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Liu X, Xu Y, Shu J, Zuo Y, Li Z, Lin M, Li C, Liu Y, Wang X, Zhao Y, Du Z, Wang G, Li W. Preoperative CT and Radiomics Nomograms for Distinguishing Bronchiolar Adenoma and Early-Stage Lung Adenocarcinoma. Acad Radiol 2024:S1076-6332(24)00611-1. [PMID: 39256085 DOI: 10.1016/j.acra.2024.08.047] [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: 04/30/2024] [Revised: 06/26/2024] [Accepted: 08/22/2024] [Indexed: 09/12/2024]
Abstract
RATIONALE AND OBJECTIVES Evaluating the capability of CT nomograms and CT-based radiomics nomograms to differentiate between Bronchiolar Adenoma (BA) and Early-stage Lung Adenocarcinoma (LUAD). MATERIALS AND METHODS In this retrospective study; we analyzed data from 226 patients who were treated at our institution and pathologically confirmed to have either BA or Early-stage LUAD. Patients were randomly divided into a training cohort (n=158) and a testing cohort (n=68). All CT images were independently analyzed and measured by two radiologists using conventional computed tomography. Clinical predictive factors were identified using logistic regression. Multivariable logistic regression analysis was used to construct differential diagnostic models for BA and early-stage LUAD, including traditional CT and radiomics models. The performance of the models was determined based on the area under the receiver operating characteristic curve, discrimination ability, and decision curve analysis (DCA). RESULTS Lesion shape, tumor-lung interface, and pleural retraction signs were identified as independent clinical predictors. The areas under the curve for the CT nomogram, radiomic features, and radiomics nomogram were 0.854, 0.769, and 0.901, respectively. Both the CT nomogram and the radiomics nomogram demonstrated good generalizability in distinguishing between the two entities. DCA indicated that the nomograms achieved a higher net benefit compared to the use of radiomic features alone. CONCLUSION The two preoperative nomograms hold significant value in differentiating between patients with BA and those with Early-stage LUAD, and they contribute to informed clinical treatment decision-making.
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Affiliation(s)
- Xiulan Liu
- Medical school, Kunming University of Science and Technology, Kunming 650500, Yunnan, China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Yanqiong Xu
- Department of Pathology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Jiajia Shu
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Yan Zuo
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Zhi Li
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Meng Lin
- Medical school, Kunming University of Science and Technology, Kunming 650500, Yunnan, China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Chenrong Li
- Medical school, Kunming University of Science and Technology, Kunming 650500, Yunnan, China; Department of MRI, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Yuqi Liu
- Medical school, Kunming University of Science and Technology, Kunming 650500, Yunnan, China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Xianhong Wang
- Medical school, Kunming University of Science and Technology, Kunming 650500, Yunnan, China; Department of MRI, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Ying Zhao
- Medical school, Kunming University of Science and Technology, Kunming 650500, Yunnan, China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Zihong Du
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Gang Wang
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - Wenjia Li
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China.
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Liu X, Xu Y, Wang G, Ma X, Lin M, Zuo Y, Li W. Bronchiolar adenoma/ciliated muconodular papillary tumour: advancing clinical, pathological, and imaging insights for future perspectives. Clin Radiol 2024; 79:85-93. [PMID: 38049359 DOI: 10.1016/j.crad.2023.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/30/2023] [Indexed: 12/06/2023]
Abstract
Bronchiolar adenoma/ciliated muconodular papillary tumour (BA/CMPT) is a benign peripheral lung tumour composed of bilayered bronchiolar-type epithelium containing a continuous basal cell layer; however, the similarities in imaging and tissue biopsy findings at histopathology between BA/CMPT and malignant tumours, including lung adenocarcinoma, pose significant challenges in accurately diagnosing BA/CMPT preoperatively. This difficulty in differentiation often results in misdiagnosis and unnecessary overtreatment. The objective of this article is to provide a comprehensive and systematic review of BA/CMPT, encompassing its clinical manifestations, pathological basis, imaging features, and differential diagnosis. By enhancing healthcare professionals' understanding of this disease, we aim to improve the accuracy of preoperative BA/CMPT diagnosis. This improvement is crucial for the development of appropriate therapeutic strategies and the overall improvement of patient prognosis.
