ^(2) test,Mann-Whitney U test and independent sample t test were used to analyze the parameter differences between non-IA group and IA group.Multivariate logistic regression analysis was performed to screen out independent predictors.Receiver operating characteristic(ROC)curve was used to assess the diagnostic efficacy of single predictor and combined independent factors for the invasiveness of pGGN.Results Significant differences were found in nodule shape,lobulation,air bronchogram,vascular abnormality,nodules size,Z_(eff),CT_(120 kVp) and CT_(40 keV)-CT_(200 keV) between non-IA and IA groups(P<0.05).The maltivariate logistic regression analysis showed that nodule size[odds ratio 9.269,95%confidence interval(CI)1.640-52.395,P=0.012]CT_(200 keV)(odds ratio 1.012,95%CI 1.006-1.019,P<0.001)as well as vascular abnormality sign(odds ratio 4.940,95%CI 1.358-17.969,P=0.015)w

关 键 词：肺肿瘤 体层摄影术 X线计算机 纯磨玻璃结节 侵袭性 

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