多层螺旋CT联合能谱CT检查在肺原位腺癌和微浸润腺癌鉴别诊断中的价值研究
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摘要
目的探讨多层螺旋CT(MSCT)联合能谱CT在肺原位腺癌(AIS)和微浸润腺癌(MIA)鉴别诊断中的价值。方法选取经手术病理证实的肺磨玻璃结节121例,其中AIS组45例和MIA组76例,术前均行MSCT和能谱CT扫描。收集两组患者性别、年龄及吸烟史,分析病灶位置、形状、密度及有无胸膜凹陷、分叶、毛刺、棘突、空泡征,测量结节最大径值、最高密度区CT值、水基值和能谱曲线斜率(k)。统计分析两组患者间的差异,建立logistic回归模型,绘制ROC曲线评估诊断效能。结果两组患者性别、年龄、吸烟史、病灶位置及空泡征比较差异均无统计学意义(均P>0.05),而形状不规则、密度不均匀、结节最大径、最高密度区CT值、水基、k及胸膜凹陷、分叶、毛刺、棘突征比较差异均有统计学意义(均P<0.05)。logistic回归模型示k为保护因素,结节最大径、水基值、密度不均匀和分叶征为危险因素。MSCT联合能谱CT检查参数分析后诊断效能增加(AUC=0.897 vs 0.885)。结论 MSCT与能谱CT有助于AIS和MIA的鉴别诊断,综合分析两者参数能提高诊断效能。
Objective To evaluate the application of multislice spiral CT(MSCT) or/and spectral CT in differential diagnosis between adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA) of the lung. Methods Total 121 lung ground glass nodules(GGN) including 45 AISs and 76 MIAs confirmed by surgery and pathology were included in the analysis. All subjects underwent MSCT and spectral CT examinations before surgery. The information of age, gender and smoking history of patients, the distribution, shape, density of the GGN, the pleural indentation sign, lobulation sign, burr sign,spinous sign and vacuole sign was documented. The maximum diameter, the highest CT value on MSCT, the corresponding water(iodine) concentration values and slope of the energy spectrum curve(k) on spectral CT were measured. The risk factors of MIA were analyzed with logistic regression model and the diagnostic value of CT parameters was evaluated with ROC curve. Results There were no significant differences in age, gender, smoking history of the patents,distribution and vacuole sign of the GGN between AIS and MIA groups. There were significant differences in the maximum diameter, the highest CT value, density unevenness, irregular shape, pleural indentation sign, lobulation sign, burr sign, spinous sign, water(iodine) concentration and k between the two groups. The multivariate Logistic regression analysis showed the k value was a protection factor and the maximum diameter, water(iodine) concentration, density unevenness and lobulation sign were risk factors for MIA. The diagnostic value of MSCT increased after adding spectral parameters(0.897 vs 0.885). Conclusion MSCT and spectral CT have the value of differential diagnosis between AIS and MIA, adding spectral parameters could increase the diagnostic efficacy.
Objective To evaluate the application of multislice spiral CT(MSCT) or/and spectral CT in differential diagnosis between adenocarcinoma in situ(AIS) and minimally invasive adenocarcinoma(MIA) of the lung. Methods Total 121 lung ground glass nodules(GGN) including 45 AISs and 76 MIAs confirmed by surgery and pathology were included in the analysis. All subjects underwent MSCT and spectral CT examinations before surgery. The information of age, gender and smoking history of patients, the distribution, shape, density of the GGN, the pleural indentation sign, lobulation sign, burr sign,spinous sign and vacuole sign was documented. The maximum diameter, the highest CT value on MSCT, the corresponding water(iodine) concentration values and slope of the energy spectrum curve(k) on spectral CT were measured. The risk factors of MIA were analyzed with logistic regression model and the diagnostic value of CT parameters was evaluated with ROC curve. Results There were no significant differences in age, gender, smoking history of the patents,distribution and vacuole sign of the GGN between AIS and MIA groups. There were significant differences in the maximum diameter, the highest CT value, density unevenness, irregular shape, pleural indentation sign, lobulation sign, burr sign, spinous sign, water(iodine) concentration and k between the two groups. The multivariate Logistic regression analysis showed the k value was a protection factor and the maximum diameter, water(iodine) concentration, density unevenness and lobulation sign were risk factors for MIA. The diagnostic value of MSCT increased after adding spectral parameters(0.897 vs 0.885). Conclusion MSCT and spectral CT have the value of differential diagnosis between AIS and MIA, adding spectral parameters could increase the diagnostic efficacy.
引文
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[2]Kakinuma R,Noguchi M,Ashizawa K,et al.Natural History of Pulmonary Subsolid Nodules:A Prospective Multicenter Study[J].JournalofThoracic Oncology,2016,11(7):1012-1028.DOI:10.1016/j.jtho.2016.04.006.
