Predictive value of CT target scan-based radiomics and clinical features for patients with chronic obstructive pulmonary disease combined with malignant pulmonary nodules.

[OBJECTIVES] This study aims to evaluate the predictive value of CT target scan-based radiomics and clinical features in patients with chronic obstructive pulmonary disease (COPD) who also present with malignant pulmonary nodules.

[METHODS] A retrospective analysis was conducted on 104 patients diagnosed with COPD and pulmonary nodules, treated at our hospital between September 2022 and September 2024. The cohort was stratified into a benign group (n = 48) and a malignant group (n = 66) based on the definitive pathological examination results. All participants underwent spiral CT target scanning. Univariate and multivariate logistic regression analyses were employed to identify influencing factors. In addition, a receiver operating characteristic (ROC) curve was constructed to assess the predictive value.

[RESULTS] In comparison with the benign group, the malignant group exhibited a greater aspect ratio, a higher proportion of patients over 45 years of age, and increased occurrences of mixed ground-glass opacities, calcification, spiculation sign, vascular convergence sign, and lobulation sign, along with a significant elevation in the CAT score (P < 0.05). The CAT score, density, spiculation sign, and lobulation sign emerged as independent risk factors for the presence of malignant pulmonary nodules in patients with COPD (P < 0.05). The aforementioned imaging factors were incorporated into a multivariate logistic regression model: Logit (P) = 10.490 + 0.917 × CAT score + 1.547 × density + 0.823 × spiculation sign + 0.736 × lobulation sign. The area under the curve (AUC) values for the CAT score, radiomics model, and combined model were 0.768, 0.826, and 0.909, respectively.

[CONCLUSIONS] Radiomics features derived from CT target scanning, when combined with clinical features, demonstrate promising potential for differentiating between benign and malignant pulmonary nodules in patients with COPD. This approach may indirectly reflect patients' pulmonary function and serve as a reference for the early diagnosis of COPD combined with lung cancer.