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Application value of CT three-dimensional reconstruction technology in the identification of benign and malignant lung nodules and the characteristics of nodule distribution
BMC Medical Imaging volume 25, Article number: 7 (2025)
Abstract
Objective
The study aimed to evaluate the application value of computed tomography (CT) three-dimensional (3D) reconstruction technology in identifying benign and malignant lung nodules and characterizing the distribution of the nodules.
Methods
CT 3D reconstruction was performed for lung nodules. Pathological results were used as the gold standard to compare the detection rates of various lung nodule signs between conventional chest CT scanning and CT 3D reconstruction techniques. Additionally, the differences in mean diffusion coefficient values and partial anisotropy index values between male and female patients were analyzed.
Results
Pathologic confirmation identified 30 patients with benign lesions and 45 patients with malignant lesions. CT 3D reconstruction demonstrated higher diagnostic accuracy for lung nodule imaging signs compared to conventional CT scanning (P < 0.05). The mean diffusion coefficient values and partial anisotropy index values were lower in female patients compared to male patients in the lung nodule lesion area, lung perinodular edema area, and normal lung tissue (P < 0.05). Conventional CT scanning showed a benign accuracy rate of 63.33% and a malignant accuracy rate of 60.00%, whereas CT 3D imaging achieved a benign and malignant accuracy rate of 86.67% for both. The accuracy rates for CT 3D imaging were significantly higher than those for conventional CT scanning (P < 0.05).
Conclusion
CT 3D imaging technology demonstrates high diagnostic accuracy in differentiating benign from malignant lung nodules.
Introduction
Lung nodules are defined as homogeneous regions that contrast with the highly scattered dispersed lung parenchyma, which contains millions of air-filled alveoli [1]. The detection of lung nodules is a concerning issue for both patients and physicians, and it is crucial to distinguish those with high potential for malignancy [2]. The differentiation between benign and malignant lung nodules remains a diagnostic challenge [3]. Current medical imaging techniques are known to have a high false positive rate in identifying the nodules [4]. Therefore, developing an accurate method for differentiating solitary lung nodules is of paramount importance [5].
Computed tomography (CT) is a primary tool used in the clinical differentiation of benign and malignant lung nodules. Early classification of lung nodules is of great significance as it can slow down degenerative process and decrease mortality [6]. With rapid advancements in detection technologies, CT imaging is clinically widely utilized in the early diagnosis of lung nodules [7]. CT has proven to be an effective tool in the detection and characterization of lung nodules in vivo. Noninvasive methods possess, such as CT, have potential to alleviate clinical burdens, reduce risks, and lowered the costs related to further procedures [8]. The accurate differentiation of malignant lung nodules on chest CT is important in detecting lung cancer at an early stage and further offering patients with better chances of treatment and improved outcomes [9]. Recently, the use of CT three-dimensional (3D) reconstruction technology is growing in the preoperative planning of ground-glass nodule patients. The technique provides an economical and convenient method for more precise localization of lung lesions, which makes lung segment resection more accurate [10]. CT images combined with 3D reconstruction/printing models have shown a 100% agreement rate with pathological results, which aid in the precise and rapid localization of nodules in resected specimens. Moreover, the pathological results of lesions exhibit a high degree of agreement with preoperative CT imaging findings, which holds significant potential for future studies to investigate the clinicopathological characteristics of multiple lung nodules [11]. Inspired by the above findings, we aimed to explore the role of CT 3D reconstruction technology in differentiating benign from malignant lung nodules. Specifically, we sought to compare conventional CT scan and CT 3D reconstruction technology in identifying imaging signs, such as the burr sign, spinous protuberance, pleural indentation sign, vascular convergence sign, and small calcification sign. We also investigated the average diffusion coefficient and anisotropy index of pulmonary nodules in male and female patients, with a focus on the potential application value of CT 3D reconstruction technology in identifying benign and malignant lung nodules and understanding nodule distribution characteristics.
Materials and methods
Ethics statement
The study was approved by the Ethics Committee of the First Affiliated Hospital of Yangtze University (approval number: 20210915) and confirmed the Helsinki Declaration. Clinical trial number: ChiCTR2100120326.
General data
The retrospective, case-control study invited 100 patients who underwent chest CT scans at the First Affiliated Hospital of Yangtze University between December 2021 to June 2023. 75 patients with lung nodules were included in the study after exclusions (Fig. 1). The cohort consisted of 43 males and 32 females, with a mean age of 56.76 ± 6.27 years and a disease duration of 1.89 ± 0.34 years. CT 3D reconstruction of lung nodules, including coronal, sagittal, and VR images was performed at the workstation.
Exclusion and inclusion criteria
Inclusion criteria: (1) patients with a single solid lung nodule smaller than 30 mm in diameter. (2) patients with clear pathological findings; (3) patients without distant metastases on examination.
Exclusion criteria: (1) patients with multiple lung nodules or nodules located in more than in one lobe, requiring resection of multiple lobes; (2) patients who had received anti-tumor therapy before surgery; (3) patients with a history of malignancy; (4) patients with unclear pathological diagnoses; (5) patients with poor quality CT images or incomplete data.
