| Objective: 1. To evaluate a new method to measure the amount of soft tissue for assessing the efficacy of Radiotherapy and chemotherapy in nodular lung cancer which have a clear boundary, and to compare the ability of this method with volumetric measurement method. 2. To evaluate the application of histogram pixel analysis in the evaluation of radiotherapy and chemotherapy for lung cancer which boundary was not clear. 3. To explore the changes-characteristics of the histogram curve and the pixel interval when the density of lung cancer reduced in the good response group.Methods: This experiment is divided into two parts. Part 1: Retrospective analysis of 52 patients imaging data of nodular lung cancer with clear boundary before and after the treatment. The total volume change rate before and after the treatment was measured by the computer three-dimensional volume measurement software; The volume change rate of solid components in the lesions was measured by CT quantitative analysis of tissue components. The rate of change of the total volume and the volume of the solid components in the same lesion were compared. Part 2:Retrospective analysis of 43 cases were standardized on chemotherapy in the treatment of the central or peripheral lung cancer patient data which volume had no significant changes. Use histogram analysis method to measure the overall disease average CT value, lesions of the axial section of the largest average CT value before and after treatment. Grade for patients Refering to the New CT response criteria(NRC)and compare with the clinical grading. Consistent with the clinical grading results were positive, not consistent with negative, evaluate the value of the two measurementmethods for the treatment of lung cancer; To the patients belong to good response group by both the overall lesion CT value histogram analysis and clinical grading,analysis the differences of the percentage of each pixel range between the before and after treatment and explore the histogram curve and the percentage of each pixel range changes。Results: Part 1: In the 52 cases of nodular lung cancer, 31 cases were pure solid nodules, and 21 cases non pure solid nodules(partial solid nodule and ground-glass nodule), among them, there were 43 cases of adenocarcinoma and 9 cases of squamous cell carcinoma. The volume change rate of solid nodule was(5.82%~190.23%,0.3723±0.6733), the change rate of total volume was(4.88%~177.36%,0.3412±0.5321), there was no statistical difference between them(P =0.101); The volume change rate of non pure solid nodule was(5.70%~225.57%,0.4660±0.5640), the change rate of total volume was(5.02%~191.15%,0.3741±0.4920), there were statistical differences between them(p=0.005). Part 2: The selected 43 cases were confirmed as NSCLC, 32 cases is male, female 11 cases, including 29 cases squamous cell carcinoma, 13 cases adenocarcinoma. Paired chi square test measured lesions in the overall average CT value measurement diagnostic specificity and the same percentage was significantly higher than that of the axial section of the largest average CT value measurement method(P = 0.012, P = 0.001), and the diagnostic sensitivity of two kinds of methods of measuring no significant statistical difference(P = 0.125); 16 patients belong to good response group by both the overall lesion CT value histogram analysis and clinical grading, Rank Sum Test results show that the difference of < 20 hu pixel range between the before and after treatment was significantly higher than that of the other groups(P = 0.000).Conclusion: 1. Soft tissue measurements can enable detection of growth of solitary pulmonary nodules earlier. The amount of soft tissue measured by the use of CT in the solitary pulmonary nodules much more accurately than does the use of the CT-measured volume. 2. The lesions overall histogram analysis method can conduct accurate quantitativeanalysis of internal components after standard chemotherapy which volume without significant changes and grade for patients refering to NRC. 3. In the good response group, the histogram curve showed negative skewness and the change of < 20 hu pixel range is most obvious. Providing a new idea and new method for early curative effect evaluation of lung cancer which has no obvious morphological changes. |
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