MSCT薄层重建对表现为肺纯磨玻璃结节的肺腺癌浸润性的定量分析

Quantitative analysis of invasive pulmonary adenocarcinoma as pure ground nodule using MSCT thin-slice reconstruction

目的通过对表现为纯磨玻璃结节(pGGN)的浸润性肺腺癌组和非浸润性肺腺癌组的CT影像特征定量分析,提高两组之间的鉴别诊断。方法选取并分析经手术及病理确诊的151例表现为单发pGGN患者,其中非浸润性腺癌组包括不典型腺瘤样增生(AAH)46例,原位癌(AIS)49例;浸润性腺癌组包括微浸润腺癌(MIA)31例,浸润性腺癌(IA)25例,所有患者确诊前均行MSCT肺部平扫并1 mm薄层重建。在薄层重建图像上测量所有pGGN最大截面面积、平均CT值,分析胸膜牵拉征、空泡征、毛刺征、分叶征及支气管充气征等征象。对pGGN最大截面面积及平均CT值做ROC曲线。结果pGGN最大截面面积、平均CT值、空泡征、分叶征及毛刺征在浸润性肺腺癌组和非浸润性肺腺癌组之间差异有统计学意义(P<0.05)。病灶最大截面面积及平均CT值诊断价值较好,两者联合ROC曲线AUC值为0.916,敏感度为81.8%,特异度为90.4%。结论pGGN最大截面面积、平均CT值、空泡征、分叶征及毛刺征均有助于鉴别浸润性肺腺癌和非浸润性肺腺癌,其中最大截面面积和平均CT值诊断价值较大,两者联合AUC值较单一指标显著增高。

Objective To analyze the MSCT quantitatively characteristics of invasive pulmonary adenocarcinoma presenting as pure ground glass nodule(pGGN)with thin-sliceCT,and to improve the diagnosis between invasive pulmonary adenocarcinoma and non-invasive pulmonary adenocarcinoma.Methods 151 patients with pGGN confirmed by surgical and pathology were enrolled in this study for retrospectiveanalysis,which included 46 atypical adenomatous hyperplasias(AAH),49 adenocarcinomas in situ(AIS),31 minimally invasive adenocarcinomas(MIA)and 25 invasive adenocarcinoma(IA).All the patients underwent MSCT scan and 1 mm thin-slice reconstruction.The maximum cross-sectional area and average CT value were measured,and the imaging characteristics of all pGGN,including pleural inelentation,vacuole sign,burr sign,lobulated sign and bronchial inflation sign,were recorded.ROC curve analysis was used in maximum cross-sectional area and average CT value.Results The maximum cross-sectional area,average CT value,vacuole sign,burr sign,lobulated sign were significantly different(P<0.05)between two groups.The diagnostic efficacy of the maximum cross-sectional area and average CT value were good.The combined ROC of AUC was 0.916,with sensitivity of 81.8%and specificity of 90.4%.Conclusion The maximum cross-sectional area,average CT value vacuole sign and lobulated sign burr sign are helpful to distinguish invasive pulmonary adenocarcinoma from non-invasive pulmonary adenocarcinoma.The AUC value of combination of the two is significantly higher than the single.