肺亚实性结节的CT影像学特征与病理等级相关性分析

The correlation between CT imaging features and pathological grade of pulmonary subsolid nodules

目的探讨肺亚实性结节(SSN)CT影像学特征与病理等级的相关性。方法我院110例SSN患者,均行胸部高分辨率CT检查,以病理结果为金标准,评价CT对肺腺癌诊断的敏感度、特异度及准确度;另根据病理结果将肺腺癌患者分为AIS+MIA组与IAC组,比较两组肺窗结节体积(WNLW)、阈值=-300 HU时结节实性成分体积(SCT)、肺窗结节实性成分体积(SCLW)、纵隔窗结节实性成分体积(SCMW)等CT定量特征指标,分析上述定量特征,获取病理等级独立预测因素,对其行受试者工作特征(ROC)曲线分析。结果 CT诊断良恶性SSN敏感度、特异度、准确度分别为84.37%、93.75%、91.41%;AIS+MIA组WNLW、SCT、SCLW、SCMW均低于IAC组(P<0.05);Logistic回归分析表明SCT是恶性SSN病理等级的独立预测因素;SCT≥138 mm^3时,对IAC诊断曲线下面积、敏感度、特异度分别为0.89、82%、94%。结论 CT诊断SSN良恶性价值大,SCT对AIS、MIA与IAC鉴别有重要意义。

Objective To investigate the correlation between CT imaging features and pathological grade of pulmonary subsolid nodules（ SSN）.Methods One hundred and ten patients with SSN diagnosed in our hospital were selected as subjects.They were examined with chest high-resolution CT.The sensitivity,specificity and accuracy of CT in the diagnosis of lung adenocarcinoma were evaluated with the pathological results as the golden standard.According to pathological results,patients with lung adenocarcinoma were divided into AIS＋MIA group and IAC group. The volume of pulmonary window nodules（ WNLW）,volume of solid components of nodules（ SCT） when the threshold value was-300 HU,volume of solid components of pulmonary window nodules（ SCLW）,volume of solid components of mediastinal window nodules（ SCMW） and other CT quantitative characteristic indexes were determined and compared between the two groups.The above quantitative objects were analyzed by univariate and multivariate logistic regression analysis.Independent predictive factors of the pathological grade were obtained and analyzed by the receiver operating characteristic（ ROC） curve. Results The sensitivity,specificity and accuracy of CT in the diagnosis of benign and malignant SSN were 84. 37%,93. 75% and91. 41% respectively.The WNLW,SCT,SCLW and SCMW in the AIS＋MIA group were significantly lower than those in the IAC group（ P〈0. 05）.Univariate logistic regression analysis showed that WNLW,SCT,SCLW and SCMW were statistically significant（ P〈0. 05）.Multivariate logistic regression analysis showed that SCT was an independent predictor of pathological grade of malignant SSN.When the SCT was or lager than 138 mm^3,the area under the curve,sensitivity and specificity of IAC diagnosis were 0. 89,82% and94%,respectively.Conclusion CT is of great value in the diagnosis of benign and malignant SSN,and SCT is of great significance for the differential diagnosis of AIS,MIA and IAC.