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Liu X, Li H, Wang S, Yang S, Zhang G, Xu Y, Yang H, Shan F. CT radiomics to differentiate neuroendocrine neoplasm from adenocarcinoma in patients with a peripheral solid pulmonary nodule: a multicenter study. Front Oncol 2024; 14:1420213. [PMID: 38952551 PMCID: PMC11215045 DOI: 10.3389/fonc.2024.1420213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/03/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose To construct and validate a computed tomography (CT) radiomics model for differentiating lung neuroendocrine neoplasm (LNEN) from lung adenocarcinoma (LADC) manifesting as a peripheral solid nodule (PSN) to aid in early clinical decision-making. Methods A total of 445 patients with pathologically confirmed LNEN and LADC from June 2016 to July 2023 were retrospectively included from five medical centers. Those patients were split into the training set (n = 316; 158 LNEN) and external test set (n = 129; 43 LNEN), the former including the cross-validation (CV) training set and CV test set using ten-fold CV. The support vector machine (SVM) classifier was used to develop the semantic, radiomics and merged models. The diagnostic performances were evaluated by the area under the receiver operating characteristic curve (AUC) and compared by Delong test. Preoperative neuron-specific enolase (NSE) levels were collected as a clinical predictor. Results In the training set, the AUCs of the radiomics model (0.878 [95% CI: 0.836, 0.915]) and merged model (0.884 [95% CI: 0.844, 0.919]) significantly outperformed the semantic model (0.718 [95% CI: 0.663, 0.769], p both<.001). In the external test set, the AUCs of the radiomics model (0.787 [95% CI: 0.696, 0.871]), merged model (0.807 [95%CI: 0.720, 0.889]) and semantic model (0.729 [95% CI: 0.631, 0.811]) did not exhibit statistical differences. The radiomics model outperformed NSE in sensitivity in the training set (85.3% vs 20.0%; p <.001) and external test set (88.9% vs 40.7%; p = .002). Conclusion The CT radiomics model could non-invasively, effectively and sensitively predict LNEN and LADC presenting as a PSN to assist in treatment strategy selection.
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Affiliation(s)
- Xiaoyu Liu
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongjian Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, China
| | - Shengping Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guobin Zhang
- Department of Radiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghua Xu
- Department of Imaging and Interventional Radiology, Zhongshan-Xuhui Hospital of Fudan University, Fudan University, Shanghai, China
| | - Hanfeng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, North Sichuan Medical College, Nanchong, China
| | - Fei Shan
- Department of Radiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Xu X, Zhu M, Wang Z, Li J, Ouyang T, Chen C, Huang K, Zhang Y, Gao YL. Prognostic and predictive value of interstitial lung abnormalities and EGFR mutation status in patients with non-small cell lung cancer. Cancer Imaging 2024; 24:66. [PMID: 38783331 PMCID: PMC11119023 DOI: 10.1186/s40644-024-00712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND To determine the predictive value of interstitial lung abnormalities (ILA) for epidermal growth factor receptor (EGFR) mutation status and assess the prognostic significance of EGFR and ILA in patients with non-small cell lung cancer (NSCLC). METHODS We reviewed 797 consecutive patients with a histologically proven diagnosis of primary NSCLC from January 2013 to October 2018. Of these, 109 patients with NSCLC were found to have concomitant ILA. Multivariate logistic regression analysis was used to identify the significant clinical and computed tomography (CT) findings in predicting EGFR mutations. Cox proportional hazard models were used to identify significant prognostic factors. RESULTS EGFR mutations were identified in 22 of 109 tumors (20.2%). Multivariate analysis showed that the models incorporating clinical, tumor CT and ILA CT features yielded areas under the receiver operating characteristic curve (AUC) values of 0.749, 0.838, and 0.849, respectively. When combining the three models, the independent predictive factors for EGFR mutations were non-fibrotic ILA, female sex, and small tumor size, with an AUC value of 0.920 (95% confidence interval[CI]: 0.861-0.978, p < 0.001). In the multivariate Cox model, EGFR mutations (hazard ratio = 0.169, 95% CI = 0.042-0.675, p = 0.012; 692 days vs. 301 days) were independently associated with extended overall survival compared to the wild-type. CONCLUSION Non-fibrotic ILA independently predicts the presence of EGFR mutations, and the presence of EGFR mutations rather than non-fibrotic ILA serves as an independent good prognostic factor for patients with NSCLC.
