Objective:To investigate the predictive value of spiral computed tomography(CT)features for visceral pleural invasion(VPI)in pulmonary adenocarcinoma appearing as sub-solid nod-ules.Methods:A total of 103 patients(34 males and 69 females,age range 25～82 years,mean age 58.5±10.2 years)with sub-solid lung adenocarcinoma diagnosed by surgical resection and pathology in our hospital from May 2016 to December 2021 were retrospectively collected.There were 19 cases(18.45％)in VPI positive group and 84 cases(81.55％)in VPI negative group.Patient's clinical data including age and gender were recorded.All patients underwent chest spiral CT examination before surgery.Spiral CT radiological features as location,size,attenuation,lobulated sharp,speculated sign,pleural indentation sign,vacuole sign and air-bronchogram sign were recorded,respectively.Nodule and pleura relationship(NPR)was subdivided into four subtypes:T,connected by one line;Ⅱ,connected by multiple lines;Ⅲ,narrow base;Ⅳ,wide base.Univariate analysis was performed to compare the differences in clinical and radiological parameters between VPI positive and negative groups.Multivari-ate logistic regression was carried out to analyze the independent risk factors,and receiver operating characteristic(ROC)curve was used to conducted the predictive models.Results:There were 49(47.57％)non-solid nodules and 54(52.43％)partial solid nodules.No significant difference was shown in gender and age between VPI positive and negative groups(P=0.883,P=0.151).The inci-dence of VPI in non-solid nodules was 8.16％(4/49),which was lower than that of part-solid nodules 27.78％(15/54)(P=0.01).The proportion of VPI in the four NPR subtypes were 6.82％(3/44),15.00％(3/20),28.00％(7/25),42.86％(6/14)for type Ⅰ,Ⅱ,Ⅲ and Ⅳ,respectively(P=0.011).Nodule attenuation and NPR subtype were independent risk factors in the differential diagnosis of VPI status.ROC results showed that the area under the curve(AUC),sensitivity and specificity were 0.663,78.9％,53.6％and 0.726,68.4％,69.0％in the nodule attenuation model and NPR subtype mod-el,respectively.The combined model constructed by nodule attenuation and NPR subtype showed bet-ter diagnostic performance with AUC,sensitivity and specificity were 0.804,73.7％,and 70.2％,re-spectively.Conclusion:The chest spiral CT radiological features of SSN were helpful for preoperative e-valuation of VPI status.Nodule attenuation and NPR subtype were independent risk factors for VPI positive groups.
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