| 摘要: |
| ［摘要］ 目的 探讨基于CT参数建立的Fisher判别函数模型对胸腺瘤与前纵隔囊肿进行鉴别诊断的价值。方法 回顾性收集2015年1月至2025年6月在中南大学湘雅医院胸外科经手术切除后病理检查证实为前纵隔囊肿（含胸腺囊肿和支气管囊肿）或胸腺瘤患者的临床病理资料，计算肿瘤平扫和增强CT值与主动脉CT值的比值，采用单因素方差分析结合Bonferroni校正进行组间比较，基于筛得CT参数建立Fisher判别函数并对其进行验证。结果 共236例患者纳入研究，其中胸腺瘤组159例、胸腺囊肿组54例、支气管囊肿组23例。三组年龄比较差异无统计学意义（P>0.05）。与胸腺瘤组和胸腺囊肿组相比，支气管囊肿组患者女性人数比例更高（P<0.001），肿瘤最大径更小（P<0.001）。胸腺瘤组中肿瘤呈分叶状的占比显著高于胸腺囊肿组和支气管囊肿组（P<0.001），脂肪间隙清晰率显著低于胸腺囊肿组和支气管囊肿组（P<0.001）。胸腺瘤组和支气管囊肿组的平扫CT值、平扫主动脉CT比值、增强CT值及增强主动脉CT比值均显著高于胸腺囊肿组（P<0.001），其中支气管囊肿组增强CT值、增强主动脉CT比值显著低于胸腺瘤组（P<0.001）。胸腺囊肿组和支气管囊肿组的CT强化值显著低于胸腺瘤组（P<0.001）。构建Fisher判别函数：D1=0.245×性别（0=女性，1=男性）+0.782×肿瘤形状（1=无分叶状，2=分叶状）+0.644×脂肪间隙（0=模糊，1=清晰）-0.344×增强CT值+97.228×增强主动脉CT比值+0.059×CT强化值-9.357；D2=0.970×性别（0=女性，1=男性）+0.583×肿瘤形状（1=无分叶状，2=分叶状）+0.903×脂肪间隙（0=模糊，1=清晰）-0.094×增强CT值+4.749×增强主动脉CT比值+0.110×CT强化值+0.546。交叉验证结果显示，该模型鉴别诊断胸腺瘤与前纵隔囊肿的总体符合率为95.76%。结论 基于CT参数建立的判别函数诊断模型在鉴别胸腺瘤与前纵隔囊肿中具有较高的诊断价值。 |
| 关键词: 胸腺瘤 前纵隔囊肿 胸腺囊肿 支气管囊肿 CT值 鉴别诊断 Fisher判别函数模型 |
| DOI：10.3969/j.issn.1674-3806.2026.02.17 |
| 分类号:R 734.5 |
| 基金项目: |
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| Study on the differential diagnosis of thymoma and anterior mediastinal cyst based on Fisher′s discriminant function model constructed using CT parameters |
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YANG Yuqi, WANG Sicong, LU Liqing, ZHANG Chunfang, CHENG Yuanda
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Department of Thoracic Surgery, Xiangya Hospital of Central South University, Changsha 410008, China
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| Abstract: |
| ［Abstract］ Objective To explore the value of Fisher′s discriminant function model constructed using computed tomography(CT) parameters in differential diagnosis of thymoma and anterior mediastinal cyst. Methods The clinicopathological data of patients with anterior mediastinal cysts(including thymic cysts and bronchial cysts) or thymoma proven by pathology examination after surgical resection of the cysts in Department of Thoracic Surgery, Xiangya Hospital of Central South University from January 2015 to June 2025 were retrospectively collected. The ratios of plain scan and enhanced CT values of the tumors to the CT values of the aorta were calculated. One-way analysis of variance combined with Bonferroni′s correction was used for inter-group comparisons. The Fisher′s discriminant function was established based on the screened CT parameters and was verified. Results A total of 236 patients were included in this study, including 159 cases of thymoma(thymoma group), 54 cases of thymic cysts(thymic cyst group), and 23 cases of bronchial cysts(bronchial cyst group). There was no statistically significant difference in age among the three groups(P>0.05). Compared with those in the thymoma group and the thymic cyst group, the proportion of female patients was higher(P<0.001), and the maximum diameter of tumors was smaller(P<0.001) in the bronchial cyst group, and the proportion of lobulated tumors in the thymoma group was significantly higher than that in the thymic cyst group and the bronchial cyst group(P<0.001). The clarity rate of fat space in the thymoma group was significantly lower than that in the thymic cyst group and the bronchial cyst group(P<0.001). The plain and enhanced CT values and their aortic CT ratios in the thymoma group and the bronchial cyst group were significantly higher than those in the thymic cyst group(P<0.001), and the enhanced CT value and the ratio in the bronchial cyst group were lower than those in the thymoma group(P<0.001). The enhanced CT values in the thymic cyst group and the bronchial cyst group were significantly lower than those in the thymoma group(P<0.001). The established Fisher′s discriminant functions: D1=0.245×gender(0=female, 1=male)+0.782×tumor shape(1=unlobulated, 2=lobulated)+0.644×fat space(0=blur, 1=clear)-0.344×enhanced CT value+97.228×aortic enhanced CT ratio+0.059×CT enhancement value-9.357; D2=0.970×gender(0=female, 1=male)+0.583×tumor shape(1=unlobulated, 2=lobulated)+0.903×fat space(0=blur, 1=clear)-0.094×enhanced CT value+4.749×aortic enhanced CT ratio+0.110×CT enhancement value+0.546. The cross-validation results showed that the overall diagnostic accuracy rate of the model in differentiating thymoma from anterior mediastinal cyst was 95.76%. Conclusion The discriminant function diagnostic model established according to the CT parameters has a high diagnostic value in differentiating thymoma from anterior mediastinal cyst. |
| Key words: Thymoma Anterior mediastinal cyst Thymic cyst(MTC) Bronchial cyst Computed tomography(CT) value Differential diagnosis Fisher′s discriminant function model |
