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Deng L, Zhang G, Lin X, Han T, Zhang B, Jing M, Zhou J. Comparison of Spectral and Perfusion Computed Tomography Imaging in the Differential Diagnosis of Peripheral Lung Cancer and Focal Organizing Pneumonia. Front Oncol 2021; 11:690254. [PMID: 34778025 PMCID: PMC8578997 DOI: 10.3389/fonc.2021.690254] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the spectral and perfusion computed tomography (CT) findings of peripheral lung cancer (PLC) and focal organizing pneumonia (FOP) and to compare the accuracy of spectral and perfusion CT imaging in distinguishing PLC from FOP. Materials and Methods Patients who were suspected of having lung tumor and underwent “one-stop” chest spectral and perfusion CT, with their diagnosis confirmed pathologically, were prospectively enrolled from September 2020 to March 2021. Patients who were suspected of having lung tumor and underwent “one-stop” chest spectral and perfusion CT, with their diagnosis confirmed pathologically, were prospectively enrolled from September 2020 to March 2021. A total of 57 and 35 patients with PLC and FOP were included, respectively. Spectral parameters (CT40keV, CT70keV, CT100keV, iodine concentration [IC], water concentration [WC], and effective atomic number [Zeff]) of the lesions in the arterial and venous phases were measured in both groups. The slope of the spectral curve (K70keV) was calculated. The perfusion parameters, including blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface (PS), were measured simultaneously in both groups. The differences in the spectral and perfusion parameters between the groups were examined. Receiver operating characteristic (ROC) curves were generated to calculate and compare the area under the curve (AUC), sensitivity, specificity, and accuracy of both sets of parameters in both groups. Results The patients’ demographic and clinical characteristics were similar in both groups (P > 0.05). In the arterial and venous phases, the values of spectral parameters (CT40keV, CT70keV, spectral curve K70keV, IC, and Zeff) were greater in the FOP group than in the PLC group (P < 0.05). In contrast, the values of the perfusion parameters (BV, BF, MTT, and PS) were smaller in the FOP group than in the PLC group (P < 0.05). The AUC of the combination of the spectral parameters was larger than that of the perfusion parameters. For the former imaging method, the AUC, sensitivity, and specificity were 0.89 (95% confidence interval [CI]: 0.82–0.96), 0.86, and 0.83, respectively. For the latter imaging method, the AUC, sensitivity, and specificity were 0.80 (95% CI: 0.70–0.90), 0.71, and 0.83, respectively. There was no significant difference in AUC between the two imaging methods (P > 0.05). Conclusion Spectral and perfusion CT both has the capability to differentiate PLC and FOP. However, compared to perfusion CT imaging, spectral CT imaging has higher diagnostic efficiency in distinguishing them.
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Affiliation(s)
- Liangna Deng
- Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Guojin Zhang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoqiang Lin
- Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Tao Han
- Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Bin Zhang
- Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Mengyuan Jing
- Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Junlin Zhou
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.,Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
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Huang T, Sun H, Luo X, Zhang X, Jin K, Wang F, Sun L, Cheng N, Wu S, Lou Q, Li B. Correlation study between flash dual source CT perfusion imaging and regional lymph node metastasis of non-small cell lung cancer. BMC Cancer 2020; 20:547. [PMID: 32532248 PMCID: PMC7291763 DOI: 10.1186/s12885-020-07032-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/03/2020] [Indexed: 01/06/2023] Open
Abstract
Background To explore the correlation of flash dual source computed tomography perfusion imaging (CTPI) and regional lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate the value of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC. Methods 120 consecutive patients with NSCLC confirmed by postoperative histopathology were underwent flash dual source CT perfusion imaging in pre-operation. The CT perfusion parameters of NSCLC, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability (PMB) were obtained by the image post-processing. Then microvessel density (MVD), luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP) of NSCLC were counted by immunohistochemistry. These cases were divided into group A (patients with lymph node metastasis, 58 cases) and group B (patients without lymph node metastasis, 62 cases) according to their pathological results. The CT perfusion parameters and the microvessel parameters were contrastively analysed between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC in pre-operation. Results Group A presented significantly lower LVA, BF and higher MTT, PMB than Group B (P < 0.05), while BV, LVN, LVP and MVD were no significant difference (P > 0.05). Correlation analysis showed that BF was correlated with LVA and LVP (P < 0.05), while BV, MTT and PMB were not correlated with LVN, LVA and LVP (P > 0.05). All the perfusion parameters were not correlated with MVD. According to the ROC curve analysis, when BF < 85.16 ml/100 ml/min as a cutoff point to predict regional lymph node metastasis of NSCLC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 60.8, 81.7, 71.5, 75.6 and 69.5% respectively. Conclusion Flash dual source CT perfusion imaging can non-invasively indicate the luminal vascular structure of tumor and BF can be used as one of the important indexes in predicting regional lymph node metastasis of NSCLC in pre-operation.