Methods
Chest CT: Philips Core 128-slice CT scanner served as the instrument. The patient was positioned supine with arms raised above the head, removing any metal objects. The patient was instructed to inhale and then hold their breath before the scan began. The scan covered the lungs, starting from the apices to the base and from the thoracic entrance to the rib-diaphragm angle. The following parameters were applied: voltage 120 kV, scan thickness 5 cm, pitch 1.375, reconstruction interval 0.625 mm, lung window size (-700, 1000), and matrix 512 × 512.
After the routine scan, the data were collected and uploaded to the Philips workstation system for processing. Reconstruction results were recorded (Fig. 2). CT 3D reconstruction results were analyzed by three experienced imaging physicians with intermediate or higher qualifications. Representative images of benign and malignant nodules using conventional CT and CT 3D imaging were shown in Fig. 3.
CT 3D and conventional CT images of benign and malignant nodules. (A) CT-3D images. VR images of benign nodules (left) and malignant nodules (right); (B) CT scan images of transverse (left), coronal (middle) and sagittal (right) plane of benign nodules; (C) CT scan images of transverse (left), coronal (middle) and sagittal (right) plane of malignant nodules; (D) CT scan images of malignant burr signs (left), malignant pleural indentation signs (middle) and malignant vascular convergence signs (right)
Pathological assessment
All patients underwent pneumonectomy, and the appropriate surgical procedure was determined based on the number, size, and location of the nodules on chest CT 3D reconstruction. Postoperative specimens were subjected to routine pathological examination. A total of 75 patients were pathologically confirmed, with 30 benign lesions and 45 malignant lesions.
Observation indicators
We compared the diagnostic accuracy of conventional chest CT and CT 3D reconstruction technology using pathological findings as the “gold standard”. The imaging characteristics and location distribution of lung nodules were obtained, and the detection rates of various lung nodule signs (such as nodule diameter, lobular sign, burr sign, pleural indentation sign, and vascular convergence sign) were compared. Differences in mean diffusion coefficient values and partial anisotropy index values between male and female patients were also recorded.
Statistics
GraphPad Prism 8.0 software (GraphPad Inc., La Jolla, CA, USA) was used for data analysis. Measurement data are expressed as mean ± standard deviation (\(\:\overline{x}\) ± sd) and analyzed using t-tests. Nominal data were analyzed using the chi-square test and presented as percentages (%). Differences were considered statistically significant when P < 0.05.
Results
General clinical data
General clinical data, such as age, gender, smoking and drinking history, nodule diameter, and nodule location did not differ significantly between the benign and malignant groups (P > 0.05) (Table 1).
Diagnostic accuracy of imaging signs between conventional CT scan and CT 3D imaging technology
CT 3D imaging technology demonstrated superior diagnostic accuracy compared to conventional CT scans in assessing burr signs, spinous protuberance, pleural indentation signs, vascular convergence signs, and small calcification signs (P < 0.05) (Table 2).
Mean diffusion coefficient values between male and female patients
Female patients exhibited lower mean diffusion coefficient values for the lung nodule lesion part, lung perinodular edema part, and normal lung tissue part compared to male patients (P < 0.05) (Table 3).
Anisotropy index values of lung nodular lesions between male and female patients
The anisotropy index values for the lung nodule lesion part, lung perinodular edema part, and normal lung tissue part were lower in female patients than in male patients (P < 0.05) (Table 4).
Accuracy of conventional CT scan and CT 3D imaging technology for nodule benignity and malignancy
Conventional CT scanning exhibited a benign accuracy rate of 63.33% and a malignant accuracy rate of 60.00%. In contrast, CT 3D imaging demonstrated a benign accuracy rate of 86.67% and a malignant accuracy rate of 86.67%. Both benign and malignant accuracy rates of CT 3D imaging surpassed those of conventional CT scanning (P < 0.05) (Table 5).
Discussion
Lung nodule evaluation aims to expediting the diagnosis and treatment of patients with malignant nodules while minimizing unnecessary diagnostic procedures for benign nodules [12]. The paper aimed to explore the application value of CT 3D reconstruction technology in the identification of benign and malignant lung nodules and in the examination of nodule distribution characteristics.
In the paper, we compared the diagnostic accuracy of imaging signs between conventional CT scans and CT 3D imaging technology. We found that CT 3D imaging offered higher diagnostic accuracy than conventional CT scans in detecting burr signs, spinous protuberance, pleural indentation signs, vascular convergence signs, and small calcification signs. Additionally, we compared the mean diffusion coefficient values and anisotropy index values of lung nodular lesions between male and female patients. Our results showed that female patients had lower mean diffusion coefficient values and anisotropy index values for the lung nodule lesion part, lung perinodular edema part, and normal lung tissue part compared to male patients. Furthermore, we evaluated the accuracy of conventional CT scanning and CT 3D imaging technology in assessing nodule benignity and malignancy. Conventional CT scans had a benign accuracy rate of 63.33% and a malignant accuracy rate of 60.00%, whereas CT 3D imaging had a benign accuracy rate of 86.67% and a malignant accuracy rate of 86.67%, demonstrating the higher accuracy of CT 3D imaging technology.