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Affiliation(s)
- Xiaoli Xu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Min Zhu
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Zixing Wang
- Institute of Basic Medical Sciences, School of Basic Medicine, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jialu Li
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Tao Ouyang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Cen Chen
- Department of Radiology, Beijing Nuclear Industry Hospital, Beijing, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China
| | - Yuhui Zhang
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China.
| | - Yanli L Gao
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China.
- Department of Pulmonary and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongtinan Road, Beijing, 100020, China.
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Jiang X, Liu MW, Zhang X, Dong JY, Miao L, Sun ZH, Dong SS, Zhang L, Yang L, Li M. Observational Study of the Natural Growth History of Peripheral Small-Cell Lung Cancer on CT Imaging. Diagnostics (Basel) 2023; 13:2560. [PMID: 37568923 PMCID: PMC10417025 DOI: 10.3390/diagnostics13152560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND This study aimed to investigate the natural growth history of peripheral small-cell lung cancer (SCLC) using CT imaging. METHODS A retrospective study was conducted on 27 patients with peripheral SCLC who underwent at least two CT scans. Two methods were used: Method 1 involved direct measurement of nodule dimensions using a calliper, while Method 2 involved tumour lesion segmentation and voxel volume calculation using the "py-radiomics" package in Python. Agreement between the two methods was assessed using the intraclass correlation coefficient (ICC). Volume doubling time (VDT) and growth rate (GR) were used as evaluation indices for SCLC growth, and growth distribution based on GR and volume measurements were depicted. We collected potential factors related to imaging VDT and performed a differential analysis. Patients were classified into slow-growing and fast-growing groups based on a VDT cut-off point of 60 days, and univariate analysis was used to identify factors influencing VDT. RESULTS Median VDT calculated by the two methods were 61 days and 71 days, respectively, with strong agreement. All patients had continuously growing tumours, and none had tumours that decreased in size or remained unchanged. Eight patients showed possible growth patterns, with six possibly exhibiting exponential growth and two possibly showing Gompertzian growth. Tumours deeper in the lung grew faster than those adjacent to the pleura. CONCLUSIONS Peripheral SCLC tumours grow rapidly and continuously without periods of nongrowth or regression. Tumours located deeper in the lung tend to grow faster, but further research is needed to confirm this finding.
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Affiliation(s)
- Xu Jiang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (X.J.); (M.-W.L.); (X.Z.); (L.M.); (L.Z.)
| | - Meng-Wen Liu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (X.J.); (M.-W.L.); (X.Z.); (L.M.); (L.Z.)
| | - Xue Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (X.J.); (M.-W.L.); (X.Z.); (L.M.); (L.Z.)
| | - Ji-Yan Dong
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (J.-Y.D.); (Z.-H.S.)
| | - Lei Miao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (X.J.); (M.-W.L.); (X.Z.); (L.M.); (L.Z.)
| | - Zi-Han Sun
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (J.-Y.D.); (Z.-H.S.)
| | - Shu-Shan Dong
- Clinical Science, Philips Healthcare, Beijing 100600, China;
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (X.J.); (M.-W.L.); (X.Z.); (L.M.); (L.Z.)
| | - Lin Yang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (J.-Y.D.); (Z.-H.S.)
| | - Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (X.J.); (M.-W.L.); (X.Z.); (L.M.); (L.Z.)
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Dual-energy computed tomography as a lower radiation dose alternative to perfusion computed tomography in tumor viability assessment. Sci Rep 2023; 13:120. [PMID: 36599882 DOI: 10.1038/s41598-022-27221-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
To present the utility of dual-energy computed tomography (DECT) in the assessment of angiogenesis of focal lesions as an example of a solitary pulmonary nodule (SPN). This prospective study comprised 28 patients with SPN who underwent DECT and perfusion computed tomography (CTP), according to a proprietary protocol. Two radiologists independently analyzed four perfusion parameters, namely blood flow (BF), blood volume (BV), the time to maximum of the tissue residue function (Tmax), permeability surface area product (PS) from CTP, in addition to the iodine concentration (IC) and normalized iodine concentration (NIC) of the SPN from DECT. We used the Pearson R correlation and interclass correlation coefficients (ICCs). Statistical significance was assumed at p < 0.05. The mean tumor size was 23.5 ± 6.5 mm. We observed good correlations between IC and BF (r = 0.78, p < 0.000) and NIC and BF (r = 0.71, p < 0.000) as well as between IC and BV (r = 0.73, p < 0.000) and NIC and BV (r = 0.73, p < 0.000) and poor correlation between IC and PS (r = 0.38, p = 0.044).There was no correlation between NIC and PS (r = 0.35, p = 0.064), IC content and Tmax (r = - 0.28, p = 0.147) and NIC and Tmax (r = - 0.21, p = 0.266). Inter-reader agreement on quantitative parameters at CTP (ICCPS = 0.97, ICCTmax = 0.96, ICCBV = 0.98, and ICCBF = 0.99) and DECT (ICCIC = 0.98) were excellent. The radiation dose was significantly lower in DECT than that in CTP (4.84 mSv vs. 9.07 mSv, respectively). DECT is useful for the functional assessment of oncological lesions with less exposure to radiation compared to perfusion computed tomography.
