CT三维定量分析对T1a期肺腺癌病理等级的预测价值  

Value of CT three-dimensional quantitative analysis in predicting of pathological grade of T1a lung adenocarcinoma

作　　者：吴瑜 张敏[1] 张冬晴 丁晓青[1] 詹松华[1] 史苗颜[1] 陆方[1] WU Yu;ZHANG Min;ZHANG Dongqing;DING Xiaoqing;ZHAN Songhua;SHI Miaoyan;LU Fang(Department of Radiology,Shuguang Hospital Affiliated to Shanghai University of TCM,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院放射科,上海201203

出　　处：《中国中西医结合影像学杂志》2023年第4期411-416,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：上海市科委上海中医临床重点实验室项目(20DZ2272200)。

摘　　要：目的:评估CT三维定量分析对表现为磨玻璃密度结节(GGN)的T1a期肺腺癌病理等级的诊断价值。方法:回顾性分析经手术病理证实的51例T1a期肺腺癌患者的术前CT图像,其中原位腺癌20例(AIS组)、微浸润性腺癌19例(MIA组)及浸润性腺癌12例(IAC组),测量3组病灶的体积、最大正交直径、平均CT值、不同CT阈值下的病灶容积(V_(-100)、V_(-150)、V_(-200)、V_(-250)、V_(-300)、V_(-350)、V_(-400)、V_(-450)、V_(-500))。3组间计量资料的比较采用克鲁斯卡尔-沃利斯检验、两两比较采用曼-惠特尼U检验。运用ROC曲线评估组间比较有显著差异参数的诊断效能。结果:3组间病灶体积、最大正交直径差异均无统计学意义(均P>0.05),平均CT值、不同CT阈值下的病灶体积差异均有统计学意义(均P<0.05)。AIS与MIA组间,V_(-350)差异有统计学意义(P=0.032)。AIS与IAC组间,各参数值差异均有统计学意义(均P<0.05)。MIA与IAC组间,最大正交直径、平均CT值、不同CT阈值下的病灶体积(V_(-100)、V_(-150)、V_(-200)、V_(-300)、V_(-350)、V_(-400)、V_(-450)、V_(-500))差异均有统计学意义(均P<0.05),病灶体积、V_(-250)差异均无统计学意义(均P>0.05)。以CT值_(-450) HU作为实性成分与磨玻璃成分的界值,AIS与IAC组及MIA与IAC组均获得最大AUC(0.925、0.860),以实性成分体积25.5 mm^(3)作为AIS与IAC组、27.0 mm^(3)作为MIA与IAC组的诊断阈值,诊断效能最优,其敏感度、特异度、约登指数分别为91.7%、95.0%、0.867及91.7%、78.9%、0.706。结论:CT三维定量分析可定量测量GGN的实性成分、预测T1a期肺腺癌的浸润程度,有助于提高对T1a期肺腺癌术前病理分型的诊断准确率。Objective:To evaluate CT three-dimensional quantitative analysis in the diagnosis of pathological grade of T1a lung adenocarcinoma characterized by ground-glass opacity nodule(GGN).Methods:The preoperative CT images of 51 patients of lung adenocarcinoma characterized by GGN in T1a stage confirmed by operation and pathology were analyzed retrospectively.Among the 51 cases,20 cases were adenocarcinoma in situ(AIS group),19 cases were microinvasive adenocarcinoma(MIA group),and 12 cases were invasive adenocarcinoma(IAC group).The lesion volume,maximum orthogonal diameter,CT value and lesion volume at different CT thresholds(V_(-100),V_(-150),V_(-200),V_(-250),V_(-300),V_(-350),V_(-400),V_(-450),V_(-500))for 3 groups were measured.The Kruskal-Wallis test and Mann-Whitney U test were used.The diagnostic efficiency of statistically significant parameters was evaluated by ROC curve analysis.Results:There were no significant differences in lesion volume and maximum orthogonal diameter of 3 groups(both P>0.05),while the CT value and lesion volume at different CT thresholds were significantly different(both P<0.05).There was a significant difference of the lesion volume at V_(-350) between AIS group and MIA group(P=0.032).Among the AIS and IAC groups,all parameters were significantly different(all P<0.05).There were significant differences in maximum orthogonal diameter,CT value and lesion volume under different CT thresholds(V_(-100),V_(-150),V_(-200),V_(-300),V_(-350),V_(-400),V_(-450),V_(-500))between MIA group and IAC group(all P<0.05),but there were no significant differences in lesion volume and lesion volume at V_(-250)(both P>0.05).With the CT value of_(-450) HU as the dividing point between the solid component and the ground glass component,the AIS and IAC groups and the MIA and IAC groups both obtained the maximum AUC of 0.925,0.860,respecetively.With the solid component volume of 25.5 mm^(3) as the diagnostic threshold for the AIS and IAC groups and 27.0 mm^(3) for the MIA and IAC groups,the diagnostic efficacy

关 键 词：肺肿瘤 腺癌 磨玻璃密度结节 体层摄影术 X线计算机 三维定量分析 

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