计算机辅助三维容积CT鉴别肺不典型腺瘤样增生和原位性腺癌  

Computer-Aided 3D Volumetric CT Differentiates Atypical Adenomatous Hyperplasia of the Lung from Adenocarcinoma In situ

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作  者:李成州 陈娟 袁永刚 杨静[3] 杨蓉 郭清奎[2] Li Chengzhou;Chen Juan;Yuan Yonggang;Yang Jing;Yang Rong;Guo Qingkui(Department of Nuclei Medicine,Tongren Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200336,China;Department of Thoracic Surgery,Tongren Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200336,China;Department of Pathology,Tongren Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200336,China)

机构地区:[1]上海交通大学医学院附属同仁医院核医学科,上海200336 [2]上海交通大学医学院附属同仁医院胸外科,上海200336 [3]上海交通大学医学院附属同仁医院病理科,上海200336

出  处:《肿瘤预防与治疗》2024年第1期26-33,共8页Journal of Cancer Control And Treatment

基  金:上海市长宁区卫生与健康委员会科研项目(编号:20214Y001);上海市长宁区科学技术委员会课题(编号:CNKW2020Y03)。

摘  要:目的:回顾性分析磨玻璃密度的肺不典型腺瘤样增生(atypical adenomatous hyperplasia,AAH)和原位性腺癌(adenocarcinoma in situ,AIS)的计算机辅助三维容积CT表现,并探讨其对两者鉴别诊断的可行性。方法:回顾性分析自2011年10月至2023年6月间,经手术切除病理证实的患有AAH和AIS结节的387例患者的薄层CT影像,对用计算机辅助三维容积CT小结节分析软件自动测量的结节最大径、平均CT值和体积的量化参数,以及半自动获取的定性数据(包括性别、结节形态、结节瘤肺界面、分叶、密度分类、空泡征和/或支气管充气征、血管集束征、胸膜凹陷征等)进行统计学分析,筛选出对AAH和AIS有鉴别意义的指标及诊断AIS的独立影响因素,同时评价计算机辅助三维CT自动获取的量化参数对AIS的评估效能。结果:本研究最终获取AAH结节79枚,AIS结节354枚。筛选出对AAH和AIS有鉴别意义的指标包括空泡和/或支气管充气征(P<0.001)、血管集束征(P=0.001)、结节最大径(P<0.001)、平均CT值(P=0.015)、结节体积(P<0.001),其中结节最大径(OR=1.259,95%CI:1.123~1.413,P<0.001)、空泡征和/或空气支气管征(OR=2.183,95%CI:1.210~3.939,P=0.009)为诊断AIS的独立影响因素。计算机辅助三维容积CT量化参数诊断AIS的效能优势顺序为结节最大径(AUC=0.670)>结节体积(AUC=0.648)>平均CT值(AUC=0.638)。结论:计算机辅助三维容积CT在鉴别诊断AAH和AIS上有一定的优势,结节的空泡和/或支气管充气征、血管集束征、结节最大径、平均CT值、结节体积对鉴别两者有诊断价值,其中结节最大径、空泡和/或空气支气管征是诊断AIS的独立影响因素,并且结节最大径诊断效能优于结节体积和结节平均CT值。Objectives:To retrospectively analyze the computer-aided 3D volumetric CT findings of ground-glass density nodules in the identification of pulmonary atypical adenomatous hyperplasia(AAH)and adenocarcinoma in situ(AIS),and explore the feasibility of differential diagnosis of the two.Methods:From October 2011 to June 2023,the thin-slice CT manifestations of 387 patients with AAH and AIS nodules confirmed by surgical resection were retrospectively analyzed.The quantitative data including the maximum nodular diameter,mean CT value and nodular volume automatically measured by Thoracic VCAR software,and the qualitative data of the patients obtained semi-automatically(sex,morphology of nodules,pulmonary nodule interface,lobulation,density classification,vacuolar sign and/or bronchial inflation sign,vessel convergence sign,pleural depression sign)were statistically analyzed to screen out the indicators that were significant in the differentiation of AAH and AIS and the independent influencing factors for the diagnosis of AIS,and evaluate the efficiency of quantitative parameters automatically obtained by computer-aided 3D volumetric CT in the diagnosis of AIS.Results:In this study,79 AAH nodules and 354 AIS nodules were obtained.The indicators that were important for differentiating AAH and AIS including vacuolar sign and/or bronchial inflation sign(P<0.001)and vessel convergence sign(P=0.001),maximum nodular diameter(P<0.001),mean CT value(P=0.013),nodular volume(P<0.001)were screened.The maximum diameter of the nodule(OR=1.259,95%CI:1.123~1.413,P<0.001)and vacuolar sign and/or bronchial inflation sign(OR=2.183,95%CI:1.210~3.939,P=0.009)were the independent influencing factors for the diagnosis of AIS.The top three efficient quantitative parameters obtained by computer-aided 3D volumetric CT in the diagnosis of AIS were maximum nodular diameter(AUC=0.670),nodular volume(AUC=0.648)and mean CT value(AUC=0.638).Conclusion:Computer-aided 3D volumetric CT has certain advantages in the differential diagnosis of AAH and AIS.T

关 键 词:不典型腺瘤样增生 原位性腺癌 计算机辅助三维容积CT 鉴别诊断 

分 类 号:R445.3[医药卫生—影像医学与核医学]

 

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