基于CT GE Lung VCAR软件鉴别肺原位腺癌和微浸润腺癌
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摘要
目的:利用GE Lung VCAR软件分析肺原位腺癌(AIS)与微浸润腺癌(MIA)的CT鉴别诊断要点。方法:收集2016年1月至2017年3月温州医科大学附属第一医院经病理证实的AIS患者50例、MIA患者55例。使用GE Lung VCAR软件对105例结节的CT图像进行三维后处理分析,比较2组结节实性成分及总体的左右径(LRD)、前后径(APD)、上下径(SID)、平均密度(DAVG)、非实性部分体积(VNS)、实性部分体积(V_S)、总体体积(V_T)、实性部分体积百分率(V_S%)以及形态学特征的差异,并与二维轴位CT图像肺窗下手动测量结节最大径的诊断效能进行比较,评估GE Lung VCAR软件的诊断价值。结果:AIS组与MIA组的二维手动测量最大径与软件分析获得结节实性部分及总体三径、V_S、V_T、V_S%、结节形态、毛刺征、结节与血管关系、累及血管根数的差异具有统计学意义(P<0.05)。GE Lung VCAR软件评估结节大小较手动测量诊断效能高;部分参数诊断效能由高到低分别为:累及血管根数、毛刺征、总体LRD、实性APD、V_T、V_S;最佳截断值分别为:累及3根血管、短毛刺征、总体LRD:14.5 mm、实性APD:8.5 mm、V_T:802 mm~3、V_S:133 mm~3。结论:GE Lung VCAR软件在肺结节CT诊断中具有较好实用价值,是鉴别AIS和MIA的一项有利工具。
Objective: The CT identification of lung adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA) was analyzed by using GE Lung VCAR software. Methods: The CT images of 50 AIS patients and 55 MIA patients from the First Affiliated Hospital of Wenzhou Medical University were analyzed by GE Lung VCAR software after taking three-dimensional computed tomographic segmentation of lung nodules. The differences between AIS and MIA solid portion and their overall left-right diameter(LRD), anteroposterior diameter(APD), suprainferior diameter(SID), Average Density(DAVG), Non-Solid portion Volume(VNS), Solid portion Volume(V_S), Total Volume(V_T), percentage of Solid portion Volume(V_S%), morphological features were compared. The diagnostic effectiveness of the two-dimensional manual measurements of nodule maximum diameter were compared to assess the diagnostic value of GE Lung VCAR software. Results: There's statistical difference(P<0.05) between two-dimensional manual measurement of the maximum diameter and software analysis of the AIS group and the MIA group to obtain the solid nodule and the total three-segment, V_S, V_T, V_S%, nodular morphology, burr sign, nodule-vessel relationship, number of vessel involvement. GE Lung VCAR software showed high diagnostic efficiency compared with manual measurement on nodule size. The diagnostic efficiency from high to low ranked as follows: involved vessel amount, spicule sign, overall LRD, solid APD, V_T, V_S. The optimal cutoff values were: three involved vessels, short spicule sign, overall LRD: 14.5 mm, solid APD: 8.5 mm, V_T: 802 mm~3, V_S: 133 mm~3. Conclusion: GE Lung VCAR software has practical value in the CT diagnosis of ground glass nodule. It is a useful supplement to identify AIS and MIA.
Objective: The CT identification of lung adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA) was analyzed by using GE Lung VCAR software. Methods: The CT images of 50 AIS patients and 55 MIA patients from the First Affiliated Hospital of Wenzhou Medical University were analyzed by GE Lung VCAR software after taking three-dimensional computed tomographic segmentation of lung nodules. The differences between AIS and MIA solid portion and their overall left-right diameter(LRD), anteroposterior diameter(APD), suprainferior diameter(SID), Average Density(DAVG), Non-Solid portion Volume(VNS), Solid portion Volume(V_S), Total Volume(V_T), percentage of Solid portion Volume(V_S%), morphological features were compared. The diagnostic effectiveness of the two-dimensional manual measurements of nodule maximum diameter were compared to assess the diagnostic value of GE Lung VCAR software. Results: There's statistical difference(P<0.05) between two-dimensional manual measurement of the maximum diameter and software analysis of the AIS group and the MIA group to obtain the solid nodule and the total three-segment, V_S, V_T, V_S%, nodular morphology, burr sign, nodule-vessel relationship, number of vessel involvement. GE Lung VCAR software showed high diagnostic efficiency compared with manual measurement on nodule size. The diagnostic efficiency from high to low ranked as follows: involved vessel amount, spicule sign, overall LRD, solid APD, V_T, V_S. The optimal cutoff values were: three involved vessels, short spicule sign, overall LRD: 14.5 mm, solid APD: 8.5 mm, V_T: 802 mm~3, V_S: 133 mm~3. Conclusion: GE Lung VCAR software has practical value in the CT diagnosis of ground glass nodule. It is a useful supplement to identify AIS and MIA.