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Wang J, Zhong F, Xiao F, Dong X, Long Y, Gan T, Li T, Liao M. CT radiomics model combined with clinical and radiographic features for discriminating peripheral small cell lung cancer from peripheral lung adenocarcinoma. Front Oncol 2023; 13:1157891. [PMID: 37020864 PMCID: PMC10069670 DOI: 10.3389/fonc.2023.1157891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/06/2023] [Indexed: 04/07/2023] Open
Abstract
Purpose Exploring a non-invasive method to accurately differentiate peripheral small cell lung cancer (PSCLC) and peripheral lung adenocarcinoma (PADC) could improve clinical decision-making and prognosis. Methods This retrospective study reviewed the clinicopathological and imaging data of lung cancer patients between October 2017 and March 2022. A total of 240 patients were enrolled in this study, including 80 cases diagnosed with PSCLC and 160 with PADC. All patients were randomized in a seven-to-three ratio into the training and validation datasets (170 vs. 70, respectively). The least absolute shrinkage and selection operator regression was employed to generate radiomics features and univariate analysis, followed by multivariate logistic regression to select significant clinical and radiographic factors to generate four models: clinical, radiomics, clinical-radiographic, and clinical-radiographic-radiomics (comprehensive). The Delong test was to compare areas under the receiver operating characteristic curves (AUCs) in the models. Results Five clinical-radiographic features and twenty-three selected radiomics features differed significantly in the identification of PSCLC and PADC. The clinical, radiomics, clinical-radiographic and comprehensive models demonstrated AUCs of 0.8960, 0.8356, 0.9396, and 0.9671 in the validation set, with the comprehensive model having better discernment than the clinical model (P=0.036), the radiomics model (P=0.006) and the clinical-radiographic model (P=0.049). Conclusions The proposed model combining clinical data, radiographic characteristics and radiomics features could accurately distinguish PSCLC from PADC, thus providing a potential non-invasive method to help clinicians improve treatment decisions.
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Affiliation(s)
- Jingting Wang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Feiyang Zhong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Feng Xiao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinyang Dong
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yun Long
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Tian Gan
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ting Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Meiyan Liao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Meiyan Liao,
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Mu R, Meng Z, Guo Z, Qin X, Huang G, Yang X, Jin H, Yang P, Deng M, Zhang X, Zhu X. Diagnostic value of dual-layer spectral detector CT in differentiating lung adenocarcinoma from squamous cell carcinoma. Front Oncol 2022; 12:868216. [DOI: 10.3389/fonc.2022.868216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022] Open
Abstract
Background and objectiveThe pathological type of non–small cell lung cancer is considered to be an important factor affecting the treatment and prognosis. The purpose of this study was to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in determining efficacy to distinguish adenocarcinoma (AC) and squamous cell carcinoma (SC), and their combined diagnostic efficacy was also analyzed.MethodsThis is a single-center prospective study, and we collected 70 patients with lung SC and 127 patients with lung AC confirmed by histopathological examination. Morphological parameters, plain scan CT value, biphasic enhanced CT value, and spectral parameters were calculated. The diagnostic efficiency of morphological parameters, spectral parameters, and spectral parameters combined with morphological parameters was obtained by statistical analysis.ResultsIn univariate analysis, seven morphological CT features differed significantly between SC and AC: tumor location (distribution), lobulation, spicule, air bronchogram, vacuole sign, lung atelectasis and/or obstructive pneumonia, and vascular involvement (all p < 0.05). In the arterial phase and the venous phase, the spectral parameters of AC were higher than those of SC (AP-Zeff: 8.07 ± 0.23 vs. 7.85 ± 0.16; AP-ID: 1.41 ± 0.47 vs. 0.94 ± 0.28; AP-NID: 0.13 ± 0.04 vs. 0.09 ± 0.03; AP-λ: 3.42 ± 1.10 vs. 2.33 ± 0.96; VP-Zeff: 8.26 ± 0.23 vs. 7.96 ± 0.16; VP-ID: 1.18 ± 0.51 vs. 1.16 ± 0.30; VP-NID: 0.39 ± 0.13 vs. 0.29 ± 0.08; VP-λ: 4.42 ± 1.28 vs. 2.85 ± 0.72; p < 0.001). When conducting multivariate analysis combining CT features and DLCT parameters with the best diagnostic efficacy, the independent predictors of AC were distribution on peripheral (OR, 4.370; 95% CI, 1.485–12.859; p = 0.007), presence of air bronchogram (OR, 5.339; 95% CI, 1.729–16.484; p = 0.004), and presence of vacuole sign ( OR, 7.330; 95% CI, 1.030–52.184; p = 0.047). Receiver operating characteristic curves of the SC and AC showed that VP-λ had the best diagnostic performance, with an area under the curve (AUC) of 0.864 and sensitivity and specificity rates of 85.8% and 74.3%, respectively; the AUC was increased to 0.946 when morphological parameters were combined, and sensitivity and specificity rates were 89.8% and 87.1%, respectively.ConclusionThe quantitative parameters of the DLCT spectrum are of great value in the diagnosis of SC and AC, and the combination of morphological parameters and spectral parameters is helpful to distinguish SC from AC.
