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Objective:To explore the value of the logistic regression model with three-dimensional CT quantitative parameters in combination with qualitative parameters in predicting the invasiveness of pure ground glass nodules (pGGN).Methods:The clinical data and image features of 191 patients (196 lesions) with pGGN on CT confirmed as lung adenocarcinoma by pathology from April 2019 to December 2019 in Anhui Chest Hospital were retrospectively analyzed. Totally, 196 lesions were divided into atypical adenomatous hyperplasia (AAH)+adenocarcinoma in situ (AIS)+minimally invasive adenocarcinoma (MIA) group ( n=128) and invasive adenocarcinoma (IAC) group ( n=68). CT quantitative parameters included the maximum diameter, volume, average CT value and quality of pGGN, and the qualitative parameters included the intrinsic vascular changes, abnormal air-bronchogram, lobulated signs, bubble-like sign, pleura-traction sign, and fuzzy tumor-lung interface sign. The Mann-Whitney U test was used to compare the quantitative parameters and the Pearson χ 2 test was used to compare the qualitative parameters between two groups. The independent predictors of IAC and predictive probability value were screened by univariate analysis in combination with multivariate logistic regression analysis. The ROC curves were drawn to compare the diagnostic probability of logistic regression prediction probability and each single parameter. Results:There were statistically significant differences in maximum diameter [0.92(0.77,1.14) cm vs. 1.41(1.12, 1.93) cm, Z=-7.366, P<0.001], volume[0.31(0.20, 0.53) cm 3 vs. 0.88(0.41, 2.00) cm 3, Z=-6.254, P<0.001], average CT value[-571.5(-637.2, -477.0) HU vs. -418.1(-532.4, -338.5) HU, Z=-5.882, P<0.001], quality[0.14(0.09, 0.25) g vs. 0.42(0.26, 1.21) g, Z=-7.438, P<0.001], intrinsic vascular changes(23 vs. 49, χ2=55.906, P<0.001), abnormal air-bronchogram(13 vs. 30, χ2=29.908, P<0.001) and pleura-traction sign(39 vs. 32, χ2=5.291, P=0.021) between the two groups. The logistic regression analysis showed that the maximum diameter, average CT value, intrinsic vascular changes and abnormal air-bronchogram were the independent risk factors of IAC, and the odds ratio value(95%CI) were 10.624(1.275-88.522), 1.004(1.000-1.008), 3.424(1.458-8.043) and 2.993(1.114-8.043), respectively. The ROC curve demonstrated that the area under the curve, sensitivity and specificity of the logistic regression model were 0.899, 0.912, and 0.711 respectively, which were better than separate analysis results from each single parameter. Conclusion:The logistic regression model with a combination of three-dimensional CT quantitative and qualitative parameters can predict the invasiveness of pGGN better.
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Objective To analyze the perfusion status of lung cancer before radiotherapy and the relationship between changes in CT perfusion parameters after radiotherapy and the efficacy of radiotherapy.Methods Twenty-eight patients clinically and pathologically diagnosed with lung cancer were enrolled as subjects.Those patients received CT perfusion imaging scan and perfusion parameters including blood flow (BF),blood volume (BV),mean transit time (MTT),and permeability surface (PS) were calculated.We use linear correlation analysis for relation between value of CT perfusion imaging and the target volume of lung cancer before radiotherapy,t-test for difference between the remission groups and non-remission groups,compared paired sample t-test for value of CT perfusion imaging before and after radiotherapy.Results According to the efficacy of radiotherapy,28 patients with lung cancer were divided into response group (n=16) and non-response group (n=12).The response group had significantly smaller tumor sizes before and after radiotherapy than the non-response group (58.72±22.95 cm3 vs.24.53±13.79 cm3,P=0.000).However,there was no significant correlation of target volume before radiotherapy with any perfusion parameter (P=0.628).The response group had significantly larger BF and BV than the non-response group before radiotherapy (1.23±1.36 vs.6.42±2.57,P=0.024 and 1.23±0.31 vs.0.59±0.18,=0.041),suggesting a low perfusion state of tumor tissue in the non-response group.However,there were no significant differences in MTT and PS between the two groups (0.93±0.58 vs.0.93±0.66,P=0.851 and 1.46±0.83 vs.1.17±0.56,P=0.141).All the 28 patients had significantly smaller BF,BV,MTT,and PS after radiotherapy (9.81±3.56 vs.7.48±3.31,P=0.006;0.96±0.41 vs.0.64±0.38,P=0.003;0.93±0.60 vs.0.53±0.30,P=0.007;1.34±0.73 vs.0.74±0.44,P=0.001).Conclusions CT perfusion imaging can predict the efficacy of radiotherapy for lung cancer,which may guide the planning and implementation of precise radiotherapy for lung cancer.