CT特征及增强定量分析预测肺磨玻璃结节浸润性的诊断价值

The value of CT features and quantitative analysis of contrast-enhanced CT scan in predicting the invasion of pulmo⁃nary ground-glass nodules

目的 探讨CT特征及增强定量分析预测磨玻璃结节(GGN)浸润性及浸润程度的价值。方法 选取经手术及病理证实CT表现为GGN 102例(114个病灶)患者的临床资料及CT资料,所有患者均行CT平扫及增强扫描。按照病理类型分为浸润前驱腺体病变(AAH+AIS)、MIA和IAC三组。比较结节的各定量资料及定性资料,并对各定量参数进行受试者操作特征(ROC)曲线分析;运用二元Logistic回归分析评估GGN浸润程度的独立预测因素。结果 病灶大小、形态、结节类型、支气管异常征、内部血管征,胸膜牵拉征等特征指标在三组间差异有统计学意义(P<0.05);而性别、吸烟史及瘤-肺界面在三组间差异无统计学意义(P=0.432、0.405、0.205)。各CT定量指标(平扫CT值、动脉期CT值、静脉期CT值、动脉期强化差值、静脉期强化差值、动脉期强化指数、静脉期强化指数)在三组间差异均有统计学意义(P<0.001),而平扫CT值在AAH+AIS和MIA组间比较差异无统计学意义(P=0.075);ROC曲线分析结果表明平扫CT值、增强各期CT值、增强差值及强化指数等方法均具有较好的鉴别效能;二元Logistic回归分析显示结节类型(OR=47.143, 95%CI 2.549~871.918, P=0.010)和内部血管征(OR=11.466, 95%CI 1.209~108.713, P=0.034)为GGN浸润程度的独立危险因素。结论 CT表现特征联合增强扫描定量分析对GGN浸润性的预测评估具有重要价值,结节类型及内部血管征是GGN浸润程度的独立危险因素。

Objective To investigate the value of CT features and contrast-enhanced quantitative analysis in predicting the invasion and degree of invasiveness of ground glass nodules(GGNs).Methods Clinical data and CT images of 102 patients(114 lesions)whose manifestations were GGNs verified by surgery and pathology were retrospectively analyzed.and all patients underwent enhanced CT scanning.According to the pathological type,they were divided into three groups:precursor gland lesions(atypical adenomatous hyperplasia AAH+adenocarcinoma in situ AIS),micro-invasive adenocarcinoma(MIA)and invasive adenocarcinoma(IAC).The quantitative and qualitative data of the nodules were compared,and subject operating characteristic(ROC)curve analysis was performed for each parameter.Binary logistic regression analysis was used to evaluate the independent risk factors of the degree of nodular invasion.Results There were statistically significant differences among the three groups in the size,shape,nodule type,bronchial abnormal sign,internal vascular sign,pleural traction sign.There was no significant difference in sex,smoking history and tumor-lung interface among the three groups(P=0.432,0.405,0.205).All CT quantitative indexes(unenhanced CT value,CT values on enhancement in arterial phase,CT values on enhancement in venous phase,arterial phase enhancement difference,venous phase enhancement difference,arterial phase enhancement index,and venous phase enhancement index)were significantly different among the three groups(P<0.001).Except that the unenhanced CT value was not statistically significant between AAH+AIS and MIA groups(P=0.075),the ROC curve analysis showed that unenhanced CT value,CT values on enhancement,degree of enhancement and enhancement index had the highest diagnostic efficiency.Binary logistic regression analysis showed that nodule type(OR=47.143,95%CI 2.549~871.918,P=0.010)and internal vascular sign(OR=11.466,95%CI 1.209~108.713,P=0.034)were independent risk factors for degree of invasiveness of GGN.Conclusion CT features and quantitative analysis of contrast-enhanced CT scan have high diagnostic and predictive value for the invasive of pulmonary ground-glass nodules,nodule type and internal vascular sign are independent risk factors for degree of invasiveness of GGN.