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Affiliation(s)
- X Liu
- Medical School, Kunming University of Science and Technology, Kunming 650500, P.R. China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Y Xu
- Department of Pathology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - G Wang
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - X Ma
- Department of Scientific Research, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China
| | - M Lin
- Medical School, Kunming University of Science and Technology, Kunming 650500, P.R. China; Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China
| | - Y Zuo
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China.
| | - W Li
- Department of Radiology, The First People's Hospital of Yunnan Province, Kunming 650032, Yunnan, China; The Affiliated Hospital of Kunming University of Science and Technology, Kunming 650032, Yunnan, China.
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Liao G, Zhang X. Clinicopathological Analysis of Bronchiolar Adenoma Lined Purely by Mucinous Luminal Cells. Case Rep Pathol 2023; 2023:5566499. [PMID: 37942425 PMCID: PMC10630002 DOI: 10.1155/2023/5566499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/16/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023] Open
Abstract
Bronchiolar adenoma (BA) is a rare lung tumor that has recently been clearly named, including the previous ciliated muconodular papillary tumor (CMPT) and the so-called nonclassical CMPT. The most prominent histological feature of BA is a double-layer cell structure composed of a continuous basal cell layer and a luminal cell layer. BA lined purely by mucinous luminal cells is very rare, and only one case has been reported in the English literature. This type of BA can easily be misdiagnosed as early mucinous adenocarcinoma. This article analyzes the clinicopathological characteristics of a newly discovered case of BA lined purely by mucinous luminal cells and fully integrated with the literatures.
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Affiliation(s)
- Guangjie Liao
- Department of Pathology, Red Cross Hospital of Yulin, Yulin, China
| | - Xinke Zhang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Artificial intelligence in lung cancer: current applications and perspectives. Jpn J Radiol 2023; 41:235-244. [PMID: 36350524 PMCID: PMC9643917 DOI: 10.1007/s11604-022-01359-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/30/2022] [Indexed: 11/10/2022]
Abstract
Artificial intelligence (AI) has been a very active research topic over the last years and thoracic imaging has particularly benefited from the development of AI and in particular deep learning. We have now entered a phase of adopting AI into clinical practice. The objective of this article was to review the current applications and perspectives of AI in thoracic oncology. For pulmonary nodule detection, computer-aided detection (CADe) tools have been commercially available since the early 2000s. The more recent rise of deep learning and the availability of large annotated lung nodule datasets have allowed the development of new CADe tools with fewer false-positive results per examination. Classical machine learning and deep-learning methods were also used for pulmonary nodule segmentation allowing nodule volumetry and pulmonary nodule characterization. For pulmonary nodule characterization, radiomics and deep-learning approaches were used. Data from the National Lung Cancer Screening Trial (NLST) allowed the development of several computer-aided diagnostic (CADx) tools for diagnosing lung cancer on chest computed tomography. Finally, AI has been used as a means to perform virtual biopsies and to predict response to treatment or survival. Thus, many detection, characterization and stratification tools have been proposed, some of which are commercially available.