[3]Macmahon H,Naidich DP,Goo JM,et al.Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images:From the Fleischner Society 2017[J].Radiology,2017,284(1):228-234.DOI:10.1148/radiol.2017161659.
[4]Wang Qun,Jiang Wei,Xi Junjie.Surgery for Pulmonary Multiple Ground Glass Opacities[J].Zhongguo Fei Ai Za Zhi,2016,19(6):355-358.DOI:10.3779/j.issn.1009-3419.2016.06.11.
[5]Ding H,Shi J,Zhou X,et al.Value of CT Characteristics in Predicting Invasiveness of Adenocarcinoma Presented as Pulmonary Ground-Glass Nodules[J].Thoracic&Cardiovascular Surgeon,2017,65(2):136-139.DOI:10.1055/s-0036-1587592.
[6]李博.CT能谱成像在冠心病中应用进展[J].中华实用诊断与治疗杂志,2016,30(2):117-119.DOI:10.13507/j.issn.1674-3474.2016.02.005.
[7]侯唯姝,殷焱,程杰军,等.能谱CT成像在鉴别周围型肺癌和肺炎性肿块中的价值[J].中华放射学杂志,2014,48(10):832-835.DOI:10.3760/cma.j.issn.1005-1201.2014.10.010
[8]Dmsci JH,Saghir Z,Wille MM,et al.Ground-Glass Opacity Lung Nodules in the Era of Lung Cancer CT Screening:Radiology,Pathology,and Clinical Management[J].Oncology,2016,30(3):266-274.
[9]邵琳,王子,谢军舰,等.胸部小于5cm结节100例的CT影像学分析[J].贵州医药,2017,41(12):1309-1311.DOI:10.3969/j.issn.1000-744X.2017.12.037.
[10]Song Yong Sub,Park Chang Min,Park Sang Joon,et al.Volume and mass doubling times of persistent pulmonary subsolid nodules detected in patients without known malignancy[J].Radiology,2014,273(1):276-284.DOI:10.1148/radiol.14132324.
[11]周静宜.宝石能谱CT在肺癌诊断及分型中的应用价值[J].海南医学,2017,28(9):1478-1480.DOI:10.3969/j.issn.1003-6350.2017.09.035.
[12]李淑静,张晨光,李建科,等.周围血管分型对不同病理类型亚实性结节的诊断价值[J].河北医药,2017,39(24):3772-3774.DOI:10.3969/j.issn.1002-7386.2017.24.026.
[13]Travis WD,Brambilla E,Nicholson AG,et al.The 2015 World Health Organization Classification of Lung Tumors:Impact of Genetic,Clinical and Radiologic Advances Since the 2004Classification[J].Journal of Thoracic Oncology,2015,10(9):1243.DOI:10.1097/JTO.0000000000000630.
[14]Lee HY,Choi YL,Lee KS,et al.Pure ground-glass opacity neoplastic lung nodules:histopathology,imaging,and management[J].AJRAm J Roentgenol,2014,202(3):W224-233.DOI:10.2214/AJR.13.11819.
[15]Si MJ,Tao XF,Du G Y,et al.Thin-section computed tomography-histopathologic comparisons of pulmonary focal interstitial fibrosis,atypical adenomatous hyperplasia,adenocarcinoma in situ,and minimally invasive adenocarcinoma with pure groundglass opacity[J].European Journal of Radiology,2016,85(10):170-177.DOI:10.1016/j.ejrad.2016.07.012.
[16]孙晶晶,杨永波,黄洁惠,等.肺原位腺癌与微浸润腺癌的MSCT表现及对比分析[J].浙江临床医学,2017,19(8):1523-1524.
[17]Eguchi T,Yoshizawa A,Kawakami S,et al.Tumor Size and Computed Tomography Attenuation of Pulmonary Pure Ground-Glass Nodules Are Useful for Predicting Pathological Invasiveness[J].Plos One,2014,9(5):167-173.DOI:10.1371/journal.pone.0097867.
[18]Li Q,Fan L,Cao ET,et al.Quantitative CT analysis of pulmonary pure ground-glass nodule predicts histological invasiveness[J].European Journalof Radiology,2017,89:67-71.DOI:10.1016/j.ejrad.2017.01.024.
[19]Hou WS,Wu HW,Yin Y,et al.Differentiation of Lung Cancers From Inflammatory Masses with Dual-Energy Spectral CTImaging[J].Academic Radiology,2015,22(3):337-344.DOI:10.1016/j.acra.2014.10.004.
[20]肖慧娟,刘谊和,关牧娟,等.单能量下CT值及能谱曲线在肺结节中的应用价值[J].实用放射学杂志,2015,31(11):1770-1773.DOI:10.3969/j.issn.1002-1671.2015.11.005.
[21]匡敏,邬颖华,郑黎,等.能谱CT定性诊断孤立性肺结节或肿块中的临床研究[J].实用医学影像杂志,2015,16(4):302-305.DOI:10.16106/j.cnki.cn14-1281/r.2015.04.008.