摘要
目的分析多平面容积再现技术(multiplanar volume rendering,MPVR)在肺磨玻璃结节浸润性诊断中的临床意义。方法选择2020年1月至2023年5月我院收治因肺磨玻璃结节(ground glass nodule,GGN)接受手术切除患者1032例,其中303例(29.36%),共325枚组织经病理学证实的GGN,包括114枚原位腺癌(adenocarcinoma in situ,AIS)、104枚微浸润性腺癌(minimally invasive adenocarcinoma,MIA)和107枚浸润性腺癌(invasive adenocarcinoma,IAC)。根据MPVR表现将GGN内部表现分为Ⅰ~Ⅴ型、外部形态表现分为Ⅰ~Ⅲ型。微浸润性腺癌及浸润性腺癌定义为浸润性病变(invasive lesions,ILs),根据MPVR上GGN内孤立性结节最大径与GGN三维(three-dimensional,3D)最大径比值,采用受试者工作特征(receiver operating characteristic,ROC)分析鉴别浸润性病变和浸润性腺癌的截断值。结果AIS内部表现以Ⅰ型(75.44%)为主;MIA内部表现以Ⅴ型(50.00%)为主;IAC内部表现以Ⅳ型为主(57.01%),三者差异有统计学意义(P<0.001)。内部表现为Ⅱ型的GGN,AIS与IAC间具有统计学差异(P<0.001),MIA与AIS、MIA与IAC间无统计学意义(P>0.05);无内部表现为Ⅲ型的GGN,AIS与MIA及IAC间有统计学差异(P<0.001),MIA与IAC间无统计学差异(P>0.05)。AIS外部MPVR表现以Ⅰ型(86.84%)、MIA外部MPVR表现以Ⅱ型(58.65%)、IAC外部MPVR表现以Ⅲ型(68.22%)为主,组间比较有统计学意义(P<0.001)。鉴别ILs和IACs时,MPVR上GGN内孤立结节最大径与GGN3D长径比值的截断值分别为0.5[曲线下面积(AUC):0.816,敏感性:71.93,特异性:85.71,(P<0.001)]和0.508(AUC:0.883,敏感性:87.5,特异性:79.03,P<0.001)。结论MPVR技术给序GGN临床诊断带来依据,对GGN浸润性诊断中有重要作用,临床实践具有意义。
Objective Exploring the clinical significance of Multiplanar volume rendering(MPVR)technology in diagnosising the invasiveness of pulmonary ground glass nodules.Methods A retrospective analysis was conducted on 325 neoplastic GGNs,114 adenocarcinoma in situ(AIS),104 minimally invasive adenocarcinoma(MIA),and 107 invasive adenocarcinoma(IAC)in 303 patients between January 2020 and May 2023.The internal performance of GGN were divided intoⅠ-Ⅴtypes,and the external morphology were divided intoⅠ-Ⅲtypes according to the multiplanar volume rendering(MPVR)performance.Define MIA and IAC as invasive lesions(ILs),and based on the ratio of the maximum diameter of solitary nodules in GGN on MPVR to the 3D maximum diameter of GGN,and then the cutoff value for distinguishing invasive lesions and invasive adenocarcinoma were obtained via ROC analysis.Results The internal manifestation of AIS,MIA,IAC on MPVR were mainly typeⅠ,typeⅤand typeⅣ,and statistical significance(P<0.001)were found between the three groups.there also were statistically significant difference between AIS and IAC in typeⅡ,and between AIS and MIA,IAC in typeⅢ(each P<0.001).The external manifestation of AIS,MIA,IAC on MPVR were mainly typeⅠ,typeⅡ,and typeⅢ,and statistical significance(P<0.001)were found between the three groups.For distinguishing invasive lesions and invasive adenocarcinoma,the cutoff value for the ratio of the maximum diameter of solitary nodules in GGN on MPVR to the 3D maximum diameter of GGN was 0.5(AUC:0.816,sensitivity:71.93,specificity:85.71,P<0.001),and 0.508(AUC:0.883,sensitivity:87.5,specificity:79.03,P<0.001).Conclusion MPVR technology has important role in evaluating the invasiveness of pulmonary ground glass nodules and has guiding significance for clinical practice.
作者
熊廷伟
陶阳
李王佳
付彬洁
褚志刚
吕发金
Xiong Tingwei;Tao Yang;Li Wangjia;Fu Binjie;Chu Zhigang;Lv Fajin(Department of Radiology,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中华肺部疾病杂志（电子版）》
2024年第4期575-579,共5页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
重庆市技术创新与应用发展专项重点项目(CSTC2021jscx-ksbN0030)
重庆市科卫联合医学科研重点项目(2022ZDXM006)。
关键词
肺磨玻璃结节
多平面容积再现技术
计算机断层扫描
原位癌
微浸润/浸润性腺癌
肺
Ground glass nodules
Multiplanar volume rendering
Computed tomography
Carcinoma in situ,microinvasive/invasive adenocarcinoma,lung
