Choi Yangsean, Gil Bo Mi, Chung Myung Hee, Yoo Won Jong, Jung Na Young, Kim Yong Hyun, Kwon Soon Seog, Kim Jeana
Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
Division of Allergy and Pulmonary, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea.
J Thorac Dis. 2019 Jun;11(6):2392-2401. doi: 10.21037/jtd.2019.05.56.
The purpose of this study was to determine whether semi-automated region of interest (ROI) measurement of CT attenuations of solitary pulmonary nodule (SPN) is an accurate approach in differentiating malignant from benign SPN.
Ninety cases of pathologically proven SPN were retrospectively reviewed. CT attenuations of SPN before and after contrast injection were measured using semi-automated ROI selection method. Attenuations within a range of -100 to 200 Hounsfield units (HU) as soft tissue density range were set. The ROI included the entire SPN regardless of its internal soft tissue contents after automatic elimination of airs, calcific, or bony densities.
There were 42 (46.7%) malignant SPN and 48 (53.3%) benign SPN, which were grouped into A (18 tuberculoma, 13 fungus), B (5 focal organizing pneumonia, 5 abscess), and C (7 other benign tumors). The malignant SPN showed significantly higher mean attenuations of enhancement and net-enhancement than all benign SPN (P<0.001). Using the area under the receiver operating characteristic curve (AUC), the cut-off net-enhancement of 15 HU gave 83% sensitivity, 65% specificity and 73% accuracy for predicting malignancy. Malignant SPN (mean 67.9 HU) had significantly higher enhancement than group A (mean 52.6 HU, P<0.001, 95% CI: 8.73, 21.81) and group B (mean 57.0 HU, P=0.025, 95% CI: -1.43, 20.34) while group C showed no significant difference (mean 68.1 HU, P=0.97). Net enhancements were higher in group B (mean 18.8 HU) than in group A (mean 8.8 HU) (P<0.001, 95% CI: 11.8, 23.18).
The semi-automated ROI measurement of SPN's attenuations on CT is an accurate approach in distinguishing indeterminate SPN.
本研究的目的是确定对孤立性肺结节（SPN）的CT衰减进行半自动感兴趣区（ROI）测量是否是区分恶性与良性SPN的准确方法。
回顾性分析90例经病理证实的SPN病例。使用半自动ROI选择方法测量对比剂注射前后SPN的CT衰减。设定软组织密度范围为-100至200亨氏单位（HU）。在自动消除空气、钙化或骨密度后，ROI包括整个SPN，无论其内部软组织成分如何。
有42例（46.7%）恶性SPN和48例（53.3%）良性SPN，良性SPN分为A组（18例结核瘤，13例真菌）、B组（5例局灶性机化性肺炎，5例脓肿）和C组（7例其他良性肿瘤）。恶性SPN的平均强化衰减和净强化衰减显著高于所有良性SPN（P<0.001）。使用受试者操作特征曲线（AUC）下的面积，15 HU的净强化衰减临界值对预测恶性肿瘤的敏感性为83%，特异性为65%，准确性为73%。恶性SPN（平均67.9 HU）的强化显著高于A组（平均52.6 HU，P<0.001，95%CI：8.73，21.81）和B组（平均57.0 HU，P=0.025，95%CI：-1.43，20.34），而C组无显著差异（平均68.1 HU，P=0.97）。B组的净强化衰减（平均18.8 HU）高于A组（平均8.8 HU）（P<0.001，95%CI：11.8，23.18）。
对SPN的CT衰减进行半自动ROI测量是区分不确定SPN的准确方法。
