| Background and ObjectiveIn recent years,the incidence of lung cancer has been increasing due to the large number of smokers,the increasingly serious environmental pollution and indoor air pollution.According to the latest statistics of the international agency for research on cancer,there will be about 2.2 million new cases of lung cancer and 1.8 million deaths worldwide in 2020.The mortality rate of lung cancer ranks the first in all cancers,and its incidence rate is only lower than that of breast cancer.For the early lung cancer,timely surgical treatment can provide a chance to cure,patients can get a good prognosis.Solitary Pulmonary nodule(SPN)is a common manifestation of lung cancer in the early stage,so it is very important for lung cancer patients to make timely diagnosis.Because of high density resolution and spatial resolution,spiral CT has high accuracy,sensitivity and specificity in SPN diagnosis,and has been the first choice for SPN diagnosis.In recent years,there are many literatures about CT scanning of SPN,but most of them focus on low-dose scanning,high-resolution scanning and thin-layer scanning.Therefore,this paper discusses the clinical value of spiral CT target scanning in SPN by comparing the spiral CT target scanning image with the conventional CT scanning image.At present,the diagnosis of SPN is mostly based on the personal experience of diagnostic doctors,but it is closely related to the clinical experience,thinking mode and judgment level of doctors,with strong subjectivity and uncertainty.Therefore,we need an objective scale and standard to judge SPN.Roundness is a physical index that can be used for quantitative analysis of SPN morphology.Some scholars have found that roundness has important predictive value for the judgement of benign and malignant breast tumors.Therefore,this study intends to establish a predictive model of benign and malignant SPN,incorporate the clinical data and imaging data of patients,and add a new index of tubercle roundness,in order to improve the judgment of SPN,to guide the clinician to carry out further intervention measures.Materials and MethodsA total of 143 patients with solitary pulmonary nodules who visited the Second Affiliated Hospital of Zhengzhou University from December 2017 to December 2019were retrospectively collected.All patients in the study underwent both conventional CT scan and spiral CT target scan.The clinical data(age,gender,smoking history,malignant tumor history and previous tumor history)and imaging features(nodule location,diameter,roundness,density,lobulation,burr,pleural traction,vascular aggregation,vacuole,cavity,air bronchogram,calcification)of the two scanning methods were recorded in detail.The diagnostic effect of two scanning methods for SPN was analyzed and compared.Then,the prediction model of SPN was established according to the clinical data and the imaging data obtained from the target scan images.In addition,60 patients with solitary pulmonary nodules from January 2020to January 2021 were selected as the validation group to test the effectiveness of the model.Spss26.0 software was used for statistical analysis.ResultSpiral CT target scan was superior to conventional CT in the display of nodule boundary,spicule sign and vacuole sign,and the differences were statistically significant.The accuracy of SPN in target scan is higher than that in conventional CT.The single factor analysis showed that there were significant differences in age,roundness,nodule type,lobulation sign,hairpin sign,pleura traction sign,air bronchosign,boundary,air cannon,vascular aggregation sign and calcification between benign and malignant nodule groups(P<0.05).Further multivariate regression analysis showed that age,roundness,nodule type,clear boundary,spiculation sign and pleural traction sign were independent predictors of benign and malignant solitary pulmonary nodules.The models were:P=e~x/(1+e~x),X=8.084+(0.087×age)-(0.150×roundness)-(1.815×solid nodule)-(1.295×clear boundary)+(1.350×hairpin sign)+(1.489×pleurothelial traction).The data of all patients in the validation group were substituted into the prediction model for validation,and the ROC curve was drawn.The area under the ROC curve was 0.852.The sensitivity,specificity,positive predictive value and negative predictive value of the model were76.3%,77.3%,85.3%,65.4%and 76.7%,respectively.ConclusionSpiral CT target scan has high diagnostic value for solitary pulmonary nodules.Age,roundness,nodule type,clear boundary,spicule sign and pleural traction sign were independent predictors of SPN.The prediction model established in this study can provide help for the clinical diagnosis of solitary pulmonary nodules. |
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