肺癌的影像组学和功能成像：除了 FDG PET/CT 和肺活检之外，影像学异质性的重要性。

Radiomics and functional imaging in lung cancer: the importance of radiological heterogeneity beyond FDG PET/CT and lung biopsy.

机构信息

Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy.

出版信息

Eur J Radiol. 2021 Sep;142:109874. doi: 10.1016/j.ejrad.2021.109874. Epub 2021 Jul 27.

DOI:10.1016/j.ejrad.2021.109874

PMID:34339955

Abstract

PURPOSE

[F]-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET/CT) has a central role in the lung nodules' characterization even if, with SUV < 2.5, percutaneous CT-guided Lung Biopsy (CTLB) is needed to assess nodule nature. In that scenario, CT Texture Analysis (CTTA) could be a non-invasive imaging biomarker. Our purpose is to test CTTA ability in differentiating malignant from benign nodules.

METHOD

Patients that underwent FDG PET/CT followed by CTLB between January 2013 and December 2018 were retrospectively enrolled. Were included patients with lung nodule SUV < 2.5 and histological diagnosis.

EXCLUSION CRITERIA

nodules SUV > 2.5, patients who refused CTLB or received oncological treatment before CTLB, indeterminate pathology report, CT motion artifacts. Two radiologists in consensus performed CTTA, drawing a volumetric Region of Interest of nodule with a dedicated first order TA software with and without spatial scaling filters, on preliminary CT performed for CTLB. Statistics included a comparison between malignant and benign neoplasms distribution (2-tailed T-test or Mann-Whitney test according to normal/non-normal data distribution), P-values < 0.05 were considered statistically significant. CTTA accuracy was tested with Receiver Operating Characteristics (ROC) curve.

RESULTS

Form an initial population of 1178, 46 patients encountered inclusion criteria. Pathologist reported 27/46 (59%) malignant and 19/46 (41%) benign nodules. In malignant lesions CTTA showed lower Kurtosis' and higher Skewness' values (all P ≤ 0.0013 and all filtered TA P < 0.024, respectively). ROC curve showed significant Area Under the Curve for Kurtosis and Skewness (0.654 and 0.642, P < 0.001) at medium filtration.

CONCLUSIONS

CTTA is a promising radiological tool to characterize benign and malignant lung nodules, even in those cases without an altered glucose metabolism.

摘要

目的

[F]-氟脱氧葡萄糖正电子发射断层扫描-计算机断层扫描（FDG PET/CT）在肺结节的特征化中具有核心作用，即使 SUV<2.5，也需要经皮 CT 引导下肺活检（CTLB）来评估结节性质。在这种情况下，CT 纹理分析（CTTA）可能是一种非侵入性的成像生物标志物。我们的目的是测试 CTTA 区分良恶性结节的能力。

方法

回顾性纳入 2013 年 1 月至 2018 年 12 月间接受 FDG PET/CT 检查后行 CTLB 的患者。纳入标准为结节 SUV<2.5 且有组织学诊断。

排除标准

结节 SUV>2.5、拒绝 CTLB 或 CTLB 前接受肿瘤治疗、不确定的病理报告、CT 运动伪影。两位放射科医生共识对 CTLB 前进行的初步 CT 进行 CTTA，使用专门的一阶 TA 软件，在结节上绘制容积感兴趣区，有无空间缩放滤波器。统计分析包括恶性和良性肿瘤分布之间的比较（根据正态/非正态数据分布，使用双尾 t 检验或曼-惠特尼检验），P 值<0.05 被认为具有统计学意义。使用接收者操作特征（ROC）曲线测试 CTTA 的准确性。

结果

从最初的 1178 例患者中，有 46 例符合纳入标准。病理报告 27/46（59%）为恶性，19/46（41%）为良性结节。在恶性病变中，CTTA 显示较低的峰度和较高的偏度值（均 P≤0.0013，所有过滤后的 TA 值 P<0.024，分别）。ROC 曲线显示峰度和偏度的曲线下面积具有显著意义（0.654 和 0.642，P<0.001），在中等滤波时。