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Cai YS, Dong HH, Li XY, Ye X, Chen S, Hu B, Li H, Miao JB, Chen QR. Incidence of venous thromboembolism after surgery for adenocarcinoma in situ and the validity of the modified Caprini score: A propensity score-matched study. Front Oncol 2022; 12:976988. [PMID: 36119540 PMCID: PMC9478866 DOI: 10.3389/fonc.2022.976988] [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: 06/24/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Recently, the new World Health Organization (WHO) tumor classification removed adenocarcinoma in situ (AIS) from the diagnosis of lung cancer. However, it remains unclear whether the “malignancy” item should be assessed when the modified Caprini Risk Assessment Model (RAM) is used to assess venous thromboembolism (VTE) risk in AIS. The purpose of our study is to assess differences between AIS and stage IA adenocarcinoma (AD) from a VTE perspective. Methods A retrospective study was performed on AIS and IA adenocarcinoma in our hospital from January 2018 to December 2021, and divided into AIS group and AD group. Propensity score matching (PSM) was used to compare the incidence of VTE and coagulation function, and to analyze whether the RAM is more effective when the “malignancy” item is not evaluated in AIS. Results 491 patients were included after screening, including 104 patients in the AIS group and 387 patients in the AD group. After PSM, 83 patients were matched. The incidence of VTE and D-dimer in the AIS group was significantly lower than that in the AD group (P<0.05).When using the RAM to score AIS, compared with retaining the “malignancy” item, the incidence of VTE in the intermediate-high-risk group was significantly higher after removing the item (7.9% vs. 36.4%, P=0.018), which significantly improved the stratification effect of the model. Conclusions The incidence of postoperative VTE in AIS was significantly lower than that in stage IA adenocarcinoma. The stratification effect was more favorable when the “malignancy” item was not evaluated in AIS using the RAM.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Qi-rui Chen
- *Correspondence: Jin-bai Miao, ; Qi-rui Chen,
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Du Y, Wang ZY, Zheng Z, Li YX, Wang XY, Du R. Bronchiolar adenoma with unusual presentation: Two case reports. World J Clin Cases 2022; 10:4541-4549. [PMID: 35663079 PMCID: PMC9125294 DOI: 10.12998/wjcc.v10.i14.4541] [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] [Received: 08/30/2021] [Revised: 12/03/2021] [Accepted: 03/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The clinicopathological features, immunohistochemical characteristics, and genetic mutation profile of two unusual cases of distal bronchiolar adenoma are retrospectively analyzed and the relevant literature is reviewed. CASE SUMMARY Case 1 was a 63-year-old female patient who had a mixed ground-glass nodule, with mild cells in morphology, visible cilia, and bilayer structures in focal areas. Immunohistochemical staining for P63 and cytokeratin (CK)5/6 revealed the lack of a continuous bilayer structure in most areas, and no mutations were found in epidermal growth factor receptor, anaplastic lymphoma kinase, ROS1, Kirsten rat sarcoma, PIK3CA, BRAF, human epidermal growth factor receptor-2 (HER2), RET, and neuroblastoma RAS genes. Case 2 was a 58-year-old female patient who presented with a solid nodule, in which most cells were observed to be medium sized, the nuclear chromatin was pale and homogeneous, local cells had atypia, and cilia were found locally. Immunohistochemical staining for P63 and CK5/6 showed no expression of these proteins in mild cell morphology whereas the heteromorphic cells showed a bilayer structure. The same nine genes as above were analyzed, and HER2 gene mutation was identified. CONCLUSION Some unresolved questions remain to be answered to determine whether the lesion is a benign adenoma or a part of the process of malignant transformation from benign adenoma of the bronchial epithelium. Furthermore, whether lesions with atypical bilayer structures are similar to atypical hyperplastic lesions of the breast remains to be elucidated. Moreover, clarity on whether these lesions can be called atypical bronchiolar adenoma and whether they are invasive precursor lesions is needed. Future studies should examine the diagnostic significance of HER2 gene mutation as a prognostic indicator.
