诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (05): 521-525.doi: 10.16150/j.1671-2870.2019.05.007

• 论著 • 上一篇    下一篇

浸润前病变的CT值变化在鉴别肺纯磨玻璃结节性质的价值探讨

肖辅国, 潘自来()   

  1. 上海交通大学医学院附属瑞金医院放射科,上海 200025
  • 收稿日期:2019-07-01 出版日期:2019-10-25 发布日期:2019-10-25
  • 通讯作者: 潘自来 E-mail:zilaipanlilly@163.com

The value of change of CT value in differentiating the nature of pulmonary pure ground-glass nodules

XIAO Fuguo, PAN Zilai()   

  1. Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2019-07-01 Online:2019-10-25 Published:2019-10-25
  • Contact: PAN Zilai E-mail:zilaipanlilly@163.com

摘要:

目的:探讨CT值增加百分比、CT值及CT值增加量鉴别肺内纯磨玻璃结节病理性质的价值。方法:收集上海交通大学医学院附属瑞金医院及仁济医院2012年12月至2018年12月期间,经病理诊断为浸润前病变的纯磨玻璃结节59例共63个结节,病理分类为非典型腺瘤样增生(atypical adenomatous hyperplasia, AAH)、原位腺癌(adenocarcinoma in situ, AIS),其最大径≤1.5 cm,其中AAH 18例,AIS 45例,测定纯磨玻璃结节的CT值增加百分比、CT值、CT值增加量及肺CT值,其中CT值增加百分比指结节CT值相对于肺CT值的增加百分比,CT值增加量指结节CT值相对于肺CT值的增加量。采用t检验、二元回归分析及绘制受试者工作特征曲线进行分析,研究发现以上指标鉴别AAH及AIS的能力。结果:当纯磨玻璃结节以CT值增加百分比为25%、CT值为-615 HU及以CT值增加量为223 HU为临界值时,有助于鉴别AAH与AIS(均P<0.05),当小于界值时诊断AAH的灵敏度分别为78%和76%、100%,特异度分别为62%、77%和71%,曲线下面积分别为0.83、0.86、0.80。结论:CT值增加百分比、CT值及CT值增加量有助于AAH及AIS的鉴别,可以指导临床随访,避免随访、手术及其他治疗延迟。

关键词: 肺肿瘤, 纯磨玻璃, 肺结节, 肺腺癌, X线计算机

Abstract:

Objective: To explore the value of percentage of CT value increment, CT value and CT value increment for differentiating the pathologic character of pulmonary ground-glass nodules. Methods: Altogether 59 cases and 63 pure ground glass nodules pathologically diagnosed as preinvasive lesion at Ruijin Hospital and Renji Hospital affilia-ted to Shanghai Jiao Tong University School of Medicine from December 2012 to December 2018 were collected. The pathological classification were atypical adenomatous hyperplasia (AAH) (18 cases) and adenocarcinoma in situ(AIS)(45 cases). Their imaging manifestations were pure ground glass nodules. The diameter of AAH and AIS was ≤1.5 cm. The percentage of CT value increment, CT value and CT value increment of pure ground glass nodules and lung CT value were measured. The percentage of CT value increment denotes the percentage of increment of nodules CT value over lung CT value; CT value increment denotes the increment of nodule CT value over lung CT value. Student's t-test, binary regression analysis and receiver operation characteristic curve were used to analyze the value for differentiating AAH and AIS. Results: When cutoff values were taken as percentage of CT value increment of pure ground glass nodule 25%, CT value -615 HU and CT value increment 223 HU, they were helpful for differentiating AAH from AIS(P<0.05). The sensitivity for diagnosis of AAH were 78%, 76% and 100%, respectively; the specificity were 62%, 77% and 71%, respectively. The area under the ROC curve were 0.83, 0.86 and 0.80, respectively. Conclusions: The percentage of CT value increment, CT value and CT value increment of pure ground- glass nodules are helpful for differentiating AAH and AIS.

Key words: Lung neoplasms, Pure ground-glass opacity, Lung nodules, Lung adenocarcinoma, Computed tomogragh

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