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Affiliation(s)
- Tingting Huang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Hui Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong Province, China
| | - Xianli Luo
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Xuemei Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.,Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, Guizhou Province, China
| | - Kaiyuan Jin
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Feng Wang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Lv Sun
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Nianlan Cheng
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Shuo Wu
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Qin Lou
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China
| | - Bangguo Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, No.149, Dalian Road, Zunyi City, Guizhou Province, China.
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Zhang C, Wang N, Su X, Li K, Yu D, Ouyang A. FORCE dual-energy CT in pathological grading of clear cell renal cell carcinoma. Oncol Lett 2019; 18:6405-6412. [PMID: 31807164 PMCID: PMC6876341 DOI: 10.3892/ol.2019.11022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/06/2019] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study was to examine the value of FORCE dual-energy CT in grading the clear cell renal cell carcinoma (ccRCC). A total of 35 cases of ccRCC were included. Hematoxylin and eosin staining was performed, and the cases were divided into low- (Fuhrman I-II) and high-grade (Fuhrman III-IV) groups. FORCE dual-energy CT parameters, including virtual network computing CT value (VNCV), iodine overlay value (IOV), mixed energy CT value (MEV), iodine concentration (IC), normalized iodine concentration (NIC), NIC based on aorta (NICA), NIC based on cortex (NICC) and NIC based on medulla (NICM), were analyzed and compared. Receiver operating characteristic analysis was also performed. There were significant differences in the arterial phase IOV, MEV and IC, and the venous phase IOV and IC between the low- and high-grade groups. No significant differences were observed in VNCV and MEV between the low -and high-grade groups in the venous phase. Significant differences were observed in the NICA and NICC between these two groups, however no difference was observed in NICM. There were significant differences in the tumor CT values for the arterial phase at the 40, 60, 80 and 100 kiloelectron volt (keV) between the low- and high-grade groups, while no significant differences were observed at the 120-140 keV levels. The k-slope for the low-grade group was significantly higher than the high-grade group. In addition, the area under curve for the arterial phase IOV, arterial phase MEV, arterial phase IC, aortic NIC, cortical NIC, venous phase IOV, venous phase IC and curve slope K of mono-energy CT value suggested high value in diagnosis of low- and high-grade ccRCC cases.
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Affiliation(s)
- Chunling Zhang
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Ning Wang
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Xinyou Su
- Department of Oncology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Kun Li
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Aimei Ouyang
- Department of Radiology, Jinan Central Hospital, Shandong University, Jinan, Shandong 250013, P.R. China
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Huang C, Liang J, Lei X, Xu X, Xiao Z, Luo L. Diagnostic Performance of Perfusion Computed Tomography for Differentiating Lung Cancer from Benign Lesions: A Meta-Analysis. Med Sci Monit 2019; 25:3485-3494. [PMID: 31077263 PMCID: PMC6526743 DOI: 10.12659/msm.914206] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Numerous studies have explored diagnosis of pulmonary nodules using perfusion computed tomography (CT); however, findings were not always consistent between studies. Th e present study aimed to summarize evidence on the diagnostic value of perfusion CT for distinguishing between lung cancer and benign lesions. Material/Methods We performed a systematic literature search on lung cancer and benign pulmonary lesions performed with perfusion CT. The searches were undertaken in English or Chinese language in Medline, PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure database from Jan 2010 to Nov 2018. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) of blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface (PS) were calculated using Review Manager 5.3. Publication bias, sensitivity, specificity, and the area under the curve (AUC) were calculated using Stata12.0. Results Fourteen studies comprising 1032 malignant and 447 benign pulmonary lesions were analyzed. Lung cancer had higher BV, BF, MTT, and PS values than benign lesions. SMDs and 95% CIs of BV, BF, MTT, and PS were 2.29 (1.43, 3.16), 0.50 (0.14, 0.86), 0.55 (0.39, 0.72), and 1.21 (0.87, 1.56), respectively. AUC values of BV and PS were 0.92 (0.90, 0.94) and 0.83 (0.80, 0.86), respectively. Conclusions CT perfusion imaging is a valuable technique for the diagnosis of pulmonary nodules. Lung cancer had higher perfusion and permeability than benign lesions. The evidence suggests blood volume is the best surrogate marker for characterizing the blood supply, while permeability surface has a high specificity in quantifying the vascular permeability.