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Affiliation(s)
- Ying Du
- Department of Pathology, The Affiliated Hospital of Shandong First Medical University (Liaocheng People’s Hospital), Liaocheng 252000, Shandong Province, China
| | - Zheng-Yan Wang
- Department of Pathology, The Affiliated Hospital of Shandong First Medical University (Liaocheng People’s Hospital), Liaocheng 252000, Shandong Province, China
| | - Zheng Zheng
- Department of Pathology, The Affiliated Hospital of Shandong First Medical University (Liaocheng People’s Hospital), Liaocheng 252000, Shandong Province, China
| | - Ying-Xue Li
- Department of Pathology, The Affiliated Hospital of Shandong First Medical University (Liaocheng People’s Hospital), Liaocheng 252000, Shandong Province, China
| | - Xiu-Yu Wang
- Department of Pathology, The Affiliated Hospital of Shandong First Medical University (Liaocheng People’s Hospital), Liaocheng 252000, Shandong Province, China
| | - Ran Du
- Department of Pathology, The Affiliated Hospital of Shandong First Medical University (Liaocheng People’s Hospital), Liaocheng 252000, Shandong Province, China
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Krishnamurthy K, Kochiyil J, Alghamdi S, Poppiti R. Bronchiolar adenomas (BA) - A detailed radio-pathologic analysis of six cases and review of literature. Ann Diagn Pathol 2021; 55:151837. [PMID: 34626934 DOI: 10.1016/j.anndiagpath.2021.151837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/12/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
Bronchiolar adenomas (BAs)/ciliated muco-nodular papillary tumors (CMPTs), are small, peripheral lung nodules arising predominantly in the elderly that follow a benign course. They can be mistaken for adenocarcinomas on frozen section. Immunohistochemistry (IHC) for basal cell markers highlights the continuous layer of basal cells underlying the tumor cells in BAs. BAs are further subdivided into proximal-type and distal type. Six BAs were retrieved from the pathology archives. The cases were classified based on morphology into proximal and distal BAs. The clinical and radiological features were reviewed. Immunohistochemistry and special stains were performed. The most common radiological picture of BA/CMPT was of a solid nodule with SUVmax < 3 as seen in 60% cases. 40% cases showed cavitation on CT. On histological examination, four cases were morphologically classified as proximal BAs and two as distal BAs. In proximal BAs, TTF1 was focally positive only in the basal cells in three of four. The mucin stained acidic. In distal BAs, TTF1 was diffusely positive in both basal and luminal cells. There was scant intracellular neutral mucin. Both the distal BAs had concomitant neuroendocrine tumors in the same lobe. Though the number of cases evaluated in this study is too low to be statistically significant, this study provides additional evidence to the concept of BA classification based on site specific histology and supplementary immunohistochemistry and reiterates the radiological features that may help distinguish it from malignant lesions.
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Affiliation(s)
- Kritika Krishnamurthy
- A.M. Rywlin, MD Department of Pathology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA.
| | - Jyotsna Kochiyil
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA
| | - Sarah Alghamdi
- A.M. Rywlin, MD Department of Pathology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA; Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
| | - Robert Poppiti
- A.M. Rywlin, MD Department of Pathology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA; Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA
