| PART I MorPhologic Study of Solitary Pulmonary Nodules with Multi-CTPurpose:to evaluate the value of imaging of the pulmonary nodules with multi-CT in differentiation malignant from benign nodules.Materials and Methods:collecting 93 patiens with SPN that confirmed by the pathology and have complete clinic information, with 64 row CT routine scan, each case were peformed multiplanar reconstruction and curved planar reconstruction. Then,three of associate chief physician estimate the characterization of each SPN(contain spiculation sign,spinous protuberant sigan,lobulation sign,air bronchogram sigan,blood vessel convergence sign and pleural indentation sign), Statistical analysis was performed with SPSS 16.0 software,using single factor analysis and multiple factor analysis of Logistic regression mode,then analyzing the useful statistic with receiver operating characteristic.Results:1. In the 93 case of solitary pulmonary nodules,benign nodules for 42 cases,16 cases of include tuberculoma,4cases of suppurative inflammation,13 cases of choronic inflammation,7 cases of harmartomas,1 cases of cryptococcus pneumonia,1 caces of mycotic pneumonia, f malignant nodules for 51 cases,34 cases of adenocacinoma,12 cases of Squamous cell carcinoma,2 cases of small cell carcinoma,1 cases of neuroendocrine carcinoma,1 cases of metastases.2. Single factor variance analysis1) spiculation sign-34 cases of malignant nodules with spiculation sign,9 cases of benign nodules with spiculation sign, a chi-square test value is 18.96,P＜O.001.2) spinous protuberant sign-- 24 cases of malignant nodules with spinous protuberant sign,11 cases of benign nodules with spinous protuberant sign, a chi-square test value is 4.27,P=0.039.3) lobulation sign--10 cases of malignant nodules with superficial lobulation sign,41cases with deep lobulation sign;28 cases of benign nodules with superficial lobulation sign,14 cases with deep lobulation sign,a chi-square test value is 21.11, P＜0.001.4) air bronchogram sign-- 13 cases of malignant nodules with air bronchogram sign,8 cases of benign nodules with air bronchogram sign, a chi-square test value is 0.547,P=0.460.5) pleural indentation sign-- 40 cases of malignant nodules with pleural indentation sign,27 cases of benign nodules with pleural indentation sign, a chi-square test value is 2.29,P=0.130.6) blood vessel convergence sign-- 39 cases of malignant nodules with air bronchogram sign,20 cases of benign nodules with air bronchogram sign, a chi-square test value is 8.27,P=0.004.3. Logistic analysis:spiculation sign and deep lobulation sign is useful for diagnosis of the property of the solitary pulmonary nodules.The patient that the pathology is malignant with spiculation sign is 7.695 times for the patient that the pathology is benign with spiculation sign,the patient that the pathology is malignant with lobulation sign is 8.589 times for the patient that the pathology is benign with lobulation sign.4. Receiver operating characteristic curve1) the area under the ROC curves of the speculation sign is 0.726,P<0.001,95% CI is 0.621-0.831.The sensitivity and specificity is 66.7%and 78.6%,positive predictive value is 3.11,nagetive predictive value is 0.42, diagnostic value is good.2) the area under the ROC curves of the deep lobulation sign is 0.735,P<0.001,95%CI is 0.630-0.841,The sensitivity and specificity is 80.4% and 66.7%.positive predictive value is 2.41.nagetive predictive value is 0.29. diagnostic value is good.Conclusions:spiculation sign,spinous protuberant sign,lobulation sign and blood vessel convengenc sign have influence for the diagnosis of the properties of the nodules.The possibility is high if the nodules have the speculation sign and lohulation signPART II Volume Histogram Analysis of the Solitatry Pulmonary NodulesPurpose:to assessment the properties of the solitary pulmonary nodules by using the volume histogram analysis,and with pathologic findings as a reference standar.Evaluate prosepectively the ablity of the volume histogram analysis in the SPN diagnosis and differential aspect, and discuss the characteristrics of the various CT threshold volume distribution with the SPN.Materials and methods:collectied 93 patiens with SPN that confirmed by the pathology and have complete clinic information, with 64 row CT routine scan。To transmission the scan data to the ADW4.3 workstaion, then the imaging post processing and volume histogram analysis was done by the software a.Three doctors record the result invidually for each SPN with the analysis for the volume histogram.The imaging of each SPN was analysed on the same workstation for the imaging measuring and post processing, and carred on the observation on the same level of window width.Results:1. The area under the ROC curves of the first group of CT threshold for the diagnosis of the benign and malignant SPN is 0.605,,P=0.150, best critical point for 5%.The sensitivity and specificity is76.92%and 44.44%.2. The area under the ROC curves of the first group of CT threshold for the diagnosis of the benign and malignant SPN is 0.726, P=0.004, best critical point for 12.4%. The sensitivity and specificity is81.48%and62.96%.3. The area under the ROC curves of the first group of CT threshold for the diagnosis of the benign and malignant SPN is 0.696,P=0.0104, best critical point for 60%. The sensitivity and specificity is88.89%and53.85%.4. The area under the ROC curves of the first group of CT threshold for the diagnosis of the benign and malignant SPN is 0.809, P<0.001, best critical point for 23.7%. The sensitivity and specificity is92.59%and 66.67%.5. The area under the ROC curves of the first group of CT threshold for the diagnosis of the benign and malignant SPN is 0.722, P=0.006, best critical point for 0%. The sensitivity and specificity is69.23%and 62.69%.6. The area under the ROC curves of the first group of CT threshold for the diagnosis of the benign and malignant SPN is 0.631, P=0.697, best critical point for 0%. The sensitivity and specificity is92.6%and 14.8%.Conclusions:1. The2,3,4,5 group of the CT threshold is useful for the diagnosis of the property of the SPN. The 2 and the 3 group of the CT threshold accounted for more than the critical point for 12.4%and 60%, the more inclined to malignant; the 4 and 5 groups of the CT threshold accounted for more than the critical point for 23.7% and 0%, the more inclined to malignant.2. The 1,6 group of the CT threshold is useless for the diagnosis of the property of the SPN. |
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