Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Korean J Radiol. 2019 Jul;20(7):1207-1215. doi: 10.3348/kjr.2018.0824.
To retrospectively investigate whether tumor size assessment on multiplanar reconstruction (MPR) CT images better reflects pathologic T-stage than evaluation on axial images and evaluate the additional value of measurement in three-dimensional (3D) space.
From 1661 patients who had undergone surgical resection for primary lung cancer between June 2013 and November 2016, 210 patients (145 men; mean age, 64.4 years) were randomly selected and 30 were assigned to each pathologic T-stage. Two readers independently measured the maximal lesion diameters on MPR CT. The longest diameters on 3D were obtained using volume segmentation. T-stages determined on CT images were compared with pathologic T-stages (overall and subgroup-Group 1, T1a/b; Group 2, T1c or higher), with differences in accuracy evaluated using McNemar's test. Agreement between readers was evaluated with intraclass correlation coefficients (ICC).
The diagnostic accuracy of MPR measurements for determining T-stage was significantly higher than that of axial measurement alone for both reader 1 (74.3% [156/210] vs. 63.8% [134/210]; = 0.001) and reader 2 (68.1% [143/210] vs. 61.9% [130/210]; = 0.049). In the subgroup analysis, diagnostic accuracy with MPR diameter was significantly higher than that with axial diameter in only Group 2 ( < 0.05). Inter-reader agreements for the ICCs on axial and MPR measurements were 0.98 and 0.98. The longest diameter on 3D images showed a significantly lower performance than MPR, with an accuracy of 54.8% (115/210) ( < 0.05).
Size measurement on MPR CT better reflected the pathological T-stage, specifically for T1c or higher stage lung cancer. Measurements in a 3D plane showed no added value.
回顾性研究多平面重建（MPR）CT 图像上的肿瘤大小评估是否比轴位图像更能反映病理 T 分期，并评估三维（3D）空间测量的附加价值。
从 2013 年 6 月至 2016 年 11 月间行手术切除的 1661 例原发性肺癌患者中，随机选择 210 例患者（男 145 例；平均年龄 64.4 岁），并将每例患者分为 30 例病理 T 分期。两位观察者分别在 MPR CT 上测量最大病变直径。使用体积分割获得 3D 最长直径。将 CT 图像上确定的 T 分期与病理 T 分期（总体和亚组 1，T1a/b；2，T1c 或更高）进行比较，采用 McNemar 检验评估准确性差异。采用组内相关系数（ICC）评估观察者间的一致性。
对于判断 T 分期，MPR 测量的诊断准确性明显高于单独轴位测量，对于观察者 1（74.3%[210/210]比 63.8%[134/210]； = 0.001）和观察者 2（68.1%[210/210]比 61.9%[130/210]； = 0.049）均如此。在亚组分析中，仅在 T2 亚组中，MPR 直径的诊断准确性明显高于轴位直径（ ＜0.05）。轴位和 MPR 测量的观察者间 ICC 分别为 0.98 和 0.98。3D 图像最长直径的准确性为 54.8%（115/210），明显低于 MPR（ ＜0.05）。
MPR CT 上的肿瘤大小测量能更好地反映病理 T 分期，特别是 T1c 或更高期的肺癌。在 3D 平面上进行测量没有附加价值。
