Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.
Eur Radiol. 2023 Jun;33(6):3908-3917. doi: 10.1007/s00330-022-09334-w. Epub 2022 Dec 20.
To assess the value of quantitative computed tomography (QCT) of the whole lung and nodule-bearing lobe regarding pulmonary nodule malignancy risk estimation.
A total of 251 subjects (median [IQR] age, 65 (57-73) years; 37% females) with pulmonary nodules on non-enhanced thin-section CT were retrospectively included. Twenty percent of the nodules were malignant, the remainder benign either histologically or at least 1-year follow-up. CT scans were subjected to in-house software, computing parameters such as mean lung density (MLD) or peripheral emphysema index (pEI). QCT variable selection was performed using logistic regression; selected variables were integrated into the Mayo Clinic and the parsimonious Brock Model.
Whole-lung analysis revealed differences between benign vs. malignant nodule groups in several parameters, e.g. the MLD (-766 vs. -790 HU) or the pEI (40.1 vs. 44.7 %). The proposed QCT model had an area-under-the-curve (AUC) of 0.69 (95%-CI, 0.62-0.76) based on all available data. After integrating MLD and pEI into the Mayo Clinic and Brock Model, the AUC of both clinical models improved (AUC, 0.91 to 0.93 and 0.88 to 0.91, respectively). The lobe-specific analysis revealed that the nodule-bearing lobes had less emphysema than the rest of the lung regarding benign (EI, 0.5 vs. 0.7 %; p < 0.001) and malignant nodules (EI, 1.2 vs. 1.7 %; p = 0.001).
Nodules in subjects with higher whole-lung metrics of emphysema and less fibrosis are more likely to be malignant; hereby the nodule-bearing lobes have less emphysema. QCT variables could improve the risk assessment of incidental pulmonary nodules.
• Nodules in subjects with higher whole-lung metrics of emphysema and less fibrosis are more likely to be malignant. • The nodule-bearing lobes have less emphysema compared to the rest of the lung. • QCT variables could improve the risk assessment of incidental pulmonary nodules.
评估全肺定量 CT（QCT）和含结节肺叶对肺结节恶性风险评估的价值。
回顾性纳入 251 名非增强薄层 CT 显示肺结节的患者（中位[IQR]年龄 65（57-73）岁；37%为女性）。20%的结节为恶性，其余结节为良性，无论是组织学还是至少 1 年随访。CT 扫描采用内部软件进行分析，计算平均肺密度（MLD）或周边肺气肿指数（pEI）等参数。使用逻辑回归进行 QCT 变量选择；选择的变量被整合到 Mayo 诊所和简约 Brock 模型中。
全肺分析显示，良性和恶性结节组之间在多个参数上存在差异，例如 MLD（-766 与-790 HU）或 pEI（40.1 与 44.7%）。基于所有可用数据，所提出的 QCT 模型的曲线下面积（AUC）为 0.69（95%CI，0.62-0.76）。将 MLD 和 pEI 整合到 Mayo 诊所和 Brock 模型后，两个临床模型的 AUC 均得到改善（AUC，分别为 0.91 至 0.93 和 0.88 至 0.91）。叶特异性分析显示，良性（EI，0.5%与 0.7%；p<0.001）和恶性结节（EI，1.2%与 1.7%；p=0.001）时，含结节肺叶的肺气肿程度低于其余肺叶。
全肺肺气肿和纤维化程度较高的患者的结节更有可能是恶性的；因此，含结节的肺叶肺气肿程度较低。QCT 变量可以提高偶然发现的肺结节的风险评估。
全肺肺气肿和纤维化程度较高的患者的结节更有可能是恶性的。
与其余肺叶相比，含结节的肺叶肺气肿程度较低。
QCT 变量可以提高偶然发现的肺结节的风险评估。