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Fan L, Yang W, Tu W, Zhou X, Zou Q, Zhang H, Feng Y, Liu S. Thoracic Imaging in China: Yesterday, Today, and Tomorrow. J Thorac Imaging 2022; 37:366-373. [PMID: 35980382 PMCID: PMC9592175 DOI: 10.1097/rti.0000000000000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Thoracic imaging has been revolutionized through advances in technology and research around the world, and so has China. Thoracic imaging in China has progressed from anatomic observation to quantitative and functional evaluation, from using traditional approaches to using artificial intelligence. This article will review the past, present, and future of thoracic imaging in China, in an attempt to establish new accepted strategies moving forward.
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Affiliation(s)
- Li Fan
- Second Affiliated Hospital, Naval Medical University
| | - Wenjie Yang
- Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenting Tu
- Second Affiliated Hospital, Naval Medical University
| | - Xiuxiu Zhou
- Second Affiliated Hospital, Naval Medical University
| | - Qin Zou
- Second Affiliated Hospital, Naval Medical University
| | - Hanxiao Zhang
- Second Affiliated Hospital, Naval Medical University
| | - Yan Feng
- Second Affiliated Hospital, Naval Medical University
| | - Shiyuan Liu
- Second Affiliated Hospital, Naval Medical University
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Ma C, Xu D, Hui Q, Gao X, Peng M. Quantitative Intracerebral Iodine Extravasation in Risk Stratification for Intracranial Hemorrhage in Patients with Acute Ischemic Stroke. AJNR Am J Neuroradiol 2022; 43:1589-1596. [PMID: 36202552 PMCID: PMC9731239 DOI: 10.3174/ajnr.a7671] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage poses a severe threat to the outcomes in patients with postthrombectomy acute stroke. We aimed to compare the absolute intracerebral iodine concentration and normalized iodine concentration ratio in predicting intracerebral hemorrhage in patients postthrombectomy. MATERIALS AND METHODS Patients with acute anterior circulation large-vessel occlusion who underwent mechanical thrombectomy and had successful recanalization were retrospectively included in the study. Dual-energy CT was performed within 1 hour after mechanical thrombectomy. Postprocessing was performed to measure the absolute intracerebral iodine concentration and the normalized iodine concentration ratio. The correlation between the absolute intracerebral iodine concentration and the normalized iodine concentration ratio was analyzed using the Spearman rank correlation coefficient. We compared the area under the receiver operating characteristic curve of the absolute intracerebral iodine concentration and the normalized iodine concentration ratio using the DeLong test. RESULTS We included 138 patients with successful recanalization. Of 43 patients who did not have parenchymal contrast staining on postthrombectomy dual-energy CT, 5 (11.6%) developed intracerebral hemorrhage. Among patients (95/138, 68.8%) with parenchymal contrast staining, 37 (38.9%, 37/95) developed intracerebral hemorrhage. The absolute intracerebral iodine concentration was significantly correlated with the normalized iodine concentration ratio (ρ = 0.807; 95% CI, 0.718-0.867; P < .001). The cutoffs of the normalized iodine concentration ratio and absolute intracerebral iodine concentration for identifying patients with intracerebral hemorrhage development were 222.8%, with a sensitivity of 67.6% and specificity of 76.4%, and 2.7 mg I/mL, with a sensitivity of 75.7% and specificity of 65.5%, respectively. No significant difference was found between the areas under the receiver operating characteristic curve for the absolute intracerebral iodine concentration and the normalized iodine concentration ratio (0.753 versus 0.738) (P = .694). CONCLUSIONS The hemorrhagic transformation predictive power of the normalized iodine concentration ratio is similar to that of the absolute intracerebral iodine concentration in patients with successful recanalization.
