| Objective:To investigate the differential diagnostic value of spectral CT quantitative parameters in pure ground-glass nodule(pGGN)lesions.Methods:A retrospective analysis of 44 patients with pure ground glass nodules performed by CT of the lung from August 2017 to September 2019 in the Second Affiliated Hospital of Suzhou University.The enrollment criteria were that patients undergo dual-phase enhanced chest CT scans in our hospital before surgery,and had surgical treatment with complete pathological results.According to the pathological results,it was divided into three groups.The first group was 12 cases of inflammatory lesions(all inflammation was chronic inflammation,and some were associated with collagen fibrosis);the second group was 17 cases of pre-infiltration lesions,including atypical There were 6 cases of atypical adenomatous hyperplasia(AAH)and 11 cases of adenocarcinoma in situ(AIS);the third group was 15 cases of invasive adenocarcinoma,including minimally invasive adenocarcinoma,10 cases were MIA and 5 cases were invasive adenocarcinoma(IAC).Measure the slope of the energy spectral curve(K40-70Kev),arterial phase and venous phase of the lesion[iodine concentration(IC),normalized iodine concentration(NIC)]and Arterial and venous water-based values.One-way Anova analysis was used to compare the three groups and multiple comparisons were used to compare pairs.P<0.05 considered the difference to be statistically significant.Results:The arterial phase water-based values of the three groups of the inflammatory lesion group,the pre-invasive lesion group,and the invasive adenocarcinoma group are:(291.95±58.66)mg/cm3,(297.61±63.96)mg/cm3,(374.52±60.62)mg/cm3;The venous phase water-based values are:(277.07±33.78)mg/cm3,(291.74±50.49)mg/cm3,and(373.33±75.12)mg/cm3.The differences in water-based values between the arterial and venous phases were statistically significant between the three groups(P<0.05).Further comparison:the difference between the water-based values in the arterial and venous phases between the inflammatory lesion group and the pre-infiltration lesion group There was no statistical significance(P values were 0.808 and 0.504 respectively);the differences between the inflammatory lesion group and the invasive adenocarcinoma group were statistically significant(P values were 0.001 and 0.000 respectively);the pre-invasive lesion group and the invasive adenocarcinoma group The difference was also statistically significant(P values were 0.001 and 0.000,respectively).There were no significant differences in the slope of the energy spectral curve and iodine-related parameters(iodine value,normalized iodine value)between the three groups in the arterial and venous phases(P>0.05).Conclusion:Quantitative energy spectral CT parameters are helpful for the qualitative analysis of ground glass nodules.Among them,the water-based value has good clinical application value in the qualitative diagnosis of ground glass nodules.The slope of the energy spectral curve and iodine-related parameters are used to identify pure ground glass.There are some limitations in the pathological types of nodules,which need further study.Objective:To investigate correlation of spectral CT parameters with ground glass nodular lung adenocarcinoma invasiveness and ki-67 expression.Methods:Forty-seven patients with pulmonary ground glass nodules(including pure ground glass nodules and mixed ground glass nodules)were collected from the Second Affiliated Hospital of Suzhou University from August 2017 to September 2019.All the cases were confirmed by surgery and pathology,and the immunohistochemical analysis included ki-67 expression percentage.According to pathological results it can be divided into three groups,including 12 cases of lesion before infiltration group[atypical adenomatous hyperplasia(atypical adenomatous hyperplasia,AAH)in 3+ adenocarcinoma in situ(adenocarcinoma in situ,AIS)9].Micro infiltrating adenocarcinoma(minimally invasive adenocarcinoma,MIA)19 cases;Invasive adenocarcinoma(IAC)in 16 cases.All patients underwent preoperative dual-phase enhanced chest CT scan with energy spectral,and the iodine and water values of the nodules were measured in the arterial and venous phases.One-way Anova and multiple comparison method were used for pairwise comparison of water base values between the three groups.P<0.05 was considered statistically significant.The comparison of ki-67 expression percentage between the three groups was analyzed by the rank sum test(kruskal-wallis H test),and the significance level was corrected by Bonferroni method for pantwise comparison.P<0.05 was considered statistically significant.Spearman correlation analysis was used to analyze the correlation between the expression percentage of ki-67 and the iodid-based and water-based values in the arterial and venous stages.Results:Pre-infiltration lesions(AAH+AIS),micro-invasive adenocarcinoma(MIA),and invasive adenocarcinoma(IAC)three groups of arterial phase water-based values were:(315.38±97.09)mg/cm3,(424.79±116.94)mg/cm3,(586.18±135.32)mg/cm3;the three groups of venous phase water-based values are:(328.68±75.72)mg/cm3,(418.02±108.70)mg/cm3,(543.10±152.97)mg/cm3;three groups of ki-67 expression percentages were 3.00(2.00,4.75)%,5.00(3.00,10.00)%,and 12.50(8.25,23.75)%.With the increase of the degree of infiltration,the water-base value and ki-67 expression percentage of the arterial phase and the venous phase gradually increased,and the overall difference was statistically significant(P values were 0.000).The arterial iodine value(ICa)and the intravenous iodine value(ICp)are negatively correlated with the percentage of ki-67 expression(r1=-0.614,P1=0.000;r2=-0.529,P2=0.000);arterial phase water-based The values(Wa),venous water-based values(Wp)and the expression percentage of ki-67 were positively correlated(r1=0.797,P1=0.000;r2=0.743,P2=0.000).Conclusion:The percentage of ki-67 expression gradually increased with the increase of infiltration of ground glass nodules.The water-based CT value was positively correlated with the expression of ki-67.Base value and iodine base value are helpful to evaluate the degree of lung adenocarcinoma invasion,and have potential application value in assessing tumor proliferation. |
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