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Affiliation(s)
- Cuiqing Huang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland).,Department of Ultrasound, Guangdong Women's and Children's Hospital, Guangzhou, Guangdong, China (mainland)
| | - Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Xueping Lei
- Key Laboratory of Molecular Target and Clinical Pharmacology, School of Pharmaceutical Sciences and Fifth Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China (mainland)
| | - Xi Xu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Zeyu Xiao
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China (mainland)
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Chen L, Zeng X, Wu Y, Yan X, Huang X, Chen H, Zhang J, Wang J, Feng L. A Study of the Correlation of Perfusion Parameters in High‐Resolution GRASP MRI With Microvascular Density in Lung Cancer. J Magn Reson Imaging 2018; 49:1186-1194. [PMID: 30390364 DOI: 10.1002/jmri.26340] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Lihua Chen
- Department of RadiologySouthwest Hospital, Army Medical University (Third Military Medical University) Chongqing P.R. China
- Department of RadiologyPLA 101st Hospital Wuxi Jiangsu P.R. China
| | - Xianchun Zeng
- Department of RadiologyGuizhou Provincial People's Hospital Guizhou P.R. China
| | - Youli Wu
- Department of PathologySouthwest Hospital, Army Medical University (Third Military Medical University) Chongqing P.R. China
| | - Xiaochu Yan
- Department of PathologySouthwest Hospital, Army Medical University (Third Military Medical University) Chongqing P.R. China
| | - Xuequan Huang
- Department of RadiologySouthwest Hospital, Army Medical University (Third Military Medical University) Chongqing P.R. China
| | - Hui Chen
- Department of RadiologySouthwest Hospital, Army Medical University (Third Military Medical University) Chongqing P.R. China
| | - Jiuquan Zhang
- Department of RadiologyChongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital Chongqing P.R. China
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University)Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital Chongqing P.R. China
| | - Jian Wang
- Department of RadiologySouthwest Hospital, Army Medical University (Third Military Medical University) Chongqing P.R. China
| | - Li Feng
- Department of Medical PhysicsMemorial Sloan Kettering Cancer Center New York New York USA
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Lin LY, Zhang Y, Suo ST, Zhang F, Cheng JJ, Wu HW. Correlation between dual-energy spectral CT imaging parameters and pathological grades of non-small cell lung cancer. Clin Radiol 2018; 73:412.e1-412.e7. [DOI: 10.1016/j.crad.2017.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/02/2017] [Indexed: 02/07/2023]
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Iwano S, Ito R, Umakoshi H, Ito S, Naganawa S. Evaluation of lung cancer by enhanced dual-energy CT: association between three-dimensional iodine concentration and tumour differentiation. Br J Radiol 2015; 88:20150224. [PMID: 26329466 DOI: 10.1259/bjr.20150224] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate the correlation between iodine concentration of dual-energy CT (DECT) and histopathology of surgically resected primary lung cancers. METHODS We reviewed the medical records, post-operative pathological records and pre-operative DECT images of patients who underwent surgical lung resection for primary lung cancer. After injection of iodinated contrast media, arterial and delayed phases were scanned using 140- and 80-kV tube voltages. Three-dimensional iodine concentration (iodine volume) of primary tumours was calculated using lung nodule application software. RESULTS A total of 60 patients (37 males and 23 females; age range, 39-84 years; mean age, 69 years) with 62 lung cancers were analysed. The resected tumours were histopathologically classified into well-differentiated (G1; n = 20), moderately differentiated (G2; n = 29), poorly differentiated (G3; n = 9) and undifferentiated (G4; n = 4) groups by degree of tumour differentiation (DTD). The mean ± standard deviation of iodine volume at the delayed phase was 59.6 ± 18.6 HU in G1 tumours, 46.5 ± 11.3 HU in G2 tumours, 34.3 ± 15.0 HU in G3 tumours and 28.8 ± 6.4 HU in G4 tumours; significant differences were observed between groups (p < 0.001). Univariate logistic regression analysis showed that iodine volumes both at the early and delayed phases were significantly correlated with DTD (p = 0.006 and p = 0.001, respectively), whereas gender, body weight and tumour size were not (p = 0.084, p = 0.062 and p = 0.391, respectively). CONCLUSION The iodine volume of lung cancers was significantly associated with their DTD. High-grade tumours tended to have lower iodine volumes than low-grade tumours. ADVANCES IN KNOWLEDGE Iodine volume measured by DECT could be a valuable functional imaging method to estimate differentiation of primary lung cancer.