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Affiliation(s)
- C Ma
- From the Departments of Radiology (C.M., Q.H., X.G.)
| | | | - Q Hui
- From the Departments of Radiology (C.M., Q.H., X.G.)
| | - X Gao
- From the Departments of Radiology (C.M., Q.H., X.G.)
| | - M Peng
- Neurology (M.P.), Deyang People's Hospital, Deyang, Sichuan, China
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Mu R, Meng Z, Zhang X, Guo Z, Zheng W, Zhuang Z, Zhu X. Parameters of Dual-Layer Spectral Detector CT could be Used to Differentiate Non-Small Cell Lung Cancer from Small Cell Lung Cancer. Curr Med Imaging 2022; 18:1070-1078. [PMID: 35260059 DOI: 10.2174/1573405618666220308105359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Differentiating non-small cell lung cancer (NSCLC) from small cell lung cancer (SCLC) remains a substantial challenge. This study aimed at evaluating the performance of dual-layer spectral detector CT (DLCT) in differentiating NSCLC from SCLC. METHODS Spectral images of 247 cancer patients confirmed by pathology were retrospectively analyzed in both the arterial phase (AP) and the venous phase (VP), which includes 197 cases of NSCLC and 50 cases of SCLC. Effective atomic umber (Z-eff), Spectral CT-Mono Energetic (MonoE [40keV~90keV]), iodine density (ID) and thoracic aorta iodine density (IDaorta) in contrast-enhanced images were calculated and compared between the SCLC and NSCLC subgroups of tumors. Slope of spectral curve (λ, interval of 10 keV) and normalized iodine density (NID) was calculated between the SCLC and NSCLC too. Through statistical analysis, the diagnostic efficiency of each spectral parameter was calculated, and the difference of their efficiency was analyzed. RESULTS Both in NSCLS and SCLC, all parameters in VP were significantly higher than those in AP (p<0.001), except for λ90. There were significant differences in all spectral parameters between NSCLS and SCLC, both in AP and VP (p < 0.001). Except VP-λ90, there was no significant difference in ROC curves of all spectral parameters. VP-NID has the best diagnostic performance with AUC value of 0.917 (95%[CI]: 0.870~0.965), sensitivity and specificity of 92.9%, 80%, and diagnostic threshold of 0.217. CONCLUSION All parameters of DLCT have high diagnostic efficiency in differentiating NSCLC from SCLC except for VP-λ90, and VP-NID has the highest diagnostic efficiency.
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Affiliation(s)
- Ronghua Mu
- Graduate School of Guilin Medical University,541004,China
| | - Zhuoni Meng
- Graduate School of Guilin Medical University,541004,China
| | - Xiaodi Zhang
- Philips (China) Investment Co., Ltd. Chengdu Branch,610000,China
| | - Zixuan Guo
- Graduate School of Guilin Medical University,541004,China
| | - Wei Zheng
- Graduate School of Guilin Medical University,541004,China
| | - Zeyu Zhuang
- Graduate School of Guilin Medical University,541004,China
| | - Xiqi Zhu
- Department of Medical Imaging, Nanxishan Hospital of Guangxi Zhuang Autonomous Region,541004 , China
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Yokoyama K, Oyama J, Tsuchiya J, Karakama J, Tamura K, Inaji M, Tanaka Y, Kobayashi D, Maehara T, Tateishi U. Branch-like enhancement on contrast enhanced MRI is a specific finding of cerebellar lymphoma compared with other pathologies. Sci Rep 2022; 12:3591. [PMID: 35246572 PMCID: PMC8897486 DOI: 10.1038/s41598-022-07581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/18/2022] [Indexed: 11/09/2022] Open
Abstract
Branch-like enhancement (BLE) on contrast-enhanced (CE) magnetic resonance imaging (MRI) was found to be effective in differentiating primary central nervous system lymphoma (PCNSL) from high-grade glioma (HGG) in the cerebellum. However, whether it can be applied to assessments of secondary central nervous system lymphoma (SCNSL), or other cerebellar lesions is unknown. Hence, we retrospectively reviewed cerebellar masses to investigate the use of BLE in differentiating cerebellar lymphoma (CL), both primary and secondary, from other lesions. Two reviewers qualitatively evaluated the presence and degree of BLE on CE-T1 weighted imaging (T1WI). If multiple views were available, we determined the view in which BLE was the most visible. Seventy-five patients with the following pathologies were identified:17 patients with CL, 30 patients with metastasis, 12 patients with hemangioblastoma, 9 patients with HGG, and 7 patients with others. Twelve patients presented with PCNSL and five with SCNSL. Of 17 patients with CL, 15 (88%) had BLE, whereas three (5%) out of 58 patients in the non-CL group showed BLE. In patients who underwent three-dimensional-CE-T1WI, BLE was the most visible on the sagittal image. In conclusion, BLE is a highly specific finding for CL and the sagittal image is important in evaluating this finding.