The large volume of medical imaging data requires the use of advanced systems to reduce clinician workload [13] Image segmentation is a well-known image processing task that involves dividing an image into homogeneous regions [14], and it is widely adopted in medical fields for disease diagnosis [15,16,17] For instance, Garg S, Jindal B, et al. explored image processing techniques for the diagnosis of skin lesions, identifying an optimal method for segmenting skin lesion images, which enhances medical image processing systems [18,19,20,21]. The segmentation of the left ventricle in cardiac magnetic resonance images is crucial for accurate diagnosis [22]; similarly, the segmentation of abdominal CT scans is essential for analyzing, diagnosing, and treating disorders of internal organs, such as hepatocellular carcinoma [23]; in addition, the segmentation of real-time liver ultrasound is crucial for diagnosing and analyzing liver conditions (e.g., hepatocellular carcinoma), and assisting surgeons and radiologists in therapeutic procedures. Accurate segmentation of lung lesions from CT images is also essential for analyzing and diagnosing lung diseases. However, accurate lung nodule segmentation is challenging due to the small size and variety of lung nodules and, the lack of high-quality markers [24]. Therefore, advanced segmentation techniques, combined with traditional and machine learning algorithms, can help classify nodules based on patterns learned from large datasets. These algorithms can be trained to identify patterns associated with benign or malignant nodules, thus improving diagnostic accuracy. In the medical field, combined use of image segmentation and CT 3D reconstruction can significantly enhance diagnosis accuracy and efficiency.
As previously reported, lung nodules are detected in about 30% of chest CT images [25]. CT is also the first choice for diagnosing solid solitary lung nodules. The clarification of differential CT characteristics based on diameter ranges may reduce ambiguities and help distinguishing the benign solid solitary lung nodules from malignant ones [26]. The use of 3D measurements during follow-up for lung ground glass nodules is of increasing significance [27]. Previous studies have shown that CT multi-plane 3D reconstruction navigation can promote the diagnostic efficiency of radial endobronchial ultrasound for solitary lung nodules, and combined CT multi-plane 3D reconstruction with radial endobronchial ultrasound improves diagnostic values for peripheral solitary lung nodules [28]. Moreover, the 3D convolution neural network has demonstrated efficiency in the identification of benign and malignant lung nodules using various CT reconstruction classification algorithms [29]. Meanwhile, 3D reconstruction combined with dial positioning methods has shown acceptable accuracy and holds promise for further clinical promotion and application [30]. The 3D gray density coding feature can provide more accurate results for the classification of benign and malignant lung nodules, and offer additional support for clinicians [31]. Thus, CT 3D reconstruction technology holds considerable value in differentiating benign from malignant lung nodules.
In summary, the research demonstrates that CT 3D imaging technology has significant application value and high diagnostic accuracy in the identification of benign and malignant lung nodules, especially small ones. CT 3D reconstruction can clearly, accurately, and intuitively display the morphology, internal structure, edge boundaries, and surrounding tissue structures of nodular lesions, which substantially enhances the ability to distinguish between benign and malignant pulmonary nodules. The technology offers value in preoperative evaluation, surgical planning, identification of pulmonary vessels and bronchi during surgery, and guiding teaching. It is suitable for clinical implementation and development. As the technology continues to mature, it may improve the accuracy of pulmonary nodule resections. The study lays the foundation for further exploration of the clinical application of CT 3D reconstruction technology in identifying benign and malignant lung nodules. Nevertheless, our study has some limitations. For example, there may be subjective differences in interpreting 3D reconstructed images, and our data derived rom a single center, which could lead to selection bias. Moreover, the sample size and representation were limited. Further high-quality studies are needed to address the limitations and promote the area of research.
Data availability
No datasets were generated or analysed during the current study.
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Acknowledgements
We would like to express our sincere gratitude to the reviewers for their constructive comments.
Funding
The work was not funded by any organization.
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G.H.J and F.L. contributed the study design, Z.Q.C. and J.P. conducted the experimental studies, H.D. and S.X. performed the data analysis, and Y.L. was responsible for manuscript editing. All authors read and approved the final version of the manuscript.
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Ethics approval and consent to participate
All patients provided informed consent and signed a written informed consent form. The study was approved by the Ethics Committee of the First Affiliated Hospital of Yangtze University (approval number: 20210915) and adhered to the Helsinki Declaration. Clinical trial number: ChiCTR2100120326.
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Not applicable.
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The authors declare no competing interests.
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Ji, G., Liu, F., Chen, Z. et al. Application value of CT three-dimensional reconstruction technology in the identification of benign and malignant lung nodules and the characteristics of nodule distribution. BMC Med Imaging 25, 7 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12880-024-01505-z
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DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12880-024-01505-z