CT quantitative parameters and imaging features of pulmonary microinvasive adenocarcinoma and invasive adenocarcinoma
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摘要:
目的 目的分析肺微浸润腺癌（MIA）和浸润性腺癌（IAC）的CT定量参数及影像学特征的鉴别诊断价值。 方法 选取2019年1月~2021年8月本院收治的80例肺腺癌患者为研究对象，根据病理结果分为MIA组（n=36）和IAC组（n=44），分析两组患者的CT征象，并采用受试者工作特征曲线（ROC）评估肺窗最大径、肺窗最大径的垂直径、肺窗病灶体积、肺窗平均CT值、纵膈窗最大径、纵膈窗最大径的垂直径、纵膈窗病灶体积、肿瘤影消失率指标鉴别IAC和MIA的敏感度和特异性。 结果 IAC组和MIA组CT影像中的病变位置、病灶形态、空泡征、肺瘤界面差异无统计学意义（P >0.05）；胸膜凹陷症、毛刺征、分叶征、血管集束征、支气管充气征差异有统计学意义（P < 0.05）；IAC组肺窗最大径、肺窗最大径的垂直径、肺窗病灶体积、纵膈窗最大径、纵膈窗最大径的垂直径、纵膈窗病灶体积均高于MIA组（P < 0.05），肺窗平均CT值和肿瘤影消失率低于MIA组（P < 0.05）；ROC曲线显示，CT定量参数中鉴别诊断价值最高的是纵膈窗病灶体积，然后依次是纵膈窗最大径、肿瘤影消失率、肺窗病灶体积、肺窗最大径的垂直径、纵膈窗最大径的垂直径、肺窗平均CT值、肺窗最大径。 结论 当病灶影像学特征具有胸膜凹陷症、毛刺征、分叶征、血管集束征、支气管充气征时，IAC的可能性大，纵膈窗病灶体积和纵膈窗最大径鉴别IAC和MIA价值较大。 Abstract:Objective To analyze the diagnostic value on imaging features and CT quantitative parameters of pulmonary microinfiltrating adenocarcinoma (MIA) and infiltrating adenocarcinoma (IAC). Methods Eighty patients with lung adenocarcinoma admitted to our hospital from January 2019 to January 2020 were selected as the study subjects. According to pathology, they were divided into MIA group (n=36) and IAC group (n=44). The CT signs of the two groups were analyzed. Receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity of lung window maximum diameter, vertical diameter of lung window maximum diameter, lung window lesion volume, lung window average CT value, mediastinal window maximum diameter, vertical diameter of mediastinal window maximum diameter, mediastinal window lesion volume, TDR indicators in the identification of IAC and MIA. Results There were no significant differences in lesion location, lesion morphology, vacuolar sign and lung tumor interface in the CT images of the IAC MIA group (P >0.05). There were significant differences in pleural depression, burr sign, lobulation sign, vascular cluster sign and bronchial inflation sign (P < 0.05). The maximum diameter of lung window, vertical diameter of maximum diameter of lung window, volume of lung window lesion, maximum diameter of mediastinal window, vertical diameter of maximum diameter of mediastinal window and lesion volume of mediastinal window in IAC group were significantly higher than those in MIA group (P < 0.05), and the mean CT value of the lung window and the disappearance rate of the tumor shadow were significantly lower than those in the MIA group (P < 0.05). ROC curve showed that the highest differential diagnostic value among the CT quantitative parameters was the volume of the mediastinal window lesion, followed by the maximum diameter of the mediastinal window, the disappearance rate of the tumor shadow, the vertical diameter of the maximum diameter of the lung window, the vertical diameter of the lung window, and the maximum diameter of the lung window. Conclusion When the imaging features of the lesion have pleural indentation, burr sign, lobulation sign, vascular cluster sign and bronchial inflatation sign, the possibility of IAC and mediastinal window lesion volume and mediastinal window maximum diameter are of great value in differentiating IAC from MIA. -
图 1 IAC和MIA影像学特征
A：IAC，右肺下叶上段见混杂磨玻璃密度结节，直径约2.2 cm，期内可见实性成分，边缘毛刺征象，形态不规则；B：MIA，右肺中叶磨玻璃密度结节，密度欠均匀，直径约1.2 cm，形态趋于类圆形，边界部分不清.
