Abstract
BackgroundEarly discrimination between transient and persistent par-solid ground-glass nodules (PSNs) at CT is essential for patient management. The objective of our study was to retrospectively investigate the value of texture analysis in differentiating pulmonary transient and persistent PSNs in addition to clinical and CT features.MethodsThis retrospective study was performed with IRB approval and a waiver of the requirement for patients' informed consent. From January 2007 to October 2009, we identified 77 individuals (39 men and 38 women; mean age, 55 years) with 86 PSNs on thin-section chest CT. Thirty-nine PSNs in 31 individuals were transient and 47 PSNs in 46 patients were persistent. The clinical, CT, and texture features of PSNs were evaluated. To investigate the additional value of texture analysis in differentiating transient from persistent PSNs, logistic regression analysis and C-statistics were performed.ResultsBetween transient and persistent PSNs, there were significant differences in age, gender, smoking history, and eosinophil count among the clinical features. As for thin-section CT features, there were significant differences in lesion size, solid portion size, and lesion multiplicity. In terms of texture features, there were significant differences in mean attenuation, skewness of whole PSN, attenuation ratio of whole PSN to inner solid portion, and 5-, 10-, 25-, 50-percentile CT numbers of whole PSN. Multivariate analysis revealed eosinophilia, lesion size, lesion multiplicity, mean attenuation of whole PSN, skewness of whole PSN, and 5-percentile CT number were significant independent predictors of transient PSNs. (P<0.05) C-statistics revealed that texture analysis incorporating clinical and CT features (AUC, 92.9%) showed significantly higher differentiating performance of transient from persistent PSNs compared with the clinical and CT features alone (AUC, 79.0%). (P = 0.004)ConclusionTexture analysis of PSNs in addition to clinical and CT features analysis has the potential to improve the differentiation of transient from persistent PSNs.
Highlights
Recent advances in CT technology and its increasingly popular utilization in clinical practice have led to a substantial increase in the number of incidentally-detected small pulmonary nodules, one of which is the pulmonary ground-glass nodule (GGN)
Comparison of clinical and thin-section CT features between transient and persistent par-solid ground-glass nodules (PSNs)
Transient PSNs were more frequently seen in younger patients, in male patients and current smokers than persistent PSNs (P,001, P = 0.001, and P,0.001, respectively)
Summary
Recent advances in CT technology and its increasingly popular utilization in clinical practice have led to a substantial increase in the number of incidentally-detected small pulmonary nodules, one of which is the pulmonary ground-glass nodule (GGN). The malignancy probability of these GGNs has been reported to be higher than that of solid nodules, and part-solid GGNs (PSNs) in particular, have been reported to have a much higher malignancy probability than solid nodules or pure GGNs, ranging from 62.5%–89.6% [1,2]. In this context, several experts [3,4,5] have suggested that PSNs may represent malignancy with a sufficient enough likelihood to warrant aggressive diagnostic workups including surgical resection. The objective of our study was to retrospectively investigate the value of texture analysis in differentiating pulmonary transient and persistent PSNs in addition to clinical and CT features
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