双能量CT定量参数预测实性肺腺癌气道播散

Dual-energy CT quantitative parameters for predicting spreading through air spaces of solid lung adenocarcinoma

目的观察双能量CT(DECT)定量参数术前预测实性肺腺癌气道播散(STAS)状态的价值。方法回顾性分析52例经手术病理确诊实性肺腺癌患者的DECT及病理学资料,评估其STAS状态(阳性或阴性);对比STAS阳性、阴性实性肺腺癌CT表现(最大径、周围不透明影、空气支气管征、胸膜凹陷征)及DECT定量参数的差异。针对差异有统计学意义的DECT定量参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评估DECT定量参数单独及联合预测实性肺腺癌STAS的效能,并以二元logistic回归分析筛选实性肺腺癌STAS的独立预测因子。结果52例中,25例STAS阳性,27例STAS阴性,其间病灶CT表现差异均无统计学意义(P均>0.05),DECT定量参数中的动脉期碘浓度(IC_(A))、动脉期标准化碘浓度(NIC_(A))及静脉期碘浓度(IC_(V))差异均有统计学意义(P均<0.05)。IC_(A)、NIC_(A)及IC_(V)预测实性肺腺癌STAS的AUC为0.82、0.83及0.73;IC_(A)和NIC_(A)均为实性肺腺癌STAS的独立预测因子,其联合AUC为0.89。结论DECT定量参数可有效预测实性肺腺癌STAS。

Objective To explore the value of dual-energy CT(DECT)quantitative parameters for preoperative prediction of spreading through air spaces(STAS)of solid lung adenocarcinoma.Methods DECT and pathological data of 52 patients with solid lung adenocarcinoma confirmed by surgical pathology were retrospectively analyzed,and patients'STAS status(positive or negative)were assessed.CT manifestations,including the maximum diameter,ill-defined peripheral opacity,air bronchogram and pleural indentation,as well as DECT quantitative parameters were compared between STAS positive and negative of solid lung adenocarcinomas.Then receiver operating characteristic(ROC)curve of parameters being significantly different between STAS positive and negative lesions was drawn,and area under the curve(AUC)was calculated to evaluate the effectiveness of DECT quantitative parameters alone and combination for predicting STAS status of solid lung adenocarcinoma.Then binary logistic regression analysis was used to screen the independent predictors related to DECT quantitative parameters for STAS of solid lung adenocarcinoma.Results Among 52 patients,25 were STAS-positive and 27 were STAS-negative.No significant difference of CT manifestations(all P>0.05),while significant differences of DECT quantitative parameters,including arterial phase iodine concentration(IC_(A)),normalized IC_(A)(NIC_(A))and venous phase IC(IC_(V))were found between STAS-positive and STAS-negative solid lung adenocarcinomas(all P<0.05).AUC of IC_(A),NIC_(A)and IC_(V)for predicting STAS of lung adenocarcinoma was 0.82,0.83 and 0.73,respectively.ICA and NICA were independent predictors for STAS of solid lung adenocarcinoma with,and the combing AUC was 0.89.Conclusion DECT quantitative parameters could effectively predict STAS of solid lung adenocarcinoma.