摘要
Abstract
Objective:To investigate the diagnostic value of multi-dimensional imaging features of mediastinal lymph nodes on contrast-enhanced multi-slice spiral CT(MSCT)in detecting lymph node metastasis in lung adenocarcinoma,and to provide evidence for accurate preoperative assessment.Methods:A retrospective analysis was performed on clinical and contrast-enhanced MSCT data of patients with lung adenocarcinoma who underwent surgical resection at Chengdu Fifth Peo-ple's Hospital between December 2023 and December 2024.Mediastinal lymph node characteristics were evaluated,inclu-ding short-axis diameter,morphology,calcification,fusion,infiltration of adjacent structures,and enhancement pattern.Un-ivariate and multivariate analyses were conducted to identify independent predictors.A combined diagnostic model was devel-oped,and its performance was validated using receiver operating characteristic curve analysis.Results:A total of 788 lymph nodes(276 metastatic and 512 non-metastatic)from 222 patients(159 metastatic and 63 non-metastatic)were finally in-cluded.Based on lymph node-level multivariable analysis,short-axis diameter,absence of calcification,fusion,invasion of surrounding tissue,and heterogeneous enhancement were independent risk factors for mediastinal lymph node metastasis(P<0.05).Based on patient-level multivariable analysis,lymph node fusion,invasion of surrounding tissue,and heterogeneous enhancement were independent risk factors for mediastinal lymph node metastasis in patients(P<0.05).The combined diagnostic model incorporating the above core in-dicators(short-axis diameter,absence of calcification,fusion,infiltration of adjacent structures,and heterogeneous en-hancement)at the lymph node level achieved an AUC of 0.832,which was significantly higher than that of any single feature except for non-calcification and heterogeneous enhancement(all P<0.001),with a sensitivity of 98.2%and a negative predictive value(NPV)of 98.6%.At the patient level,the AUC of the combined diagnosis model was 0.810,the sensitivi-ty was 96.9%,the accuracy was 87.8%,and the NPV was 89.1%.Conclusion:Confluent lymph nodes,infiltration of adjacent structures,and heterogeneous enhancement on contrast-enhanced MSCT are core indicators for diagnosing mediasti-nal lymph node metastasis in patients with lung adenocarcinoma.The combined model demonstrates high sensitivity and NPV,enabling effective exclusion of lymph node metastasis and providing a reference for individualized clinical treatment planning.关键词
肺腺癌/纵隔淋巴结转移/增强多层螺旋CT/影像学特征/联合诊断模型Key words
Lung adenocarcinoma/Mediastinal lymph node metastasis/Contrast-enhanced MSCT/Imaging features/Combined diagnostic model分类
医药卫生
