灶周肺组织密度改变在亚厘米肺实性结节鉴别诊断中的价值  

The Value of Density Changes of Lung Tissue Around Lesion in Differentiating Sub-Centimeter Pulmonary Solid Nodules

作　　者：林芮羽 吕发金[1] 付彬洁 李王佳 郑伊能 褚志刚[1] LIN Ruiyu;LV Fajin;FU Binjie(Department of Radiology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,P.R.China)

机构地区：[1]重庆医科大学附属第一医院放射科,400016

出　　处：《临床放射学杂志》2022年第3期474-478,共5页Journal of Clinical Radiology

基　　金：重庆市科卫联合医学科研项目(编号:2022MSXM050)。

摘　　要：目的探讨亚厘米(<1 cm)肺实性结节邻近肺组织密度改变在鉴别其性质中的价值。方法回顾性搜集经手术切除病理确诊的202例亚厘米肺实性结节(良性肿瘤56例,恶性肿瘤80例,炎性病变66例)患者的临床及CT资料。两位放射学医师分别测量环绕结节周围1 cm范围内肺组织的CT值(CT_(1))及同层面、同肺叶正常肺组织的CT值(CT_(2)),并计算二者的差值(ΔCT=CT_(1)-CT_(2)),比较3组不同性质结节之间CT_(1)、CT_(2)和ΔCT值的差异。同时应用最小密度投影(MinIP)(3.00 mm)观察所有结节周围肺组织密度改变情况。结果炎性结节的CT;值[-855.42 HU(-902.30,-817.13)]明显高于良性肿瘤[-886.92HU(-918.12,-852.67)](P=0.015),但二者与恶性肿瘤的CT;值[-868.33HU(-899.50,-836.67)]相比均无显著差异(P>0.05)。3组间CT;值的差异均无统计学意(P=0.073)。炎性结节的ΔCT值[38.59 HU(23.05,64.80)]明显高于良性[9.92 HU(3.12,21.29)]及恶性肿瘤[18.33 HU(9.17,25.83)](P<0.001),而良、恶性肿瘤之间ΔCT值差异无统计学意义(P=0.069)。ROC曲线分析显示:以ΔCT值做为区分炎性及肿瘤性结节的指标,其曲线下面积(AUC)为0.817(95%CI:0.749~0.885),判断炎性结节的最佳阈值为29.75 HU,相对应的敏感性为0.621、特异性为0.901。在MinIP图像上,炎性结节周围稍高密度影环绕(30.30%)较常见,大部分恶性肿瘤(86.25%)与良性肿瘤(85.71%)周围肺组织密度改变均不明显,三者间灶周肺组织密度减低均少见且差异不明显。结论不同性质的亚厘米肺实性结节灶周肺组织密度改变存在一定差异,其显著升高提示为炎性结节可能性较大,可作为无显著形态特征结节鉴别的参考依据。Objective To investigate the value of density changes of lung tissue around lesion in differentiating subcentimeter pulmonary solid nodules.Methods FromJanuary 2012 to January 2021,the clinical and CTdata of 202 patients with sub-centimeter pulmonary solid nodules confirmed by postoperative pathological examination were enrolled(including56 benign tumors,80 malignances and 66 inflammatory nodules).The CT value of lung tissue within 1cm around the nodules(CT_(1))and the CT value of adjacent normal lung tissue in the same section and lobe(CT_(2))were measured bytworadiologists,and the difference(ΔCT=CT_(1)-CT_(2))was calculated.The CT_(1),CT_(2)andΔCT value amongthese three groups were compared respectively.Meanwhile,the density changes of lung tissue around nodules were observed with MinIP(3.00 mm)images.Results The CT_(1)value of inflammatory nodules[-855.42 HU(-902.30,-817.13)]was significantly higher than that of benign tumors[-886.92 HU(-918.12,-852.67)](P=0.015),while the CT;value of malignant tumors[-868.33 HU(-899.50,-836.67)]was similar to that of inflammatory nodules and benign tumors(P>0.05).There was no significant difference in CT_(2)among the three groups(P=0.073).TheΔCT value of inflammatory nodules was significantly higher than that of benign and malignant tumors[38.59HU(23.05,64.80)vs.9.92HU(3.12,21.29)and 18.33HU(9.17,25.83),eachP<0.001],while the latter two were similar(P=0.069).ROC analysis showed that the area under the curve(AUC)was 0.817(95%CI:0.749-0.885)when theΔCT value was used as a factor to distinguish inflammatorynodules and tumors.The optimal threshold for determining inflammatory nodules was 29.75HU,and the corresponding sensitivity and specificity were 0.621 and 0.901,respectively.On MinIP(3.00 mm)images,more inflammatory nodules(30.30%)were surrounded by slightly high attenuation,the perpheral lung tissue density changes in most malignant(86.25%)and benign tumors(85.71%)were insignificant,and decrease of perpheral lung tissue density was rare and their differences were not obvi

关 键 词：亚厘米 实性 肺结节 体层摄影术 X线计算机 

分 类 号：R563[医药卫生—呼吸系统] R816.4[医药卫生—内科学]