CAJ | 학술논문

目的研究钙化点偏在率(Ecc)对肺部良恶性球形病变预测的可行性.方法收集经病理或随访证实的肺球形病变患者240例(恶性病变170例、良性病变70例),所有患者均进行CT扫描.使用Nodule CAD软件分割、提取肺球形病变及其内部的钙化点,将球形病变内CT值＞120 HU定义为钙化密度,具有钙化密度且面积大于3个像素的区域定义为钙化点.分别计算良恶性肺球形病变内钙化点中心距与钙化点边缘距的比值,即Ecc.采用x2检验比较良性与恶性病变之间钙化点出现率的差别;采用Mann-Whitney秩和检验比较良恶性球形病变内Ecc的差异;以病理结果为金标准,采用ROC曲线分析Ecc对钙化点性质预测的诊断效能.结果在240个病灶内,计算机共检出钙化点65个,其中恶性钙化点18个,分布在10个病灶内;良性钙化点47个,分布在16个病灶内.良恶性病变Ecc的中位数(上下四分位数范围)分别为0.80(0.28～ 1.29)、3.01(1.52～4.47),良性病变的Ecc明显低于恶性病变,差异具有统计学意义(U=183.000,P＜0.01).以Ecc=1.00作为截点,良性钙化点多位于病变的内1/2带[61.70％(29/47)],而恶性钙化点多位于病变的外1/2带[77.78％(14/18)],两者间差异有统计学意义(x2=8.117,P＜0.01).以Ecc=1.72作为良恶性钙化点的截断值,其对良性钙化点诊断的灵敏度、特异度、准确性分别为83.1％、77.8％、81.5％,诊断ROC曲线下面积为0.804.结论 Ecc从数值上展现了良恶性肺球形病变内钙化点的位置特征,有望成为定量诊断建模的理想参数,为量化诊断提供依据.
목적 연구개화점편재솔(Ecc)대폐부량악성구형병변예측적가행성.방법 수집경병리혹수방증실적폐구형병변환자240례(악성병변170례、량성병변70례),소유환자균진행CT소묘.사용Nodule CAD연건분할、제취폐구형병변급기내부적개화점,장구형병변내CT치＞120 HU정의위개화밀도,구유개화밀도차면적대우3개상소적구역정의위개화점.분별계산량악성폐구형병변내개화점중심거여개화점변연거적비치,즉Ecc.채용x2검험비교량성여악성병변지간개화점출현솔적차별;채용Mann-Whitney질화검험비교량악성구형병변내Ecc적차이;이병리결과위금표준,채용ROC곡선분석Ecc대개화점성질예측적진단효능.결과 재240개병조내,계산궤공검출개화점65개,기중악성개화점18개,분포재10개병조내;량성개화점47개,분포재16개병조내.량악성병변Ecc적중위수(상하사분위수범위)분별위0.80(0.28～ 1.29)、3.01(1.52～4.47),량성병변적Ecc명현저우악성병변,차이구유통계학의의(U=183.000,P＜0.01).이Ecc=1.00작위절점,량성개화점다위우병변적내1/2대[61.70％(29/47)],이악성개화점다위우병변적외1/2대[77.78％(14/18)],량자간차이유통계학의의(x2=8.117,P＜0.01).이Ecc=1.72작위량악성개화점적절단치,기대량성개화점진단적령민도、특이도、준학성분별위83.1％、77.8％、81.5％,진단ROC곡선하면적위0.804.결론 Ecc종수치상전현료량악성폐구형병변내개화점적위치특정,유망성위정량진단건모적이상삼수,위양화진단제공의거.
Objective To study feasibility of differentiation of benign and malignant by using eccentric rate of calcification in pulmonary spherical lesions.Methods Two hundred and forty cases with pulmonary spherical lesions(malignant in 170 and benign in 70) confirmed by pathology or clinical follow-up were collected in this study.All cases were underwent chest CT examinations.Nodule CAD software was used to demarcation of pulmonary spherical lesions and internal calcification.Calcification was defined as an area more than 3 pixel with calcification density(CT value＞120 HU).Furthermore,the ratio of calcification center distanceand calcification edge distance was calculated as Ecc.Mann-Whitney U test was used to compare the eccentric calcification rates between the malignant and the benign pulmonary spherical lesions.Taking pathological results as golden standard,the diagnostic efficacy of Ecc was analyzed using ROC curves.Results In 240 lesions,65 calcifications were detected,of which 18 were malignant calcification distributed in 10 lesions,and 47 were benign calcifications distributed in 16 lesions.The median of Ecc in benign and in malignant lesions were 0.80(0.28-1.29) and 3.01(1.52-4.47).The Ecc of calcification in benign lesions were lower than those in malignant lesions (U=183.000,P＜0.01).Under the cut-off value of 1.00,benign calcifications were more likely to lie inner 1/2 part of lesion [61.70％(29/47)],while malignant calcifications were more likely to lie outer 1/2 part of lesion [77.78％(14/18)].The difference was statistically significant(x2=8.117,P＜0.01).Under the cut-off value of 1.72,the resultant sensitivity,specificity,accurate rate were 83.1％,77.8％,81.5％ respectively.The area under the ROC was 0.804.Conclusions Ecc exhibits the location characteristics of calcification and may be an ideal parameter in quantitative diagnostic modeling for providing evidence of quantitative diagnosis.