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Affiliation(s)
- Kota Yokoyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Jun Oyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Jun Karakama
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kaoru Tamura
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Kobayashi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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11
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Zhao L, Liu L, Zhao H, Bao J, Dou Y, Yang Z, Lin Y, Sun Z, Meng L, Yan L, Liu A. Therapy response assessment of non-small cell lung cancer using dual-energy computed tomography iodine map. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:111-122. [PMID: 34719473 DOI: 10.3233/xst-210989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate feasibility of the quantitative parameters of dual-energy computed tomography (DECT) to assess therapy response in advanced non-small cell lung cancer (NSCLC) compared with the traditional enhanced CT parameters based on the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. METHODS Forty-five patients with unresectable locally advanced NSCLC who underwent DECT before and after chemotherapy or concurrent chemoradiotherapy (cCRT) were prospectively enrolled. By comparing baseline studies with follow-up, patients were divided into two groups according to RECIST guidelines as follows: disease control (DC, including partial response and stable disease) and progressive disease (PD). The diameter (D), attenuation, iodine concentration and normalized iodine concentration of arterial and venous phases (ICA, ICv, NICA, NICv) and the percentage of these changes pre- and post-therapy were measured and calculated. The Pearson correlation was used to analyze correlation between various quantitative parameters. The receiver operating characteristic (ROC) curves were used to evaluate accuracy of therapy response prediction. RESULTS The change percentages of Attenuation (Δ-Attenuation-A and Δ-Attenuation-V), IC (ΔICA and ΔICV) and NIC (ΔNICA and ΔNICV) pre- and post-therapy correlate with the change percentage of D (ΔD). Among these, ΔICA strongly correlates with ΔD (r = 0.793, P < 0.001). The areas under ROC curves generated using Δ-Attenuation-A, ΔICA, and ΔNICA are 0.796, 0.900, and 0.880 with the corresponding cutoff value of 9.096, -15.692, and -4.7569, respectively, which are significantly different (P < 0.001). CONCLUSIONS The quantitative parameters of DECT iodine map, especially iodine concentration, in arterial phase provides a new quantitative image marker to predict therapy response of patients diagnosed with advanced NSCLC.
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Affiliation(s)
- Lei Zhao
- Department of Radiology, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Lijuan Liu
- Department of Radiology, the Affiliated Beijing Chuiyangliu Hospital of Tsinghua University, Beijing, China
| | - Haiyan Zhao
- Department of Oncology, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Jiaqi Bao
- Department of Oncology, Inner Mongolia People's Hospital, Inner Mongolia, China
| | - Yana Dou
- Department of Scientific Marketing, Siemens Healthineers AG, China
| | - Zhenxing Yang
- Department of Radiology, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Yang Lin
- Department of Scientific Marketing, Siemens Healthineers AG, China
| | - Zhenting Sun
- Department of Radiology, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Lingxin Meng
- Department of Radiology, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Li Yan
- Department of Respiratory, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Aishi Liu
- Department of Radiology, the Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
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12
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Green CA, Solomon JB, Ruchala KJ, Samei E. Design and implementation of a practical quality control program for dual-energy CT. J Appl Clin Med Phys 2021; 22:249-260. [PMID: 34472700 PMCID: PMC8504583 DOI: 10.1002/acm2.13396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 12/16/2022] Open
Abstract
A novel routine dual‐energy computed tomography (DECT) quality control (QC) program was developed to address the current deficiency of routine QC for this technology. The dual‐energy quality control (DEQC) program features (1) a practical phantom with clinically relevant materials and concentrations, (2) a clinically relevant acquisition, reconstruction, and postprocessing protocol, and (3) a fully automated analysis software to extract quantitative data for database storage and trend analysis. The phantom, designed for easy set up for standalone or adjacent imaging next to the ACR phantom, was made in collaboration with an industry partner and informed by clinical needs to have four iodine inserts (0.5, 1, 2, and 5 mg/ml) and one calcium insert (100 mg/ml) equally spaced in a cylindrical water‐equivalent background. The imaging protocol was based on a clinical DECT abdominal protocol capable of producing material specific concentration maps, virtual unenhanced images, and virtual monochromatic images. The QC automated analysis software uses open‐source technologies which integrates well with our current automated CT QC database. The QC program was tested on a GE 750 HD scanner and two Siemens SOMATOM FLASH scanners over a 3‐month period. The automated algorithm correctly identified the appropriate region of interest (ROI) locations and stores measured values in a database for monitoring and trend analysis. Slight variations in protocol settings were noted based on manufacturer. Overall, the project proved to provide a convenient and dependable clinical tool for routine oversight of DE CT imaging within the clinic.