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Affiliation(s)
- Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyasu Umakoshi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Rajendran R, Liang J, Tang MYA, Henry B, Chuang KH. Optimization of arterial spin labeling MRI for quantitative tumor perfusion in a mouse xenograft model. NMR IN BIOMEDICINE 2015; 28:988-997. [PMID: 26104980 DOI: 10.1002/nbm.3330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 03/18/2015] [Accepted: 04/22/2015] [Indexed: 06/04/2023]
Abstract
Perfusion is an important biomarker of tissue function and has been associated with tumor pathophysiology such as angiogenesis and hypoxia. Arterial spin labeling (ASL) MRI allows noninvasive and quantitative imaging of perfusion; however, the application in mouse xenograft tumor models has been challenging due to the low sensitivity and high perfusion heterogeneity. In this study, flow-sensitive alternating inversion recovery (FAIR) ASL was optimized for a mouse xenograft tumor. To assess the sensitivity and reliability for measuring low perfusion, the lumbar muscle was used as a reference region. By optimizing the number of averages and inversion times, muscle perfusion as low as 32.4 ± 4.8 (mean ± standard deviation) ml/100 g/min could be measured in 20 min at 7 T with a quantification error of 14.4 ± 9.1%. Applying the optimized protocol, heterogeneous perfusion ranging from 49.5 to 211.2 ml/100 g/min in a renal carcinoma was observed. To understand the relationship with tumor pathology, global and regional tumor perfusion was compared with histological staining of blood vessels (CD34), hypoxia (CAIX) and apoptosis (TUNEL). No correlation was observed when the global tumor perfusion was compared with these pathological parameters. Regional analysis shows that areas of high perfusion had low microvessel density, which was due to larger vessel area compared with areas of low perfusion. Nonetheless, these were not correlated with hypoxia or apoptosis. The results suggest that tumor perfusion may reflect certain aspect of angiogenesis, but its relationship with other pathologies needs further investigation.
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Affiliation(s)
- Reshmi Rajendran
- Magnetic Resonance Imaging Group, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
| | - Jieming Liang
- Magnetic Resonance Imaging Group, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
| | - Mei Yee Annie Tang
- Magnetic Resonance Imaging Group, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
| | - Brian Henry
- Translational Medicine Research Centre, MSD, Singapore
| | - Kai-Hsiang Chuang
- Magnetic Resonance Imaging Group, Singapore Bioimaging Consortium, Agency for Science, Technology and Research, Singapore
- Clinical Imaging Research Centre, National University of Singapore, Singapore
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Coche E. Advances and perspectives in lung cancer imaging using multidetector row computed tomography. Expert Rev Anticancer Ther 2013; 12:1313-26. [PMID: 23176619 DOI: 10.1586/era.12.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The introduction of multidetector row computed tomography (CT) into clinical practice has revolutionized many aspects of the clinical work-up. Lung cancer imaging has benefited from various breakthroughs in computing technology, with advances in the field of lung cancer detection, tissue characterization, lung cancer staging and response to therapy. Our paper discusses the problems of radiation, image visualization and CT examination comparison. It also reviews the most significant advances in lung cancer imaging and highlights the emerging clinical applications that use state of the art CT technology in the field of lung cancer diagnosis and follow-up.