Figure 1. Imaging features of IAC and MIA.
图 2 CT定量参数对IAC和MIA鉴别诊断的ROC曲线
Figure 2. ROC curve of CT quantitative parameters for differential diagnosis of IAC and MIA.
表 1 两组一般资料比较
Table 1. Comparison of general data between the two groups
[n(%)] 一般资料 IAC组（n=44） MIA组（n=36） t/ χ2 P 性别 0.205 0.651 男 31（70.45） 27（75.00） 女 13（29.55） 9（25.00） 年龄（岁, Mean±SD) 54.97±10.26 55.72±10.74 0.319 0.751 吸烟 16（36.36） 10（27.78） 0.665 0.415 并发症 8（18.18） 5（13.89） 0.268 0.605 手术方式 0.730 0.694 肺叶切除 25（56.82） 22（61.11） 肺段切除 8（18.18） 10（27.78） 楔形切除 11（25.00） 14（38.89） 家族肺癌史 6（13.64） 7（19.44） 0.491 0.484 IAC：浸润性腺癌；MIA：微浸润腺癌. 
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表 2 IAC组和MIA组影像学特征比较
Table 2. Comparison of imaging characteristics between IAC group and MIA group
[n(%)] 项目 IAC组（n=44） MIA组（n=36） χ2 P 病变位置 1.142 0.887 右肺上叶 13（29.55） 10（27.78） 右肺中叶 7（15.91） 6（16.67） 右肺下叶 9（20.45） 6（16.67） 左肺上叶 10（22.73） 7（19.44） 左肺下叶 （11.36） 7（19.44） 病灶形态 0.485 0.486 圆形/类圆形 15（34.09） 15（41.67） 不规则形 29（65.91） 21（58.33） 空泡征 13（29.55） 7（19.44） 1.077 0.299 胸膜凹陷症 12（27.27） 3（8.33） 4.662 0.031 毛刺征 15（34.09） 5（13.89） 4.310 0.038 分叶征 27（61.36） 13（36.11） 5.051 0.025 血管集束征 23（52.27） 10（27.78） 4.902 0.027 支气管充气征 20（45.45） 7（19.44） 5.991 0.014 肺瘤界面 0.131 0.718 清楚 19（43.18 17（47.22） 不清楚 25（56.82） 19（52.78）
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表 3 IAC组和MIA组CT定量参数水平比较
Table 3. Comparison of CT quantitative parameters between IAC group and MIA group
(Mean±SD) 指标 截点值 AUC 敏感度（%） 特异性（%） 95%CI 肺窗最大径 2.35 0.644 52.27 80.56 0.529~0.748 肺窗最大径的垂直径 1.67 0.747 70.45 77.78 0.637~0.837 肺窗病灶体积 5.83 0.754 59.09 88.89 0.645~0.843 肺窗平均CT值 -509.64 0.648 79.55 52.78 0.534~0.752 纵膈窗最大径 1.27 0.786 75.00 77.78 0.680~0.870 纵膈窗最大径的垂直径 1.15 0.719 45.45 97.22 0.608~0.814 纵膈窗病灶体积 0.98 0.788 65.91 88.89 0.682~0.871 TDR 0.04 0.779 70.45 94.44 0.672~0.864 TDR：肿瘤影消失率.
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表 4 CT定量参数对IAC和MIA鉴别诊断价值分析
Table 4. Value analysis of CT quantitative parameters for differential diagnosis of IAC and MIA
参数 IAC组（n=44） MIA组（n=36） t P 肺窗最大径 2.44±0.82 1.98±0.61 2.792 0.007 肺窗最大径的垂直径 1.92±0.68 1.40±0.48 3.866 < 0.001 肺窗病灶体积 7.11±3.86 3.83±1.76 4.710 < 0.001 肺窗平均CT值 -444.42±79.83 492.73±104.18 2.348 0.021 纵膈窗最大径 1.77±0.86 0.94±0.56 4.987 < 0.001 纵膈窗最大径的垂直径 1.15±0.62 0.72±0.29 3.829 < 0.001 纵膈窗病灶体积 1.25±0.54 0.79±0.21 4.817 < 0.001 TDR -0.65±1.51 0.67±0.43 5.074 < 0.001
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