相对CT值作为鉴别鼻窦息肉、内翻性乳头状瘤和鳞状细胞癌的定量影像生物标志物：一项初步回顾性研究

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中文摘要

背景/目的： 单侧鼻窦病变在平扫计算机断层扫描（CT）上可能难以定性，因为炎性息肉、良性肿瘤和恶性肿瘤可表现为相似的单侧软组织肿块。平扫CT广泛可及，但相对CT值在单一队列中对炎性、良性肿瘤性和恶性鼻窦病变的诊断性能仍缺乏充分描述。本研究旨在通过比较鼻窦息肉（SP）、内翻性乳头状瘤（IP）和鳞状细胞癌（SCC）之间的相对CT值，并评估预先设定的二分类诊断比较，为平扫CT相对CT值的诊断性能提供更多证据。方法：这项回顾性单中心研究纳入92例经组织病理学证实的单侧或单侧优势鼻窦病变患者：49例SP、24例IP和19例SCC。回顾术前鼻窦平扫CT图像。相对CT值计算为病变平均衰减与脑桥平均衰减的比值。采用非参数检验分析组间差异，并通过受试者工作特征（ROC）曲线分析评估诊断性能。对预先设定的二分类比较还进行了年龄校正的二元logistic回归分析。敏感性分析额外校正了病变ROI面积。结果：相对CT值在三组间差异显著（总体p < 0.001）。ROC分析显示，SP与IP的AUC为0.815（95% CI，0.704-0.904），IP与SCC为0.667（95% CI，0.498-0.826），SP与IP+SCC为0.869（95% CI，0.792-0.932），SP与SCC为0.937（95% CI，0.866-0.986）。年龄校正后，相对CT值在所有四项比较中均与阳性诊断类别相关；然而，ROI面积校正后IP-SCC的关联不再显著（p = 0.073）。区分SP与SCC时观察到最高的诊断性能。结论：这些初步发现提示，相对CT值可作为辅助定量CT参数，用于区分单侧炎性鼻窦病变与肿瘤性病变，其中SP与SCC的鉴别诊断性能最强。然而，其单独区分IP与SCC的能力有限，且年龄校正后的关联仍具有假设生成性质。

英文摘要

Background/Objectives: Unilateral sinonasal lesions may be difficult to characterize on non-contrast computed tomography (CT) because inflammatory polyps, benign neoplasms, and malignant tumors can appear as similar unilateral soft-tissue masses. Non-contrast CT is widely available, but the diagnostic performance of relative CT number across inflammatory, benign neoplastic, and malignant sinonasal lesions within a single cohort remains insufficiently characterized. This study aimed to provide additional evidence regarding the diagnostic performance of relative CT number on non-contrast CT by comparing its values among sinonasal polyp (SP), inverted papilloma (IP), and squamous cell carcinoma (SCC), and by evaluating predefined binary diagnostic comparisons. Methods: This retrospective single-center study included 92 patients with histopathologically confirmed unilateral or unilateral-dominant sinonasal lesions: 49 SP, 24 IP, and 19 SCC. Preoperative non-contrast paranasal sinus CT images were reviewed. Relative CT number was calculated as the ratio of mean lesion attenuation to mean pontine attenuation. Group differences were analyzed using non-parametric tests, and diagnostic performance was assessed with receiver operating characteristic (ROC) curve analysis. Age-adjusted binary logistic regression analyses were also performed for the predefined binary comparisons. Sensitivity analyses were additionally adjusted for lesion ROI area. Results: Relative CT number differed significantly among the three groups (overall p < 0.001). ROC analysis showed an AUC of 0.815 (95% CI, 0.704-0.904) for SP versus IP, 0.667 (95% CI, 0.498-0.826) for IP versus SCC, 0.869 (95% CI, 0.792-0.932) for SP versus IP+SCC, and 0.937 (95% CI, 0.866-0.986) for SP versus SCC. After age adjustment, relative CT number was associated with the positive diagnostic category in all four comparisons; however, the IP-SCC association was no longer significant after ROI-area adjustment (p = 0.073). The highest diagnostic performance was observed for distinguishing SP from SCC. Conclusions: These preliminary findings suggest that relative CT number may serve as an adjunctive quantitative CT parameter for differentiating unilateral inflammatory sinonasal lesions from neoplastic lesions, with the strongest diagnostic performance observed for SP versus SCC. However, its standalone discrimination between IP and SCC was limited, and the age-adjusted association remains hypothesis-generating.