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Affiliation(s)
- Emmanuel Coche
- Department of Medical Imaging, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Avenue Hippocrate, 10, 1200 Brussels, Belgium.
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Zhou H, Xiong Z, Liu JK, Chen SX, Zhou ML, Zhou JH, Chen W, Liu YTY, Fan F. Low tumor blood flow assessed with perfusion CT correlates with lymphatic involvement in patients with stage T1b non-small cell lung cancer. Thorac Cancer 2013; 4:131-137. [PMID: 28920205 DOI: 10.1111/j.1759-7714.2012.00142.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To investigate the correlation of computed tomography (CT) perfusion parameters and lymphatic involvement in patients with stage T1b non-small cell lung cancer (NSCLC). METHODS Forty-six patients (30 men and 16 women; age range, 36-73 years; mean age, 57 years), with stage T1b non-small cell lung cancer, underwent perfusion CT before surgery. The correlations between CT perfusion parameters (blood flow, blood volume, peak enhancement intensity), tumor angiogenesis (microvessel density and maturity of microvessels of surgical specimens) and lymphatic involvement were retrospectively investigated. Receiver operator curve (ROC) analysis was used to identify the parameter threshold at which tumors had or did not have lymph node metastasis, and the corresponding sensitivity and specificity were calculated. RESULTS A significant tendency for tumors with low blood flow and high density of immature microvessels to show lymphatic involvement was found (all P < 0.001). High correlation (r =-0.769, P < 0.001) was observed between tumor blood flow and immature microvessels. The area under ROC curves (AUC) for blood flow to detect lymph node metastasis was 0.866 (95% confidence interval, 0.766-0.966). For blood flow, the sensitivity, specificity, and accuracy of predicting lymph node metastasis were 88.9, 64.3, and 73.9% respectively, if the cutoff point was set at 43.05 mL/100 g/minute. CONCLUSIONS Blood flow may be useful to predict lymphatic involvement before surgery in stage T1b NSCLC.
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Affiliation(s)
- Hui Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Zeng Xiong
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Jin-Kang Liu
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Shen-Xi Chen
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Mo-Ling Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Jian-Hua Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Chen
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Yang-Teng-Yu Liu
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
| | - Fan Fan
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Cardiothoracic Surgery, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Department of Pathology, Xiang Ya Hospital, Central South University, Changsha, Hunan, China Clinical Medicine (eight-year program), Xiang Ya Hospital, Central South University, Changsha, Hunan, China
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Assessment of tumor vascularity in lung cancer using volume perfusion CT (VPCT) with histopathologic comparison: a further step toward an individualized tumor characterization. J Comput Assist Tomogr 2013; 37:15-21. [PMID: 23321828 DOI: 10.1097/rct.0b013e318277c84f] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To measure perfusion in different lung cancer subtypes and compare results with histopathological/immunohistochemical results. METHODS Seventy-two consecutive untreated patients with lung cancer (40 adenocarcinomas, 20 squamous cell, and 12 small cell lung cancers) were enrolled. A 40-second volume perfusion computed tomography of the tumor bulk was obtained. Blood flow (BF), blood volume (BV), and transit constant were determined. Tumor volume and tumor necrosis were determined on contrast-enhanced computed tomography. Pathologic specimens were assessed for microvessel density (MVD), hypoxia-induced transcription (hif-1/-2), and proliferation (Ki-67). RESULTS Higher MVD is associated with higher BF and BV. Higher tumor grade leads to lower BF but increased necrosis and tumor volume. Markers of hypoxia were independent from perfusion parameters, extent of necrosis or MVD. Blood flow, BV, and MVD were not significantly different among lung cancer subtypes. Transit constant was significantly reduced in small cell lung cancer versus adenocarcinoma. CONCLUSIONS Perfusion values are related to MVD and tumor grade but vary considerably among lung cancer subtypes.