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Iguchi T, Hiraki T, Matsui Y, Tomita K, Uka M, Tanaka T, Munetomo K, Gobara H, Kanazawa S. CT-guided biopsy of lung nodules with pleural contact: Comparison of two puncture routes. Diagn Interv Imaging 2021; 102:539-544. [PMID: 34099434 DOI: 10.1016/j.diii.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively compare two puncture routes (transpleural vs. transpulmonary) for computed tomography (CT) fluoroscopy-guided cutting needle biopsy of lung nodules with pleural contact. PATIENTS AND METHODS A total of 102 patients (72 men; mean age, 71.1±9.5 [SD] years) were included and 102 biopsies of 102 lung nodules (mean size, 16.7±5.9 [SD] mm; range, 6.0-29.4mm; mean length of pleural contact, 10.1±4.2 [SD] mm; range, 2.8-19.6mm) were analyzed. All procedures were classified as biopsies via the direct transpleural route or the transpulmonary route. The patient-, lesion-, and biopsy-related variables, diagnostic yields, and incidence of complications were compared between the two routes. RESULTS Biopsy was performed via the direct transpleural route (n=59; 57.8%) and transpulmonary route (n=43; 42.2%). In the transpulmonary route group, the mean distance of the intrapulmonary pathway was 17.7±9.4 [SD] mm (range: 4.1-47.6mm; P<0.001) and the introducer needle trajectory angle of<45° was significantly observed (8.5% [5/59] vs. 60.5% [26/43]; P<0.001). There was no significant difference in diagnostic accuracy between the direct transpleural and transpulmonary routes (93.2% [55/59] vs. 90.7% [39/43]; P=0.718). The frequencies of all complications (64.4% [38/59] vs. 97.7% [42/43]; P<0.001), pneumothorax (33.9% [20/59] vs. 65.1% [28/43]; P=0.003), pneumothorax with chest tube placement (3.4% [2/59] vs. 18.6% [8/43]; P=0.016), and pulmonary hemorrhage (47.5% [28/59] vs. 76.7% [33/43]; P=0.004) were significantly lower in the direct transpleural group. CONCLUSION Direct transpleural route is recommended for CT fluoroscopy-guided biopsy of lung nodules with pleural contact because it is safer and yields similar diagnostic accuracy than transpulmonary route.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Takashi Tanaka
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho kita-ku, 700-8558 Okayama, Japan
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Sun J, Liu K, Tong H, Liu H, Li X, Luo Y, Li Y, Yao Y, Jin R, Fang J, Chen X. CT Texture Analysis for Differentiating Bronchiolar Adenoma, Adenocarcinoma In Situ, and Minimally Invasive Adenocarcinoma of the Lung. Front Oncol 2021; 11:634564. [PMID: 33981603 PMCID: PMC8109050 DOI: 10.3389/fonc.2021.634564] [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: 11/30/2020] [Accepted: 02/22/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study aimed to investigate the potential of computed tomography (CT) imaging features and texture analysis to distinguish bronchiolar adenoma (BA) from adenocarcinoma in situ (AIS)/minimally invasive adenocarcinoma (MIA). Materials and Methods: Fifteen patients with BA, 38 patients with AIS, and 36 patients with MIA were included in this study. Clinical data and CT imaging features of the three lesions were evaluated. Texture features were extracted from the thin-section unenhanced CT images using Artificial Intelligence Kit software. Then, multivariate logistic regression analysis based on selected texture features was employed to distinguish BA from AIS/MIA. Receiver operating characteristics curves were performed to determine the diagnostic performance of the features. Results: By comparison with AIS/MIA, significantly different CT imaging features of BA included nodule type, tumor size, and pseudo-cavitation sign. Among them, pseudo-cavitation sign had a moderate diagnostic value for distinguishing BA and AIS/MIA (AUC: 0.741 and 0.708, respectively). Further, a total of 396 quantitative texture features were extracted. After comparation, the top six texture features showing the most significant difference between BA and AIS or MIA were chosen. The ROC results showed that these key texture features had a high diagnostic value for differentiating BA from AIS or MIA, among which the value of a comprehensive model with six selected texture features was the highest (AUC: 0.977 or 0.976, respectively) for BA and AIS or MIA. These results indicated that texture analyses can effectively improve the efficacy of thin-section unenhanced CT for discriminating BA from AIS/MIA. Conclusion: CT texture analysis can effectively improve the efficacy of thin-section unenhanced CT for discriminating BA from AIS/MIA, which has a potential clinical value and helps pathologist and clinicians to make diagnostic and therapeutic strategies.
