| Objectives To explore the correlation between the quantitative parameters of energy spectrum CT and the pathological invasiveness of ground-glass nodule(GGN)-like lung adenocarcinoma,in order to guide the clinic to make the best diagnosis,treatment or follow-up plan.Methods From September 2019 to December 2020,chest energy spectrum plain scan+enhanced CT was performed in North China University of Science and Technology Affiliated Hospital with GE Revolution CT one week before operation.93 patients with single GGN were diagnosed as lung adenocarcinoma by postoperative pathology,and the patients with maximum cross-sectional length≤3.0cm were studied.According to the postoperative pathological results,the patients were divided into three groups:preinvasive lesion group,Minimally invasive adenocarcinoma(MIA)and Invasive adenocarcinoma(IAC).The preinvasive lesion group included Atypical adenomatous hyperplasia(AAH),and Adenocarcinoma in situ(AIS).First of all,the morphological signs of the lesions were analyzed on unenhanced images with the lung window setting(window width,1200;window level,-600).Lesion border(lobulated,nonlobulated),lesion margin(spiculated,nonspiculated),air bronchogram(present,absent),bubble lucency(present,absent),and pleura retraction(present,absent).Observe and compare whether there are differences in the above morphological signs among the three groups,and whether the differences are statiscally aignificant.Moreover,at the 70ke V level,several quantitative parameters of energy spectrum CT were measured and calculated,such as:water content(WC)and slope of energy spectrum curve(k value)in three phases;iodine concentration(IC),normalized iodine concentration(NIC),modified normalized iodine concentration(m NIC)both in arterial phase and venous phase.Statistical analysis was carried out to compare the differences of multiple quantitative parameters of energy spectrum CT among the pre-invasive lesion group,MIA and IAC groups,whether the difference was statistically significant,and whether they can be used as an effective predictive index to distinguish preinvasive lesions(AAH,AIS)from invasive lesions(MIA,IAC).Results There was no significant difference in lobulation sign,spiculation sign,bronchial inflation sign and vacuole sign between different pathological types of GGN and CT morphological signs(P>0.05).The difference between different pathological types of GGN and pleural retraction was statistically significant(P<0.05).The comparison between different pathological types of GGN showed that there was no significant difference in water content(WC)and slope of energy spectrum curve(k)between the two quantitative parameters of plain scan energy spectrum CT(P>0.05).The comparison of different pathological types of GGN showed that there was significant difference in arterial phase modified standardized iodine concentration(m NIC)among the three groups(F=40.598,P<0.05).The m NIC of preinvasive lesions was significantly lower than that of MIA and IAC.There was no significant difference in arterial phase WC,iodine concent(IC),Normalized iodine concentration(NIC)and slope of energy spectrum curve(k)among different pathological types of GGN.The comparison of different pathological types of GGN showed that there was significant difference in venous phases WC among the three groups(F=5.8518,P<0.05).The WC of preinvasive lesions(317.24±82.13)was lower than that of MIA(344.33±91.47)and IAC(404.64±99.18).There was no significant difference in IC,NIC,m NIC and slope of energy spectrum curve(k)among different pathological types of GGN in venous phase.Arterial phase m NIC and venous phase WC were compared among preinvasive lesion group,MIA,IAC.There were significant differences in arterial phase m NIC among the three groups,and there were significant differences in venous phase WC between preinvasive lesion group and IAC,MIA and IAC,but there was no significant difference between preinvasive lesion group and MIA(P>0.05).The best critical value of energy spectrum CT arterial phase m NIC for differential diagnosis is 0.505,AUC is 0.873,the sensitivity is 78.7%,the specificity is 100%.The best critical value of energy spectrum CT venous phase WC for differential diagnosis is383.15mg/cm~3,AUC is 0.718,the sensitivity is 55.7%,the specificity is 6.3%.It can be concluded that the diagnostic efficiency of arterial phase m NIC is better.Conclusions Pleural retraction,arterial phase m NIC,venous phase WC and CT showed GGN-like lung adenocarcinoma with a good correlation of pathological invasiveness,can be used for differential diagnosis of preinvasive lesions,MIA and IAC.Arterial phase m NIC showed better diagnostic efficacy in the differential diagnosis of preinvasive lesion group and invasive lesion group,in addition,arterial phase m NIC can be as an effective parameter to predict the pathological invasiveness of GGN lesions of lung adenocarcinoma.Figure25;Table 5;Reference 131... |
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