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Liu YTY, Zhou H, Liu JK. CT perfusion imaging in the diagnosis of esophageal cancer. Shijie Huaren Xiaohua Zazhi 2012; 20:3494-3498. [DOI: 10.11569/wcjd.v20.i35.3494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Esophageal cancer is one of the most common malignant tumors in China. The symptoms of early esophageal cancer often tend to be unspecific and are easily ignored. Diagnosis of esophageal cancer at early stage can improve its therapy and prognosis. Currently, there are still limitations for the application of digestive barium meal examination and endoscopic pathological biopsy in diagnosis of esophageal cancer. CT perfusion imaging, a technique developed in recent years, can assess tissue microcirculation quickly, conveniently, and non-invasively. These unique advantages have led to its gradual application to tumor diagnosis and prognosis evaluation. In this article, we review the application of CT perfusion imaging in the diagnosis of esophageal cancer.
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Aguila Rodríguez Y, Vicente Sánchez BM, Llaguno Pérez GA, Sánchez Pedraza JF, Costa Cruz M. Effect of physical exercise on metabolic control and risk factors in patients with type 2 diabetes mellitus: a quasi-experimental study. Medwave 2012. [DOI: 10.5867/medwave.2012.10.5547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Iwano S, Koike W, Matsuo K, Kitano M, Kawakami K, Okada T, Naganawa S. Correlation between dynamic CT findings and pathological prognostic factors of small lung adenocarcinoma. Cancer Imaging 2012; 12:187-93. [PMID: 22752199 PMCID: PMC3392779 DOI: 10.1102/1470-7330.2012.0018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To compare pathological prognostic factors of small lung adenocarcinomas with findings of contrast-enhanced dynamic computed tomography (CT) scans. MATERIALS AND METHODS We evaluated 108 patients with lung adenocarcinomas ≤ 30 mm in diameter who underwent dynamic CT scans (80-96 ml of contrast material, 2.5-3 ml/s injection) and tumor resections. Attenuation values of both the early phase (20-36 s after injection) and delayed phase (91-95 s) of enhanced CT minus baseline plain CT attenuation were defined as ΔEarly and ΔDelay. The early enhancement ratio was defined as ΔEarly/ΔDelay×100 (%). We statistically compared the early enhancement ratios between the presence and absence of each pathological finding (lymph node metastasis, lymphatic permeation, vascular invasion, and pleural involvement). Patients were divided into 2 groups based on early enhancement ratios: ratio ≥50% (n = 41) and ratio <50% (n = 67) and we statistically compared these 2 groups. RESULTS The early enhancement ratios in the group with lymph node metastasis, lymphatic permeation, and vascular invasion were significantly lower than in the group without these findings (24.9% vs 48.6%; P < 0.001, 30.0% vs 47.5%; P = 0.002, and 26.5% vs 47.0%; P = 0.002, respectively). Lymph node metastasis, lymphatic permeation, and vascular invasion were significantly more frequent in tumors with a ratio <50% than in tumors with ratio ≥50% (P < 0.001, P = 0.008, and P = 0.005, respectively). CONCLUSIONS There was a significant correlation between the early enhancement ratio of enhanced dynamic CT and the pathological prognostic factors in small lung adenocarcinomas.
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Affiliation(s)
- Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Shouwa-ku, Japan.
