| 摘要: |
| 目的探讨CT能谱成像参数定量分析对肺磨玻璃密度结节（GGN）浸润前病变[包括非典型腺瘤样增生（AAH）和原位腺癌（AIS）]与微浸润腺癌（MIA）的鉴别诊断价值。方法选取经手术病理证实的GGN患者127例，分为AAH+AIS51例和MIA组76例。所有患者术前均经CT能谱成像靶扫描检查。多平面图像测量结节最大径（Dmax）、密度较高区70KeV单能图像CT值（CT70KeV）、能谱曲线斜率（姿HU）及水基值。观察空泡征、胸膜凹陷。ROC曲线分析评估诊断效能。结果两组患者空泡征比较差异无统计学意义（P＞0.05）。两组患者胸膜凹陷、Dmax、CT70KeV、水基值和姿HU比较差异均有统计学意义（均P＜0.05）。Dmax诊断最佳临界值为0.780cm，AUC为0.771，灵敏度为0.711，特异度为0.725。CT70KeV诊断最佳临界值为-560.035HU，AUC为0.765，灵敏度为0.680，特异度为0.720。水基值诊断最佳临界值为388.847mg/ml，AUC为0.777，灵敏度为0.750，特异度0.667。结论CT能谱成像参数定量分析对GGNAAH+AIS与MIA的鉴别诊断有潜在价值。 |
| 关键词: 肺腺癌 磨玻璃密度结节 定量分析 能谱成像 |
| DOI：10.12056/j.issn.1006-2785.2018.40.12.2018-199 |
| 分类号: |
| 基金项目:浙江省医药卫生基金项目（2018KY891） |
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| Differential diagnosis of pre-invasive lesions and minimally invasive adenocarcinomas presented as ground glass opacity nodules by CT energy spectral imaging |
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| Abstract: |
| Objective To examine the application of CT energy spectral imaging multi-parameter analysis in differentiating pre-invasive lesions from minimally invasive adenocarcinoma (MIA) appearing as ground-glass nodules. Methods The CT images of 127 ground-glass nodules confirmed by surgery and pathology in our hospital were retrospectively reviewed. There were 51 cases of pre-invasive lesions , including 6 cases of atypical adenomatous hyperplasia ( AAH ) and 45 cases of adenocarcinoma in situ (AIS), 76 cases of minimally invasive adenocarcinoma (MIA). All nodules underwent CT target scanning in energy spectral mode, and the spectral CT features of the AAH+AIS and MIA were analyzed and compared. the quantitative parameters were measured in the multiplanar reconstruction imaging including the maximum diameter(Dmax), the CT value of 70 KeV monochromatic CT images(CT70KeV) on the highest attenuation region of the nodules, the slope of the energy spectrum
( 姿HU ) and water ( iodine ) concentration . The vacuole signs and pleural depressions were observed . Receiver operating
characteristic(ROC) analyses were conducted to evaluate the diagnostic efficacy. Results There was no significant difference between two groups in vascular signs(P ＞0.05). There were significant differences in pleural indentation, Dmax, CT70KeV, water and 姿HU between two groups (all P＜0.05). The cut-off value of Dmax was 0.780cm with a sensitive of 0.711 and specificity of 0.725 and AUC of 0.771. The cut-off value of CT70KeV was -560.035HU with a sensitive of 0.680, specificity of 0.720 and AUC of 0.765.
The cut-off value of Water was 388.847mg/ml with a sensitive of 0.750, specificity of 0.667 and AUC of 0.777. Conclusion Mul- ti-parameter analysis of CT energy spectral imaging is of value in distinguishing pre-invasive lesions from minimally invasive adenocarcinomas presenting as ground-glass nodules. |
| Key words: Lung neoplasm Ground-glass nodule Quantitative analysis Spectral imaging |