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Affiliation(s)
- Crystal A Green
- Department of Radiology, Clinical Imaging Physics Group, Duke University Medical Center, Durham, North Carolina, USA
| | - Justin B Solomon
- Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Ehsan Samei
- Department of Radiology, Clinical Imaging Physics Group, Carl E. Ravin Advanced Imaging Laboratories, Duke University Medical Center, Durham, North Carolina, USA
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13
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Wen Q, Yue Y, Shang J, Lu X, Gao L, Hou Y. The application of dual-layer spectral detector computed tomography in solitary pulmonary nodule identification. Quant Imaging Med Surg 2021; 11:521-532. [PMID: 33532253 DOI: 10.21037/qims-20-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Differentiating between malignant solitary pulmonary nodules (SPNs) and other lung diseases remains a substantial challenge. The latest generation of dual-energy computed tomography (CT), which realizes dual-energy technology at the detector level, has clinical potential for distinguishing lung cancer from other benign SPNs. This study aimed to evaluate the performance of dual-layer spectral detector CT (SDCT) for the differentiation of SPNs. Methods Spectral images of 135 SPNs confirmed by pathology were retrospectively analyzed in both the arterial phase (AP) and the venous phase (VP). Patients were classified into two groups [the malignant group (n=93) and the benign group (n=42)], with the malignant group further divided into small cell lung cancer (SCLC, n=30) and non-small cell lung cancer (NSCLC, n=63) subtypes. The slope of the spectral Hounsfield Unit (HU) curve (λHU), normalized iodine concentration (NIC), CT values of 40 keV monochromatic images (CT40keV), and normalized arterial enhancement fraction (NAEF) in contrast-enhanced images were calculated and compared between the benign and malignant groups, as well as between the SCLC and NSCLC subgroups. ROC curve analysis was performed to assess the diagnostic performance of the above parameters. Seventy cases were randomly selected and independently measured by two radiologists, and intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to calculate the reliability of the measurements. Results Except for NAEF (P=0.23), the values of the parameters were higher in the malignant group than in the benign group (all P<0.05). NIC, λHU, and CT40keV performed better in the VP (NICVP, λVPHU, and CTVP40keV) (P<0.001), with an area under the ROC curve (AUC) of 0.93, 0.89, and 0.89 respectively. With respective cutoffs of 0.31, 1.83, and 141.00 HU, the accuracy of NICVP, λVPHU, and CTVP40keV was 91.11%, 85.19%, and 88.15%, respectively. In the subgroup differentiating NSCLC and SCLC, the diagnostic performances of NICAP (AUC =0.89) were greater than other parameters. NICAP had an accuracy of 86.02% when the cutoff was 0.14. ICC and Bland-Altman analyses indicated that the measurement of SDCT has great reproducibility. Conclusions Quantitative measures from SDCT can help to differentiate benign from malignant SPNs and may help with the further subclassification of malignant cancer into SCLC and NSCLC.
