Naeem Muhammad Qasim, Darira Jaideep, Ahmed Muhammad Saad, Hamid Kamran, Ali Muhammad, Shazlee Muhammad Kashif
Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK.
Cureus. 2021 Mar 21;13(3):e14025. doi: 10.7759/cureus.14025.
Introduction Lung cancer is the most common cancer overall, and the foremost cause of cancer-related mortality. Almost all lung cancers evolve from pulmonary nodules. As multidetector CT (MDCT) scanners are now widely available, there is an increased rate of detection of pulmonary nodules. It is of utmost importance to evaluate pulmonary nodules to rule out the possibility of neoplastic diseases. With advancements in technology, there are various manual and automatic analytic software providing a wide range of post-processing techniques. Maximum intensity projection (MIP) and volume rendering (VR) techniques have been analyzed previously regarding pulmonary nodules but there is a scarcity of data in terms of low-density nodules. This study aims to delineate the comparison and supremacy of both techniques in terms of low-density nodules. Methodology The current prospective study was conducted from June 2019 to June 2020 in the Radiology Department at Dr. Ziauddin Hospital, Karachi. Chest CT scans were performed on 16 slice MDCT (Alexion 16 Multi-slice, Toshiba Medical System Corporation, Houston, TX). A consultant radiologist of six years experience and a postgraduate trainee of three years experience analyzed each patient on a workstation (Vitrea 6.2.0, Vital Images, Minnetonka, MN). SPSS 23.0 (SPSS Inc., Chicago, IL) was incorporated for data analysis. Data were expressed in the median and interquartile range (IQR). Data collected for this study were analyzed using analyzing the median difference in nodule count using Wilcoxon's signed-rank test. A p-value of <0.05 was considered significant. Results After informed consent, 236 patients were recruited for the study. MIP outperformed VR in terms of nodule detection and low-density nodules at each evaluated slab thicknesses (p<0.001). A 10-mm MIP was superior to all other techniques in terms of detection of pulmonary nodules and low-density nodules (p<0.001). MIP was also considered an easier technique as there was excellent inter-rater reliability and agreement. Conclusion This study is robust evidence regarding the supremacy of MIP. MIP outperformed VR on every slab thicknesses. The 10-mm MIP technique was superior to all others evaluated and was recorded to be an easier analyzing technique.
引言
肺癌是总体上最常见的癌症，也是癌症相关死亡的首要原因。几乎所有肺癌都由肺结节演变而来。由于多排螺旋CT（MDCT）扫描仪现已广泛应用，肺结节的检出率有所增加。评估肺结节以排除肿瘤性疾病的可能性至关重要。随着技术的进步，有各种手动和自动分析软件提供广泛的后处理技术。最大密度投影（MIP）和容积再现（VR）技术先前已针对肺结节进行过分析，但关于低密度结节的数据较少。本研究旨在阐明这两种技术在低密度结节方面的比较及优势。
方法
本前瞻性研究于2019年6月至2020年6月在卡拉奇齐亚丁医院放射科进行。使用16排MDCT（Alexion 16多层，东芝医疗系统公司，得克萨斯州休斯顿）进行胸部CT扫描。一位有六年经验的放射科顾问医生和一位有三年经验的研究生实习生在工作站（Vitrea 6.2.0，Vital Images，明尼苏达州明尼通卡）对每位患者进行分析。采用SPSS 23.0（SPSS公司，伊利诺伊州芝加哥）进行数据分析。数据以中位数和四分位间距（IQR）表示。本研究收集的数据通过使用Wilcoxon符号秩检验分析结节计数的中位数差异进行分析。p值<0.05被认为具有统计学意义。
结果
在获得知情同意后，招募了236名患者进行研究。在每个评估的层厚下，MIP在结节检测和低密度结节方面均优于VR（p<0.001）。10毫米的MIP在肺结节和低密度结节检测方面优于所有其他技术（p<0.001）。MIP也被认为是一种更简便的技术，因为其具有出色的评分者间可靠性和一致性。
结论
本研究有力证明了MIP的优势。MIP在每个层厚上均优于VR。10毫米的MIP技术优于所有其他评估技术，且被记录为一种更简便的分析技术。