引文
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[12]范丽,于红,刘士远,等.3 cm以下肺恶性局灶性磨玻璃结节与实性结节螺旋CT征象对照[J].中华放射学杂志,2010,44(1):16-19.
[13]肖时满,张玉,强金伟,等.超高分辨率CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA)[J].复旦学报(医学版),2014,41(3):285-290.
[14]陈聪,傅钢泽,陈永华,等.肺腺癌浸润前病变的CT诊断评价[J].温州医科大学学报,2016,46(10):738-742.
[2]YANKELEVITZ D F,YIP R,SMITH J P,et al.CT screening for lung cancer:nonsolid nodules in baseline and annual repeat rounds[J].Radiology,2015,277(2):555-564.
[3]张永奎,谭林林,乐涵波,等.原发性周围型小肺癌临床病理特征及预后分析[J].温州医科大学学报,2016,46(6):408-412.
[4]YANAGAWA N,SHIONO S,ABIKO M,et al.New IASLC/ATS/ERS classification and invasive tumor size are predictive of disease recurrence in stage I lung adenocarcinoma[J].J Thorac Oncol,2013,8(5):612-618.
[5]杨海,李欣,陈盈,等.窗口技术鉴别纯磨玻璃样密度肺原位腺癌与微浸润腺癌[J].浙江实用医学,2016,21(6):398-401.
[6]齐琳琳,王建卫,杨琳,等.肺纯磨玻璃结节体积和质量倍增时间在鉴别浸润腺癌与微浸润腺癌及浸润前病变中的作用[J].中华放射学杂志,2017,51(7):493-499.
[7]GAO F,LI M,GE X,et al.Multi-detector spiral CT study of the relationships between pulmonary ground-glass nodules and blood vessels[J].Eur Radiol,2013,23(12):3271-3277.
[8]LINNING E,DAQING M.Volumetric measurement pulmonary ground-glass opacity nodules with multi-detector CT:effect of various tube current on measurement accuracy-a chest CT phantom study[J].Acad Radiol,2009,16(8):934-939.
[9]YANAGAWA M,TANAKA Y,KUSUMOTO M,et al.Automated assessment of malignant degree of small peripheral adenocarcinomas using volumetric CT data:correlation with pathologic prognostic factors[J].Lung Cancer,2010,70(3):286-294.
[10]HASHIZUME T,YAMADA K,OKAMOTO N,et al.Prognostic significance of thin-section CT scan findings in smallsized lung adenocarcinoma[J].Chest,2008,133(2):441-447.
[11]TAKAHASHI M,SHIGEMATSU Y,OHTA M,et al.Tumor invasiveness as defined by the newly proposed IASLC/ATS/ERS classification has prognostic significance for pathologic stage IA lung adenocarcinoma and can be predicted by radiologic parameters[J].J Thorac Cardiovasc Surg,2014,147(1):54-59.
[12]范丽,于红,刘士远,等.3 cm以下肺恶性局灶性磨玻璃结节与实性结节螺旋CT征象对照[J].中华放射学杂志,2010,44(1):16-19.
[13]肖时满,张玉,强金伟,等.超高分辨率CT(UHRCT)鉴别肺原位腺癌(AIS)与微浸润腺癌(MIA)[J].复旦学报(医学版),2014,41(3):285-290.
[14]陈聪,傅钢泽,陈永华,等.肺腺癌浸润前病变的CT诊断评价[J].温州医科大学学报,2016,46(10):738-742.