三期CT图像纹理分析对肺良恶性结节的鉴别诊断价值

The value of three-phase CT images texture analysis in differential diagnosis of benign and malignant pulmonary nodules

目的探讨基于胸部三期CT图像的纹理分析对鉴别肺内良恶性结节的价值。方法选取本院159例肺结节(恶性83例,良性76例,均有病理证实)的CT平扫、动脉期及静脉期(三期)图像进行回顾性纹理分析。手动勾画三期均为同一层面的病灶为感兴趣区并提取33个纹理特征。通过秩和检验及独立样本t检验找出有统计学差异的纹理参数。进一步分析三期图像有统计学差异纹理参数中的能量、熵、相关性、惯性并分别进行ROC曲线分析,比较三期图像的诊断效能差异。结果对于肺内良恶性结节的鉴别诊断,三期图像均得出较多具有统计学意义的纹理参数。其中相关性、惯性在动脉期图像的诊断效能较高,两者的P值均为0.000。以相关性≥0.00004、惯性≤12272作为诊断恶性结节标准时,ROC曲线下AUC值分别为0.731、0.702,敏感度分别为77.1%,85.5%。能量、熵两个参数在平扫、动脉期、静脉期三期的诊断效能无显著差异。结论胸部三期CT图像的纹理分析能够为肺内良恶性结节的鉴别诊断提供帮助,其中以动脉期图像的诊断效能较高。

Objective To explore the value of texture analysis based on three-phase CT images of the chest in distinguishing benign and malignant nodules in the lung.Methods From June 2015 to June 2019,159 cases of pulmonary nodules(83 cases of malignant and 76 cases of benign,all confirmed by pathology)were retrospectively analyzed by CT plain scan,arterial phase and venous phase(three-phase)images.We manually outlined the lesions in the three-phase images at the same level as the region of interest(ROI)and extracted 33 texture features.The rank sum test and independent sample t test were used to find out the statistically different texture parameters.We further analyzed the energy,entropy,correlation,and inertia in the texture parameters of the three-phase images with statistical differences,and performed ROC curve analysis to compare the differences in diagnostic efficiency of the three-phase images.Results For the differential diagnosis of benign and malignant nodules in the lung,the three-phase images obtained more statistically significant texture parameters.Among them,correlation and inertia had higher diagnostic efficiency in arterial phase images,and the P value of both was 0.000.When correlation≥0.00004 and inertia≤12272 were used as the criteria for diagnosing malignant nodules,the AUC values under the ROC curve were 0.731 and 0.702,and the sensitivity was 77.1%and 85.5%,respectively.The two parameters of energy and entropy had no significant difference in the diagnostic efficacy of plain scan,arterial phase,and venous phase.Conclusion The texture analysis of three-phase CT images of the chest can provide help for the clinical diagnosis of benign and malignant nodules in the lung,and the arterial phase images have higher diagnostic efficiency.