Clinical Value of Dual-Layer Spectral Detector CT Plain Scan to Distinguishthe Invasive Adenocarcinoma from Minimally Invasive Adenocarcinoma in Pure Ground-Glass Nodules with Pleural Contact
Objective To explore the clinical application of dual-layer spectral detector CT plain scan for differentiating the invasive adenocarcinoma from minimally invasive adenocarcinoma in pure ground-glass nodules with pleural contact(P-pGGNs).Methods 104 patients with total 111 P-pGGNs,who underwent preoperative dual-layer spectral detector CT scan were included retrospectively.According to invasiveness by pathology,the nodules were divided into two groups:inva-sive adenocarcinoma(IAC,n=33)group and minimally invasive adenocarcinoma(MIA,n=78)group.The electron cloud density map and effective atomic number map were reconstructed on dedicated workstation(IntelliSpace Discovery),and the maximum diameter and vertical short diameter,as well as the 3D CT value,electron density value(ED value)and effec-tive atomic number(Zeffvalue)of P-pGGNs were measured.The clinical data included sex and age.The qualitative param-eters included P-pGGN shape,interface,lobulation,spiculation,pleural retraction,bubble-like lucency,air bronchogram and vascular abnormality.Diagnostic performance was evaluated by receiver operating characteristic(ROC)curve analysis.Results Significant differences were observed from nodule shape,interface,lobulation,spiculation,bubble-like lucency,air bronchogram,vascular abnormality,age,maximum diameter and vertical short diamete,3D CT value and ED value between IAC and MIA groups(P＜0.05).Logistic regression analysis revealed that the 3D CT value[odds ratio(OR)=0.0919,P=0.010],3D ED value(OR=3.384,P=0.003),maximum diameter(OR=2.747,P=0.014),shape(OR=17.740,P=0.018),lobulation(OR=0.030,P=0.012)and bubble-like lucency(OR=0.029,P=0.006)were inde-pendent factors for diagnosing I AC manifesting as P-pGGNs.The analysis of ROC curves showed that the AUC of the com-bination of six independent predictors was 0.953(sensitivity=90.91％,specificity=89.74％).Conclusion The com-bination of qualitative and quantitative parameters of dual-layer spectral detector CT plain scan displayed a noteworthy ca-pacity to differentiate IAC from MIA in P-pGGNs.
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