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Antiangiogenic and radiation therapy: early effects on in vivo computed tomography perfusion parameters in human colon cancer xenografts in mice. Invest Radiol 2012; 47:25-32. [PMID: 22178893 DOI: 10.1097/rli.0b013e31823a82f6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess early treatment effects on computed tomography (CT) perfusion parameters after antiangiogenic and radiation therapy in subcutaneously implanted, human colon cancer xenografts in mice and to correlate in vivo CT perfusion parameters with ex vivo assays of tumor vascularity and hypoxia. MATERIALS AND METHODS Dynamic contrast-enhanced CT (perfusion CT, 129 mAs, 80 kV, 12 slices × 2.4 mm; 150 μL iodinated contrast agent injected at a rate of 1 mL/min intravenously) was performed in 100 subcutaneous human colon cancer xenografts on baseline day 0. Mice in group 1 (n=32) received a single dose of the antiangiogenic agent bevacizumab (10 mg/kg body weight), mice in group 2 (n=32) underwent a single radiation treatment (12 Gy), and mice in group 3 (n=32) remained untreated. On days 1, 3, 5, and 7 after treatment, 8 mice from each group underwent a second CT perfusion scan, respectively, after which tumors were excised for ex vivo analysis. Four mice were killed after baseline scanning on day 0 for ex vivo analysis. Blood flow (BF), blood volume (BV), and flow extraction product were calculated using the left ventricle as an arterial input function. Correlation of in vivo CT perfusion parameters with ex vivo microvessel density and extent of tumor hypoxia were assessed by immunofluorescence. Reproducibility of CT perfusion parameter measurements was calculated in an additional 8 tumor-bearing mice scanned twice within 5 hours with the same CT perfusion imaging protocol. RESULTS The intraclass correlation coefficients for BF, BV, and flow extraction product from repeated CT perfusion scans were 0.93 (95% confidence interval: 0.78, 0.97), 0.88 (0.66, 0.95), and 0.88 (0.56, 0.95), respectively. Changes in perfusion parameters and tumor volumes over time were different between treatments. After bevacizumab treatment, all 3 perfusion parameters significantly decreased from day 1 (P ≤ 0.006) and remained significantly decreased until day 7 (P ≤ 0.008); tumor volume increased significantly only on day 7 (P=0.04). After radiation treatment, all 3 perfusion parameters decreased significantly on day 1 (P < 0.001); BF and flow extraction product increased again on day 3 and 5, although without reaching statistically significant difference; and tumor volumes did not change significantly at all time points (P ≥ 0.3). In the control group, all 3 perfusion parameters did not change significantly, whereas tumor volume increased significantly at all the time points, compared with baseline (P ≤ 0.04). Ex vivo immunofluorescent staining showed good correlation between all 3 perfusion parameters and microvessel density (ρ=0.71, 0.66, and 0.69 for BF, BV, and flow extraction product, respectively; P < 0.001). There was a trend toward negative correlation between extent of hypoxia and all 3 perfusion parameters (ρ=-0.53, -0.47, and -0.40 for BF, BV, and flow extraction product, respectively; P ≥ 0.05). CONCLUSIONS CT perfusion allows a reproducible, noninvasive assessment of tumor vascularity in human colon cancer xenografts in mice. After antiangiogenic and radiation therapy, BF, BV, and flow extraction product significantly decrease and change faster than the tumor volume.
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Lymphatic microvessel density combined with CT used in the diagnosis of mediastinal and hilar lymph node metastasis of non-small cell lung cancer. Arch Med Res 2012; 43:132-8. [PMID: 22386563 DOI: 10.1016/j.arcmed.2012.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/23/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Lymphatic microvessel density (LMVD) has been demonstrated to correlate with tumor metastasis. The purpose of this study is to determine whether the criteria combining LMVD with computed tomography (CT) could improve the diagnostic accuracy of lymph node (LN) metastasis in non-small cell lung cancer (NSCLC). METHODS Ninety four patients with NSCLC who had chest CT scans preoperatively and LMVD tested by immunohistochemistry postoperatively were randomized into two groups: the training set (n = 66) and the test set (n = 28). Cut-off point of LMVD was selected to separate the LN metastasis-predictive positive and negative groups. On the basis of LMVD levels, chest CTs of the training set were re-analyzed and hypothetical criteria for LN metastasis diagnosis were established. Diagnostic characteristics for LN metastasis were tested by using the combined criteria in the test set as compared to those of CT alone. RESULTS There was a significantly positive correlation between LMVD and LN metastasis (p <0.01). For sensitivity, specificity, positive predictive value (PPV) and negative predictive values (NPV), accuracy was 67, 81, 75, 81 and 79% for the combined criteria, respectively. Diagnostic efficacy of the combined criteria was significantly higher than that of CT only (p <0.05). CONCLUSIONS Diagnosis of LN metastasis using a combination of LMVD and CT is superior to the CT-only diagnosis. In future clinical trials, it is necessary to evaluate the efficacy of adjuvant therapy for the selection of patients according to the combined criteria.
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