CT纹理特征和形态征象对肺部纯磨玻璃结节侵袭性的诊断价值

Diagnostic Value of CT Texture Features and Morphologic Features in the Invasiveness of Pulmonary Pure Ground Glass Nodules

目的分析CT纹理特征和形态征象对肺部纯磨玻璃结节(Pure Ground Glass Nodules,pGGN)侵袭性的诊断价值。方法回顾分析我院2015年1月至2018年6月接受手术治疗的102个pGGN病例资料和CT图像,按照肺腺癌分类标准将其分为未浸润组(n=40)、微浸润组(n=32)和浸润组(n=30),分析3组患者CT形态征象和纹理征象对肺部pGGN侵袭性的进行诊断,统计诊断效能。结果绘制受试者工作特征曲线图,病灶大小界值为8.6时,诊断灵敏度67.32%,特异度83.65%;CT值界值为-514 HU时,曲线下面积为0.786,诊断灵敏度84.09%,特异度78.51%;pGGN患者中AAH、AIS、MIA、I-ADC的CT表现征象大多相同或重叠,对所有表现特征进行Logistic单因素分析,结果显示病灶形状、边缘形态为分叶征、内部气腔隙征、周围结构血管改变和胸膜凹陷是pGGN浸润的危险因素(P<0.05);Logistic多因素回归分析显示边缘形态为分叶征、病变周围血管改变及胸膜凹陷是pGGN发生浸润的独立危险因素。通过CT纹理特征和征象综合判断对pGGN是否具有浸润进行鉴别,结果显示CT诊断灵敏度为83.87%,特异度为92.50%,准确度为87.25%。结论临床通过CT纹理特征和形态征象综合判断对pGGN是否发生侵袭具有较高的诊断价值,值得研究和推广。

Objective To analyze the value of CT texture and morphological features in the diagnosis of pulmonary pure ground glass nodules(pGGN).Methods The data and CT images of 102 pGGN patients who were operated in our hospital from January 2015 to June 2018 were analyzed retrospectively.According to the classification standard of lung adenocarcinoma,the patients were divided into three groups:non infiltrated group(n=40),micro infiltrated group(n=32)and infiltrated group(n=30).The CT morphological and texture signs of the three groups were analyzed to diagnose the invasiveness of pGGN in the lungs.Results The working characteristic curve of subjects was drawn.The diagnostic sensitivity was 67.32%and the specificity was 83.65%when the boundary value of lesion size was 8.6;the area under the curve was 0.786,the diagnostic sensitivity was 84.09%and the specificity was 78.51%when the boundary value of CT was-514 HU.The CT manifestations of AAH,AIS,MIA and I-ADC in pggn patients were mostly the same or overlapped.Logistic univariate analysis of all the manifestations showed that the shape and edge of the lesions were divided into leaf sign,internal air gap sign,peripheral structural vascular changes and pleural depression were the risk factors of pggn infiltration(P<0.05).Logistic regression analysis showed that the edge shape was lobular sign,vascular changes around the lesion and pleural depression were independent risk factors for pggn infiltration.The comprehensive judgment of CT texture features and signs to identify whether pGGN was infiltrating showed that CT diagnostic sensitivity was 83.87%,specificity was 92.50%,and accuracy was 87.25%.Conclusion It has a high diagnostic value for the invasion of pggn through the comprehensive judgment of CT texture features and morphological signs,which is worthy of research and promotion.