基于三维重建技术的肺磨玻璃结节生长规律研究  

Growth Regularity of Pulmonary Ground Glass Nodules Based on 3D Reconstruction Technology

作　　者：周莹莹 张永奎 张善华 张弛[1] 陈志军 Yingying ZHOU;Yongkui ZHANG;Shanhua ZHANG;Chi ZHANG;Zhijun CHEN(Jiamusi University,Jiamusi 154007,China;Department of Thoracic Surgery,Zhoushan Hospital,Zhoushan 316021,China;Department of Radiology,Zhoushan Hospital,Zhoushan 316021,China)

机构地区：[1]佳木斯大学,佳木斯154007 [2]舟山医院胸外科,舟山316021 [3]舟山医院放射科,舟山316021

出　　处：《中国肺癌杂志》2023年第4期265-273,共9页Chinese Journal of Lung Cancer

摘　　要：背景与目的自计算机断层扫描(computed tomography,CT)技术普及以来,影像学随访为主要管理方法的磨玻璃结节(ground glass nodules,GGNs)检出率明显增加,本研究旨在应用三维重建技术定量分析GGNs随访过程中的变化情况,探索GGNs自然进展规律,为临床指导患者合理地进行结节管理提供有效依据。方法纳入2015年3月-2022年11月舟山医院肺结节联合门诊中规律随访的GGNs患者共115例。利用3DSlicer软件半自动分割提取结节的定量影像学特征,评估随访过程中的结节增长情况及临床干预情况。结果患者平均基线年龄为(56.9±10.1)岁;平均随访时间为(48.8±18.9)个月。CT二维直径为(7.9±2.9)mm,三维最大径为(10.1±3.4)mm。末次CT扫描二维直径为(9.9±4.7)mm,三维最大径为(11.4±5.1)mm。共27例(23.5%)随访期间出现增长,中位体积倍增时间为822 d,中位质量倍增时间为1,007 d。手术切除32例,其中6例浸润性腺癌(invasive adenocarcinoma,IAC),16例微浸润腺癌(minimally invasive adenocarcinoma,MIA),8例原位腺癌(adenocarcinoma in situ,AIS),2例非典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)。5例结节因二维直径显示进展而行手术干预,病理证实为浸润前病变,但其三维最大径提示无明显变化。单因素分析结果显示形态不规则、边缘欠光整,具有分叶、毛刺、空泡征均为促进结节增长的因素;增长组与稳定组年龄、基线直径和平均CT值、中位CT值、10%位数CT值、90%位数CT值差异具有统计学意义(P<0.05)。多因素Logistic回归分析结果表明年龄和平均CT值是影响结节增长的危险因素(P<0.05)。受试者工作特征(receiver-operating characteristic,ROC)曲线分析结果提示年龄≥63岁、基线三维最大径≥9.2 mm、平均CT值≥-507.8 HU的GGNs出现增长的可能性更大;三维最大径≥14.4 mm、平均CT值≥-495.7 HU时恶性概率更高。结论GGNs呈惰性生长过程,随访过程中应用三维测�Background and objective Since the popularization of computed tomography(CT)technology,the detection rate of pulmonary ground glass nodules(GGNs)with imaging follow-up as the main management method has increased significantly.The purpose of this study is to quantitatively analyze the changes of pulmonary GGNs during the followup process with three-dimensional reconstruction technology,explore the natural progression of pulmonary GGNs,and provide effective basis for clinical guidance for patients to conduct reasonable management of nodules.Methods A total of 115 cases of pulmonary GGNs with regular follow-up in the Combined Outpatient Department of Zhoushan Hospital from March 2015 to November 2022 were enrolled.Quantitative imaging features of nodules were extracted by semi-automatic segmentation of 3D Slicer software to evaluate the growth of nodules and clinical intervention during follow-up.Results The average baseline age of the patients was(56.9±10.1)yr.The mean follow-up time was(48.8±18.9)months.The two-dimensional diameter of baseline CT scan was(7.9±2.9)mm,and the maximum three-dimensional diameter was(10.1±3.4)mm.The twodimensional diameter of the last CT scan was(9.9±4.7)mm,and the maximum three-dimensional diameter was(11.4±5.1)mm.A total of 27 cases(23.5%)showed an increase during follow-up,with a median volume doubling time of 822 days and a median mass doubling time of 1,007 days.32 cases were surgically resected,including 6 cases of invasive adenocarcinoma(IAC),16 cases of minimally invasive adenocarcinoma(MIA),8 cases of adenocarcinoma in situ(AIS)and 2 cases of atypical adenomatous hyperplasia(AAH).Five nodules underwent surgical intervention due to the progression of two-dimensional diameter,which was pathologically confirmed as pre-invasive lesions,but their three-dimensional maximum diameter showed no significant change.Nodular morphology,lobulated sign,spiculated sign and vacuole signs all promoted the growth of nodules in univariate analysis.There were significant differences in age,b

关 键 词：肺磨玻璃结节 计算机断层扫描 随访 三维重建 

分 类 号：R734.2[医药卫生—肿瘤]