基于CT三维可视化定量参数在肺磨玻璃结节术前手术方式评估中的价值

The value of quantitative parameters based on CT 3D visualization in preoperative evaluation of pulmonary glass nodule

目的:旨在研究<3 cm肺磨玻璃结节(GGN)浸润风险性评估的最佳诊断指标及其临界值,通过重点分析GGN的CT三维可视化定量参数,探讨其在临床术前手术方法评估中的应用价值。方法:回顾性搜集本院2021年9月~2022年6月进行手术治疗并确诊的3 cm以下的肺磨玻璃结节126例,依照最终病理结果将浸润性腺癌(IA)纳入到高浸润风险组,非典型腺瘤样增生(AAH)、原位腺癌(AIS)及微浸润性腺癌(MIA)纳入低浸润风险组。利用三维可视化技术获取肺GGN三维定量参数:包括三维体积、三维平均CT值、实性占比等,并从中筛选出预测浸润风险性的参数指标并评估其诊断价值。结果:共纳入患者126例,高浸润风险组70例,平均年龄57岁(49岁,62岁),低浸润风险组56例,平均年龄50岁(40岁,54岁),两组平均年龄、年龄段及结节大小分布差异具有统计学意义(P<0.05),两组性别的比例及结节位置的分布差异均无统计学意义(P>0.05)。高浸润风险组和低浸润风险组之间的各项三维定量参数在统计学上具有显著差异(P<0.05)。肺GGN风险性受试者工作特征曲线(ROC)显示GGN长径、短径、长径/短径、三维平均CT值、三维体积、三维密度、三维质量以及实性占比预测肺GGN浸润风险性的最佳阈值为11.85 mm、8.95 mm、1.351、-597.1 HU、447.75 mm 3、0.403 mg·mm-3、223.628 mg、7.85%,其中当病灶的三维体积大于447.75 mm 3时,可预测为高浸润风险肺GGN的敏感度较高,为81.4%、特异度69.6%。根据多因素Logistic回归分析的结果,发现三维体积和实性占比对于预测肺GGN浸润风险性具有独立的预测价值。当这两个指标联合应用时,其预测准确性进一步提高(AUC=0.826)。结论:通过合理使用三维可视化技术,获取肺结节三维体积、质量等定量参数,能够有效辅助对<3 cm肺GGN的浸润风险性评估,结合临床相关资料,对临床术前手术方式评估和判断具有重要的指导意义。

Objective:This study aims to analyze the three-dimensional(3D)quantitative parameters of ground glass nodules(GGN)on CT scans,identify the optimal diagnostic indicators and their cut-off values for assessing the invasion risk of GGN smaller than 3cm,and explore their application value in preoperative evaluation.Methods:126 patients with pulmonary ground glass nodules smaller than 3cm diagnosed after surgical treatment were retrospectively collected from September 2021 to June 2022 in Ganzhou People's Hospital(Ganzhou Hospital Affiliated to Nanchang University).Based on the final pathological findings,the patients were divided into two distinct groups.Invasive adenocarcinoma(IA)was included into high-risk group,while atypical adenomatous hyperplasia(AAH),adenocarcinoma in situ(AIS),and minimally invasive adenocarcinoma(MIA)were included into low-risk group.The 3D quantitative parameters of pulmonary ground-glass nodules,including 3D volume,3D average CT value,solid proportion of the nodules,were acquired using 3D technology for visualization.Parameters that can be used to predict the likelihood of invasion were selected,and their diagnostic value was subsequently evaluated.Results:A total of 126 patients were included in the study.70 individuals were divided into the high-risk group,with a mean age of 57 years(range:49~62 years),and 56 patients were divieded into the low-risk group,with an average age of 50 years(range:40~54 years).Significantly difference of age distributions,nodule sizes and distributions were observed between the high-risk and low-risk groups(P<0.05).There were no significant differences in gender ratio and nodule location between the two groups(P>0.05).Notably,all 3D quantitative parameters exhibited statistically significant differences between the high-risk and low-risk groups(P<0.05).The receiver operating characteristic curves(ROC)of pulmonary GGN invasion risk indicated the following optimal thresholds:11.85mm for long diameter,8.95mm for short diameter,1.351 for long diameter/short diameter ratio,-597.1HU for 3D mean CT value,447.75mm 3 for 3D volume,0.403mg·mm-3 for 3D density,223.628mg for 3D mass,and 7.85%for the solid proportion of GGN.These thresholds served as predictive indicators for pulmonary GGN invasion risk.Especially when the three-dimensional volume of the lesion exceeded 447.75mm 3,the sensitivity and specificity for predicting a high risk of pulmonary GGN were 81.4%and 69.6%,respectively.Binary Logistic regression analysis identified the 3D volume and solid proportion as independent predictors of pulmonary GGN invasion risk.Combining these two indicators further enhanced prediction accuracy and increase the area under the curve(AUC=0.826).Conclusion:The reasonable use of 3D visualization technology to obtain quantitative parameters such as 3D volume and quality of pulmonary nodules can effectively assist in the evaluation of invasion risk of GGN<3cm.Combined with relevant clinical data,it has important guiding significance for the evaluation and judgment of preoperative strategy.