计算机辅助三维容积CT鉴别肺不典型腺瘤样增生和原位性腺癌OACSTPCD

Objectives:To retrospectively analyze the computer-aided 3D volumetric CT findings of ground-glass density nodules in the identification of pulmonary atypical adenomatous hyperplasia(AAH)and adenocarcinoma in situ(AIS),and explore the feasibility of differential diagnosis of the two.Methods:From October 2011 to June 2023,the thin-slice CT manifestations of 387 patients with AAH and AIS nodules confirmed by surgical resection were retrospective-ly analyzed.The quantitative data including the maximum nodular diameter,mean CT value and nodular volume automatical-ly measured by Thoracic VCAR software,and the qualitative data of the patients obtained semi-automatically(sex,morphology of nodules,pulmonary nodule interface,lobulation,density classification,vacuolar sign and/or bronchial inflation sign,vessel convergence sign,pleural depression sign)were statistically analyzed to screen out the indicators that were significant in the dif-ferentiation of AAH and AIS and the independent influencing factors for the diagnosis of AIS,and evaluate the efficiency of quan-titative parameters automatically obtained by computer-aided 3D volumetric CT in the diagnosis of AIS.Results:In this study,79 AAH nodules and 354 AIS nodules were obtained.The indicators that were important for differentiating AAH and AIS includ-ing vacuolar sign and/or bronchial inflation sign(P<0.001)and vessel convergence sign(P = 0.001),maximum nodular diame-ter(P<0.001),mean CT value(P = 0.013),nodular volume(P<0.001)were screened.The maximum diameter of the nodule(OR = 1.259,95%CI:1.123～1.413,P<0.001)and vacuolar sign and/or bronchial inflation sign(OR = 2.183,95%CI:1.210～3.939,P = 0.009)were the independent influencing factors for the diagnosis of AIS.The top three efficient quantitative pa-rameters obtained by computer-aided 3D volumetric CT in the diagnosis of AIS were maximum nodular diameter(AUC = 0.670),nodular volume(AUC = 0.648)and mean CT value(AUC = 0.638).Conclusion:Computer-aided 3D volumetric CT has certain advantages in the differential diagnosis of AAH and AIS.The vacuolar sign and/or bronchial inflation sign,vessel convergence sign,maximum nodular diameter,mean CT value and nodular volume are valuable in the differential diagnosis of the two.Maxi-mum nodular diameter and vacuolar sign and/or bronchial inflation sign are independent factors affecting the diagnosis of AIS,and the diagnostic efficiency of maximum nodular diameter is better than nodular volume and mean CT value.