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Affiliation(s)
- Qingyun Wen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yong Yue
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jin Shang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaomei Lu
- CT Clinical Science, Philips Healthcare, Shenyang, China
| | - Lu Gao
- Department of Radiology, Liaoning Cancer Hospital, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
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14
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Wang X, Liu D, Jiang S, Zeng X, Li L, Yu T, Zhang J. Subjective and Objective Assessment of Monoenergetic and Polyenergetic Images Acquired by Dual-Energy CT in Breast Cancer. Korean J Radiol 2021; 22:502-512. [PMID: 33569928 PMCID: PMC8005343 DOI: 10.3348/kjr.2020.0310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/04/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Objective To objectively and subjectively assess and compare the characteristics of monoenergetic images [MEI (+)] and polyenergetic images (PEI) acquired by dual-energy CT (DECT) of patients with breast cancer. Materials and Methods This retrospective study evaluated the images and data of 42 patients with breast cancer who had undergone dual-phase contrast-enhanced DECT from June to September 2019. One standard PEI, five MEI (+) in 10-kiloelectron volt (keV) intervals (range, 40–80 keV), iodine density (ID) maps, iodine overlay images, and Z effective (Zeff) maps were reconstructed. The contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) were calculated. Multiple quantitative parameters of the malignant breast lesions were compared between the arterial and the venous phase images. Two readers independently assessed lesion conspicuity and performed a morphology analysis. Results Low keV MEI (+) at 40–50 keV showed increased CNR and SNRbreast lesion compared with PEI, especially in the venous phase ([CNR: 40 keV, 20.10; 50 keV, 14.45; vs. PEI, 7.27; p < 0.001], [SNRbreast lesion: 40 keV, 21.01; 50 keV, 16.28; vs. PEI, 10.77; p < 0.001]). Multiple quantitative DECT parameters of malignant breast lesions were higher in the venous phase images than in the arterial phase images (p < 0.001). MEI (+) at 40 keV, ID, and Zeff reconstructions yielded the highest Likert scores for lesion conspicuity. The conspicuity of the mass margin and the visual enhancement were significantly better in 40-keV MEI (+) than in the PEI (p = 0.022, p = 0.033, respectively). Conclusion Compared with PEI, MEI (+) reconstructions at low keV in the venous phase acquired by DECT improved the objective and subjective assessment of lesion conspicuity in patients with malignant breast lesions. MEI (+) reconstruction acquired by DECT may be helpful for the preoperative evaluation of breast cancer.
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Affiliation(s)
- Xiaoxia Wang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Shixi Jiang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Xiangfei Zeng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Lan Li
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Tao Yu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, China.
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15
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Zopfs D, Graffe J, Reimer RP, Schäfer S, Persigehl T, Maintz D, Borggrefe J, Haneder S, Lennartz S, Große Hokamp N. Quantitative distribution of iodinated contrast media in body computed tomography: data from a large reference cohort. Eur Radiol 2020; 31:2340-2348. [PMID: 32997173 PMCID: PMC7979665 DOI: 10.1007/s00330-020-07298-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Dual-energy computed tomography allows for an accurate and reliable quantification of iodine. However, data on physiological distribution of iodine concentration (IC) is still sparse. This study aims to establish guidance for IC in abdominal organs and important anatomical landmarks using a large cohort of individuals without radiological tumor burden. METHODS Five hundred seventy-one oncologic, portal venous phase dual-layer spectral detector CT studies of the chest and abdomen without tumor burden at time point of imaging confirmed by > 3-month follow-up were included. ROI were placed in parenchymatous organs (n = 25), lymph nodes (n = 6), and vessels (n = 3) with a minimum of two measurements per landmark. ROI were placed on conventional images and pasted to iodine maps to retrieve absolute IC. Normalization to the abdominal aorta was conducted to obtain iodine perfusion ratios. Bivariate regression analysis, t tests, and ANOVA with Tukey-Kramer post hoc test were used for statistical analysis. RESULTS Absolute IC showed a broad scatter and varied with body mass index, between different age groups and between the sexes in parenchymatous organs, lymph nodes, and vessels (range 0.0 ± 0.0 mg/ml-6.6 ± 1.3 mg/ml). Unlike absolute IC, iodine perfusion ratios did not show dependency on body mass index; however, significant differences between the sexes and age groups persisted, showing a tendency towards decreased perfusion ratios in elderly patients (e.g., liver 18-44 years/≥ 64 years: 0.50 ± 0.11/0.43 ± 0.10, p ≤ 0.05). CONCLUSIONS Distribution of IC obtained from a large-scale cohort is provided. As significant differences between sexes and age groups were found, this should be taken into account when obtaining quantitative iodine concentrations and applying iodine thresholds. KEY POINTS • Absolute iodine concentration showed a broad variation and differed between body mass index, age groups, and between the sexes in parenchymatous organs, lymph nodes, and vessels. • The iodine perfusion ratios did not show dependency on body mass index while significant differences between sexes and age groups persisted. • Provided guidance values may serve as reference when aiming to differentiate healthy and abnormal tissue based on iodine perfusion ratios.
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Affiliation(s)
- David Zopfs
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Josefine Graffe
- Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Robert Peter Reimer
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | | | - Thorsten Persigehl
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - David Maintz
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Jan Borggrefe
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Stefan Haneder
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - Simon Lennartz
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany.,Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nils Große Hokamp
- University Cologne, Faculty of Medicine and University Hospital Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany.
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