世界各地的健康系统正在实施肺癌筛查计划，旨在发现早期肺癌并最大限度地提高患者的生存率。体积测量法已被推荐用于肺部结节的后续随访，且其性能优于其他测量方法。然而，众所周知，体积测量法受多种因素的影响。本系统综述（PROSPERO CRD42022370233）的目标是总结关于影响肺部结节体积测量工具的因素的现有知识，评估其在临床上的重要影响，确定现有知识中的空白，并建议未来的研究方向。我们在2022年9月21日在五个数据库（Medline、Scopus、Journals@Ovid、Embase和Emcare）中进行了检索，并纳入了137项原始研究，明确测试了影响因素对体积测量工具结果的潜在影响。这些研究的摘要被列成表，并提供了一篇述评。我们选择了部分报道有临床意义的研究（n=16），并在适当的情况下使用荟萃分析对其结果进行了综合。有临床意义的因素包括分割算法、分割质量、切片厚度、实性结节的吸气水平以及亚实性结节中的重建算法和核函数。尽管在这一领域有大量的证据，但由于大多数研究并未测试临床相关性，因此目前并不清楚如何将这些研究的结果应用于临床实践。由于测试临床意义的研究数量较少且异质性较大，荟萃分析并没有提高我们的理解。 具有关键重要性的陈述：大量研究已经调查了影响肺结节体积测量的因素，但只有11%的研究对其临床意义进行了评估。这些研究之间的异质性给结果的整合和临床应用带来了挑战。关键要点：• 影响肺结节测量体积的因素已经得到了广泛的研究。 • 只有11%的研究测试了临床意义（错误诊断生长）。 • 结节大小与大多数其他影响因素相互作用（特别是对于较小的结节）。 • 研究之间的异质性使得比较和整合结果具有挑战性。 • 未来的研究应着重于临床适用性、筛查和更新技术。© 2023。欧洲放射学会（ESR）。

Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance. CRITICAL RELEVANCE STATEMENT: Many studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence. KEY POINTS: • Factors influencing the volumetry of pulmonary nodules have been extensively investigated. • Just 11% of studies test clinical significance (wrongly diagnosing growth). • Nodule size interacts with most other influencing factors (especially for smaller nodules). • Heterogeneity among studies makes comparison and consolidation of results challenging. • Future research should focus on clinical applicability, screening, and updated technology.© 2023. European Society of Radiology (ESR).