CAJ | 학술논문

背景与目的肺内亚实性结节（包括磨玻璃密度结节和部分实性结节）体积增长常较缓慢，但恶性概率比实性结节大，常需随访确定其生长特性。恶性亚实性结节的生长性不仅可以表现为体积的增长，也可以表现为密度的增加或新出现实性成分。计算机断层扫描（computed tomography, CT）质量（Mass）测量能综合评估其体积及密度的变化，在结节随访中量化反映其生长特性。本研究目的是评估亚实性结节质量测量的重复性，并与体积测量重复性比较。方法两名医生盲法应用结节分析软件对44例患者共80个亚实性结节的CT影像资料进行三维体积及质量重复测量，对自动分割效果不佳的结节采用手动调整。应用Bland-Altman法评估质量测量及体积测量的观察者内及观察者间差异，组内相关及Wilcoxon检验评估质量测量与体积测量观察者内、间测量变异度的差异。结果74个（92.5%）亚实性结节分割效果满意纳入研究。结节直径（7.2±2.5）mm（3.2 mm-16.4 mm）。质量测量的观察者内、观察者间95%一致性区间分别为-11.5%-10.4%、-17.4%-19.3%，体积测量的观察者内、观察者间95%一致性区间分别为-8.4%-8.8%、-17.9%-19.4%，观察者内、间质量测量与体积测量变异度的组内相关系数分别为0.95、0.93（P均<0.001），二者之间无统计学差异（P值分别为0.78、0.09）。手动调整结节分割对测量的重复性有一定影响。结论亚实性肺结节的质量测量重复性较好，可作为随访定量评估方法。
배경여목적폐내아실성결절（포괄마파리밀도결절화부분실성결절）체적증장상교완만，단악성개솔비실성결절대，상수수방학정기생장특성。악성아실성결절적생장성불부가이표현위체적적증장，야가이표현위밀도적증가혹신출현실성성분。계산궤단층소묘（computed tomography, CT）질량（Mass）측량능종합평고기체적급밀도적변화，재결절수방중양화반영기생장특성。본연구목적시평고아실성결절질량측량적중복성，병여체적측량중복성비교。방법량명의생맹법응용결절분석연건대44례환자공80개아실성결절적CT영상자료진행삼유체적급질량중복측량，대자동분할효과불가적결절채용수동조정。응용Bland-Altman법평고질량측량급체적측량적관찰자내급관찰자간차이，조내상관급Wilcoxon검험평고질량측량여체적측량관찰자내、간측량변이도적차이。결과74개（92.5%）아실성결절분할효과만의납입연구。결절직경（7.2±2.5）mm（3.2 mm-16.4 mm）。질량측량적관찰자내、관찰자간95%일치성구간분별위-11.5%-10.4%、-17.4%-19.3%，체적측량적관찰자내、관찰자간95%일치성구간분별위-8.4%-8.8%、-17.9%-19.4%，관찰자내、간질량측량여체적측량변이도적조내상관계수분별위0.95、0.93（P균<0.001），이자지간무통계학차이（P치분별위0.78、0.09）。수동조정결절분할대측량적중복성유일정영향。결론아실성폐결절적질량측량중복성교호，가작위수방정량평고방법。
Background and objective Subsolid pulmonary nodules tend to exhibit considerably slower growth rates than solid lesions, nevertheless, higher malignancy probability. hTe diagnosis of indeterminate nodules largely depends on the growth evaluation during follow-up. hTe growth can manifested as an increase in size or the appearance and/or subsequent increase of solid components. hTe mass relfect the product of volume and density and can be more sensitive in growth evalu-ation. However, the repeatability needs a further validation. hTe purpose of this study is to assess the intra and inter-observer variability of mass measurement for subsolid nodules. Methods 80 subsolid nodules in 44 patients were retrospectively en-rolled. Both the volume and mass were measured by two radiologists using blind method independently. Intra-observer and inter-observer variability were analyzed and compared by Bland-Altman method intra-class correlation test and Wilcoxon test. Results Sotfware achieved satisifed segmentation for 92.5%nodules. Of them, 35%underwent manual modiifcation. hTe 95%limits of agreement for intra-observer variability were-11.5%-10.4%for mass and-8.4%-8.8%for volume. hTe 95%limits of agreement for inter-observer variability were-17.4%-19.3%for mass and-17.9%-19.4%for volume.hTe intra-class correlation foeffcients between volume and mass measument was 0.95 and 0.93 (both P<0.001) and no signiifcant differences (P=0.78, 0.09) was found for intra-and inter-observer variability. Manual modiifcation of the segmentation caused the worse mass mea-surement repeatability in spite of the reader satisfaction. Conclusion hTe repeatability of mass measurement has no signiifcant difference with that of volume measurement and may act as a reliable method in the follow-up of subsolid nodules.