容积CT值量化判断5 mm以上肺结核病灶活动性的应用价值  

Application value of volume CT value inquantifying the activity of pulmonary tuberculosis lesions above 5 mm

作　　者：魏赣辉 张加成 邱小伟 Wei Ganhui;Zhang Jiacheng;Qiu Xiaowei(Department of Radiology,Hangzhou Chest Hospital,Medical College of Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属杭州市胸科医院放射科,杭州310003

出　　处：《中国防痨杂志》2022年第9期934-939,共6页Chinese Journal of Antituberculosis

基　　金：浙江省医药卫生科技计划项目(面上项目,2021KY252)。

摘　　要：目的:探讨容积CT值量化判断肺结核活动性的辅助诊断价值。方法:选取浙江大学医学院附属杭州市胸科医院结核科2013年1月至2017年5月临床确诊的224例肺结核患者胸部CT影像资料,以纵隔窗上最短径线>5 mm为入选标准,挑选出216个活动性肺结核病灶与128个非活动性肺结核病灶,通过ITK-SNAP软件手动分割病灶图像,计算病灶容积CT值并进行ROC曲线分析;再以临床最终诊断为参照标准,比较常规CT阅片法与容积CT值判断肺结核活动性的辅助诊断效能及一致性。结果:216个活动性肺结核病灶的容积CT值[32.38(28.17,36.23)HU]明显低于128个非活动性肺结核病灶[78.89(57.78,120.27)HU],差异有统计学意义(Z=-15.439,P<0.001)。ROC曲线分析显示,当约登指数取最大值0.958时,最佳容积CT临界值为45.79 HU,容积CT值判断肺结核活动性的敏感度为96.3%、特异度为100.0%,ROC曲线下最大面积为0.998。以临床最终诊断为参照标准,常规CT阅片法判断肺结核活动性的敏感度、特异度、一致率和Kappa值分别为71.8%(155/216)、71.1%(91/128)、71.5%(246/344)和0.413,而容积CT值判断肺结核活动性的对应数值分别为96.3%(208/216)、100.0%(128/128)、97.7%(336/344)和0.951。结论:通过测量肺结核病灶容积CT值可以精确量化、判断肺结核活动性,具有非常重要的辅助诊断价值。Objective:To explore the auxiliary diagnostic value of volume CT value in quantifying the activity of pulmonary tuberculosis.Methods:A total of 224 patients with clinically confirmed pulmonary tuberculosis from January 2013 to May 2017 in the Department of Tuberculosis,Hangzhou Chest Hospital,Medical College of Zhejiang University were selected.And 216 active tuberculosis lesions and 128 inactive tuberculosis lesions were included according to the standard of that the shortest diameter line on the mediastinal window>5 mm.ITK-SNAP software was used to manually segment lesion images,calculate CT values of lesion volume,and analysis the ROC curve.Based on the final clinical diagnosis,the auxiliary diagnostic efficacy and consistency of the conventional CT reading method and the volume CT values in determining the activity of pulmonary tuberculosis were compared.Results:The volume CT value of 216 active pulmonary tuberculosis lesions was significantly lower than that of 128 inactive pulmonary tuberculosis lesions(32.38(28.17,36.23)HU vs.78.89(57.78,120.27)HU,Z=-15.439,P<0.001).ROC curve analysis showed that,when the maximum value of Youden index was 0.958,the best critical value was 45.79 HU,the sensitivity and specificity of volume CT value in judging active pulmonary tuberculosis were 96.3%and 100.0%,with a maximum area under the AUC curve of 0.998.Taking the final clinical diagnosis as the reference standard,the sensitivity,specificity,accuracy and Kappa value of the conventional CT reading method to determine the activity of pulmonary tuberculosis were 71.8%(155/216),71.1%(91/128),71.5%(246/344)and 0.413,respectively;while those of volume CT value were 96.3%(208/216),100.0%(128/128),97.7%(336/344)and 0.951,respectively.Conclusion:By measuring the volume of pulmonary tuberculosis lesions,CT value can accurately quantify the activity of pulmonary tuberculosis,which is of very important auxiliary diagnostic value.

关 键 词：结核 肺 体层摄影扫描仪 X线计算机 放射测量术 诊断显像 

分 类 号：R521[医药卫生—内科学] R445.3[医药卫生—临床医学]