能谱CT参数对纯磨玻璃结节肺腺癌浸润程度的预测价值  

The clinical application value of spectral CT for predicting the invasiveness of lung adenocarcinoma presenting as pure ground glass nodules

作　　者：陈昌焕 周腾兴 万婷洁 郑彩霞[1] 王承胜[1] 许尚文 CHEN Chang-huan;ZHOU Teng-xing;WAN Ting-jie;ZHENG Cai-xia;WANG Cheng-sheng;XU Shang-wen(Department of Radiology,Fuzhou First General Hospital Affiliated to Fujian Medical University,Fuzhou 350000,China;The Graduate School of Fujian Medical University,Fuzhou 350000,China;Department of Radiology,Fuzong Clinical Medical College of Fujian Medical University(The 900th Hospital),Fuzhou 350000,China)

机构地区：[1]福建医科大学附属福州市第一总医院放射科,福建福州350000 [2]福建医科大学研究生院,福建福州350000 [3]福建医科大学福总临床医学院(第九○○医院)放射诊断科,福建福州350000

出　　处：《中国临床医学影像杂志》2024年第6期411-417,共7页Journal of China Clinic Medical Imaging

基　　金：福州市科技计划项目(编号:2021-S-182)。

摘　　要：目的:探讨能谱CT定性及定量参数对表现为纯磨玻璃结节(Pure ground glass nodule,pGGN)的肺腺癌浸润程度的预测价值。方法:回顾性分析2019年11月-2023年6月经手术病理证实的79例pGGN肺腺癌患者的临床及影像资料,共79枚pGGN,分为非浸润性病变组(A组)和浸润性病变组(B组)。纳入分析的形态学征象包括是否存在分叶、毛刺、空泡、支气管充气征、胸膜凹陷征和异常血管征,定量参数包括结节大小、能谱曲线斜率、碘基值、标准化碘基值和水基值。采用卡方检验和独立样本t检验对A、B两组各参数进行比较分析,将P<0.05的参数指标纳入多因素Logistic回归分析并进行ROC曲线绘制,评价各参数对pGGN肺腺癌浸润程度的预测效能,采用Delong检验比较各效能之间的区别。结果:pGGN出现胸膜凹陷征和异常血管征更倾向浸润性病变;能谱曲线斜率、碘基值和标准化碘基值在两组中的差异均无统计学意义,而结节大小与动静脉期水基值B组均大于A组,有统计学意义;多因素Logistic回归分析显示结节大小和动静脉期水基值是pGGN肺腺癌浸润程度的独立预测因素;ROC曲线分析显示,动静脉期水基值和结节大小在预测pGGN肺腺癌浸润程度中的效能类似(P>0.05),但三者联合有助于提高预测效能(AUC=0.866,95%CI 0.770~0.932,P<0.05)。结论:能谱CT衍生定量参数水基值联合结节大小对pGGN肺腺癌浸润程度具有良好的预测效能,有助于临床治疗决策的选择。Objective:To investigate the value of qualitative and quantitative parameters of spectral CT for predicting the invasiveness of lung adenocarcinoma presenting as pure ground glass nodules(pGGN).Methods:This study enrolled 79 patients with lung adenocarcinoma with pGGNs confirmed by surgical pathology from November 2019 to June 2023.Clinical and imaging data were analyzed retrospectively.A total of 79 pGGNs were classified into non-infiltrating group(Group A)and infiltrating group(Group B).Morphological signs included the presence of lobulation,spiculation,bubblelike lucency,air bronchogram,pleural indentation and abnormal vascular architecture.Quantitative parameters included were nodule size,the slope of the spectral curve,iodine concentration,normalized iodine concentration and water content.The diference of each parameter between group A and group B was performed using the chi-square test and independent samples t-test.Multifactorial logistic regression and ROC curves were performed to evaluate the predictive efficacy of each parameter on the degree of pGCN infiltration.The difference between the efficacies was compared using the Delong test.Results:The presence of pleural retraction and abnormal vascular architecture in pGGNs were more inclined to infiltrate.The performances of the slope of spectral curve,iodine concentration and normalized iodine concentration were not statistically significant between the two groups.While nodule size and water content of both arterial and venous phases of group B were larger than those of group A(P<0.05).The multifactorial logistic regression showed that nodule size and water content of both arterial and venous phases in pCGNs were independent predictors of the degree of lung adenocarcinoma infiltration.ROC curve showed that water content of both arterial and venous phases and nodule size in pGGNs had a similar effect in predicting the degree of lung adenocarcinoma infiltration(P>0.05).The combination of the above three parameters in pGGNs could improve the predictive effic

关 键 词：肺腺癌 体层摄影术 螺旋计算机 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]