CT定量指标对肺部磨玻璃结节病理侵袭性的预测价值

The Value of CT Quantitative Indicators in Predicting the Pathological Invasiveness of Pulmonary Ground Glass Nodules

目的探讨利用CT定量指标预测肺部磨玻璃结节(GGNs)病理侵袭性的应用价值。方法回顾性分析2019年10月至2021年10月于天津市北辰区中医医院诊治的156例肺部GGNs患者的临床资料和影像学资料,并依据组织病理学诊断结果分为未浸润组(71例)和浸润组(85例)。由2名对该研究和病理结果均不知情的资深影像科医师共同阅片,借助CT后台软件自动测量肺部GGNs的定量指标,包括最大横截面直径、最大横截面积、体积和CT测量值,比较两组的一般资料和上述CT定量指标,采用二元Logistic回归分析肺部GGNs侵袭性的影响因素,并绘制ROC曲线分析CT定量指标对肺部GGNs侵袭性的预测价值。结果两组肺部GGNs的最大CT值、平均CT值和CT差值比较,差异均有统计学意义(t=2.084、5.604、5.923,P<0.05)。Logistic回归分析显示,平均CT值(OR=1.317,95%CI:1.038~2.816)、CT差值(OR=1.658,95%CI:1.127~3.021)是肺部GGNs侵袭性的独立影响因素(P<0.05)。ROC曲线分析显示,平均CT值、CT差值预测肺部GGNs侵袭性的曲线下面积(AUC)分别为0.819、0.875,最佳截断值分别为-571.38、-260.47 HU;两者联合预测的AUC为0.935,明显大于平均CT值单独预测,差异有统计学意义(Z=2.738,P<0.05),联合预测的灵敏度和特异度分别为85.88%、80.28%。结论平均CT值、CT差值与肺部GGNs的侵袭性密切相关,可作为预测肺部GGNs侵袭性的可靠CT定量指标,且两者联合预测价值更高。

Objective The application value of CT quantitative indicators in predicting the pathological invasiveness of pulmonary ground glass nodules(GGNs)was explored.Methods The clinical data and imaging data of 156 patients with pulmonary GGNs treated in Beichen District Hospital of Traditional Chinese Medicine,Tianjin from October 2019 to October 2021 were analyzed retrospectively.According to the histopathological diagnosis results,they were divided into non infiltration group(71 cases)and infiltration group(85 cases).The films were read by two senior imaging physicians who were unaware of the study and pathological results.The quantitative indicators of pulmonary GGNs were automatically measured with the help of CT background software,including the maximum cross-sectional diameter,maximum cross-sectional area,volume and CT measurement value.The general data and the above CT quantitative indicators of the two groups were compared.The influencing factors of pulmonary GGNs invasiveness were analyzed by binary Logistic regression,and the receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of CT quantitative indicators on pulmonary GGNs invasiveness.Results There were statistically significant differences in the maximum CT value,average CT value and CT difference of pulmonary GGNs between the two groups(t=2.084,5.604,5.923,P<0.05).Logistic regression analysis showed that the mean CT value(OR=1.317,95%CI:1.038~2.816)and CT difference(OR=1.658,95%CI:1.127~3.021)were independent factors affecting the invasiveness of pulmonary GGNs(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the average CT value and CT difference in predicting the invasiveness of pulmonary GGNs were 0.819,0.875,and the best cut-off values were-571.38,-260.47 HU.The AUC predicted by the combination of the two was 0.935,which was significantly higher than that of the average CT value alone(Z=2.738,P<0.05).The sensitivity and specificity predicted by the combination of the two were 85.88% and 80.28% respectively.Conclusion The average CT value and CT difference are closely related to the invasiveness of pulmonary GGNs,so they can be used as reliable CT quantitative indicators to predict pulmonary GGNs invasiveness,besides,the predictive value of the combination of the two is higher.