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Affiliation(s)
- Jinju Sun
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Kaijun Liu
- Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Haipeng Tong
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | | | - Xiaoguang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yi Luo
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Li
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Yun Yao
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Rongbing Jin
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China.,Chongqing Clinical Research Center for Imaging and Nuclear Medicine, Chongqing, China
| | - Xiao Chen
- Department of Nuclear Medicine, Daping Hospital, Army Medical University, Chongqing, China.,Chongqing Clinical Research Center for Imaging and Nuclear Medicine, Chongqing, China
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Feasibility of lung imaging with a large field-of-view spectral photon-counting CT system. Diagn Interv Imaging 2021; 102:305-312. [PMID: 33610503 DOI: 10.1016/j.diii.2021.01.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to characterize the technical capabilities and feasibility of a large field-of-view clinical spectral photon-counting computed tomography (SPCCT) prototype for high-resolution (HR) lung imaging. MATERIALS AND METHODS Measurement of modulation transfer function (MTF) and acquisition of a line pairs phantom were performed. An anthropomorphic lung nodule phantom was scanned with standard (120kVp, 62mAs), low (120kVp, 11mAs), and ultra-low (80kVp, 3mAs) radiation doses. A human volunteer underwent standard (120kVp, 63mAs) and low (120kVp, 11mAs) dose scans after approval by the ethics committee. HR images were reconstructed with 1024 matrix, 300mm field of view and 0.25mm slice thickness using a filtered-back projection (FBP) and two levels of iterative reconstruction (iDose 5 and 9). The conspicuity and sharpness of various lung structures (distal airways, vessels, fissures and proximal bronchial wall), image noise, and overall image quality were independently analyzed by three radiologists and compared to a previous HR lung CT examination of the same volunteer performed with a conventional CT equipped with energy integrating detectors (120kVp, 10mAs, FBP). RESULTS Ten percent MTF was measured at 22.3lp/cm with a cut-off at 31lp/cm. Up to 28lp/cm were depicted. While mixed and solid nodules were easily depicted on standard and low-dose phantom images, higher iDose levels and slice thicknesses (1mm) were needed to visualize ground-glass components on ultra-low-dose images. Standard dose SPCCT images of in vivo lung structures were of greater conspicuity and sharpness, with greater overall image quality, and similar image noise (despite a flux reduction of 23%) to conventional CT images. Low-dose SPCCT images were of greater or similar conspicuity and sharpness, similar overall image quality, and lower but acceptable image noise (despite a flux reduction of 89%). CONCLUSIONS A large field-of-view SPCCT prototype demonstrates HR technical capabilities and high image quality for high resolution lung CT in human.
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Aissaoui M, Lupo A, Coriat R, Terris B, Bennani S, Chassagnon G, Revel MP. CT features of lung metastases from pancreatic adenocarcinoma: Correlation with histopathologic findings. Diagn Interv Imaging 2020; 102:371-377. [PMID: 33358342 DOI: 10.1016/j.diii.2020.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the prevalence of an atypical, alveolar presentation of pulmonary metastases from pancreatic adenocarcinoma (PDAC) on computed tomography (CT) and to correlate CT features with those obtained at histopathologic analysis. MATERIAL AND METHODS A total of 76 patients with lung metastases from PDAC over a 10-year period (2009-2019) in a French university hospital were retrospectively included. There were 34 men and 42 women with a mean age of 67.6±11.3 (SD) years (range: 38-89 years). CT features of PDAC were classified according to their presentations as usual metastatic pattern or atypical alveolar pattern; the atypical alveolar pattern corresponding to either ground glass nodules or opacities, solid nodules with a halo sign, "air-space" nodules with air bronchogram, or parenchymal consolidation. Imaging-histopathologic correlation was performed when tissue samples were available. RESULTS Pulmonary metastases were synchronous in 36 patients (36/76; 47%) and metachronous in 40 patients (40/76; 53%). A predominant alveolar presentation on CT was observed in 17 patients (17/76, 22%). Nodules with halo sign were the predominant alveolar pattern in 7 patients (7/17; 41%), air-space nodules were predominant in 4 patients (4/17; 24%) whereas pure ground glass nodules and consolidations were observed as predominant features in 3 patients (3/17; 18%) each. For 5 patients who had histopathological confirmation, alveolar metastases of PDAC were characterized by columnar tumor cells lining the alveolar wall, which was not seen in other radiological presentations, whereas there were no differences regarding mucin secretion between pulmonary metastases with alveolar presentation and those with typical pattern. CONCLUSIONS Lung metastases from PDAC may present with a so-called "alveolar" pattern on CT. This misleading CT features is found in 22% of patients with lung metastases from PDAC and is due to lepidic growth of the metastatic cells.
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Affiliation(s)
- Mathilde Aissaoui
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France.
| | - Audrey Lupo
- Université de Paris, 75006 Paris, France; Department of Pathology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Romain Coriat
- Université de Paris, 75006 Paris, France; Department of Gastroenterology and Digestive Oncology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Benoit Terris
- Université de Paris, 75006 Paris, France; Department of Pathology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Souhail Bennani
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université de Paris, 75006 Paris, France
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