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Mu J, Huang J, Ao M, Li W, Jiang L, Yang L. Advances in diagnosis and prediction for aggression of pure solid T1 lung cancer. PRECISION CLINICAL MEDICINE 2023; 6:pbad020. [PMID: 38025970 PMCID: PMC10680022 DOI: 10.1093/pcmedi/pbad020] [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: 06/08/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
A growing number of early-stage lung cancers presenting as malignant pulmonary nodules have been diagnosed because of the increased adoption of low-dose spiral computed tomography. But pure solid T1 lung cancer with ≤3 cm in the greatest dimension is not always at an early stage, despite its small size. This type of cancer can be highly aggressive and is associated with pathological involvement, metastasis, postoperative relapse, and even death. However, it is easily misdiagnosed or delay diagnosed in clinics and thus poses a serious threat to human health. The percentage of nodal or extrathoracic metastases has been reported to be >20% in T1 lung cancer. As such, understanding and identifying the aggressive characteristics of pure solid T1 lung cancer is crucial for prevention, diagnosis, and therapeutic strategies, and beneficial to improving the prognosis. With the widespread of lung cancer screening, these highly invasive pure solid T1 lung cancer will become the main advanced lung cancer in future. However, there is limited information regarding precision medicine on how to identify these "early-stage" aggressive lung cancers. To provide clinicians with new insights into early recognition and intervention of the highly invasive pure solid T1 lung cancer, this review summarizes its clinical characteristics, imaging, pathology, gene alterations, immune microenvironment, multi-omics, and current techniques for diagnosis and prediction.
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Affiliation(s)
- Junhao Mu
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jing Huang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Min Ao
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Weiyi Li
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Li Jiang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Li Yang
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Intratumoral and peritumoral radiomics nomograms for the preoperative prediction of lymphovascular invasion and overall survival in non-small cell lung cancer. Eur Radiol 2023; 33:947-958. [PMID: 36064979 DOI: 10.1007/s00330-022-09109-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/03/2022] [Accepted: 07/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To evaluate the predictive value of intratumoral and peritumoral radiomics and radiomics nomogram for preoperative lymphovascular invasion (LVI) status and overall survival (OS) in patients with non-small cell lung cancer (NSCLC). METHODS In total, 240 NSCLC patients from our institution were randomly divided into the training cohort (n = 145) and internal validation cohort (n = 95) with a ratio of 6:4, and 65 patients from the Cancer Imaging Archive were enrolled as the external validation cohort. We extracted 1217 CT-based radiomics features from the gross tumor volume (GTV) and gross tumor volume incorporating peritumoral 3, 6, and 9 mm regions (GPTV3, GPTV6, GPTV9). A radiomics nomogram based on clinical independent predictors and radiomics score (Radscore) of the best radiomics model was constructed. The correlation between factors and OS was evaluated with the Kaplan-Meier survival analysis and Cox proportional hazards regression analysis. RESULTS Compared with GTV, GPTV3, and GPTV6 radiomics models, GPTV9 radiomics model exhibited better prediction performance with the AUCs of 0.82, 0.75, and 0.67 in the training, internal validation, and external validation cohorts, respectively. In the clinical model, smoking and clinical stage were independent predictors. The nomogram incorporating independent predictors and GPTV9-Radscore was clinically useful, with the AUCs of 0.89, 0.83, and 0.66 in three cohorts. Pathological LVI, GPTV9-Radscore-predicted, and Nomoscore-predicted LVI were associated with poor OS (p < 0.05). CONCLUSIONS CT-based radiomics nomogram can predict LVI and OS in patients with NSCLC and may help in making personalized treatment strategies before surgery. KEY POINTS • Compared with GTV, GPTV3, and GPTV6 radiomics models, GPTV9 radiomics model showed better prediction performance for LVI status in NSCLC. • The radiomics nomogram based on GPTV9 radiomics features and clinical independent predictors could effectively predict LVI status and OS in NSCLC and outperformed the clinical model. • The radiomics nomogram had a wider scope of clinical application.
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Dual-energy CT iodine map in predicting the efficacy of neoadjuvant chemotherapy for hypopharyngeal carcinoma: a preliminary study. Sci Rep 2022; 12:21356. [PMID: 36494378 PMCID: PMC9734148 DOI: 10.1038/s41598-022-25828-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Neoadjuvant chemotherapy has become one of the important means for advanced hypopharyngeal carcinoma. So far, there is no effective index to predict the curative effect. To investigate the value of iodine map of dual-energy computed tomography (CT) in predicting the efficacy of neoadjuvant chemotherapy for hypopharyngeal carcinoma. A total of 54 hypopharyngeal carcinomapatients who underwent two courses of TPF neoadjuvant chemotherapy were recruited in this study. Three cases had a complete response (CR), thirty-six cases had a partial response (PR), eleven cases had stable disease (SD), and four cases had a progressive disease (PD) after the chemotherapy. All patients underwent a dual-source CT scan before chemotherapy and rescanned after chemotherapy. The normalized iodine-related attenuation (NIRA) of the mean of maximum slice and most enhanced region of lesion at arterial and parenchymal phase were measured: NIRAmean-A, NIRAmax-A, NIRAmean-P, and NIRAmax-P, respectively. Correlation analysis was conducted between different metrics of NIRA and the diameter change rate of lesions, and the curative effect was evaluated based on the receiver operating characteristic (ROC) curve. There were a significant correlation between NIRAmean-A, NIRAmax-A, NIRAmean-P, NIRAmax-P and the change rate of lesion's maximum diameter (ΔD%) (all P < 0.01). The NIRAmax-A, NIRAmean-P, NIRAmax-P had significant differences between CR, PR, SD, PD groups, but NIRAmean-A did not reach a significant difference. All NIRAmean-A, NIRAmax-A, NIRAmean-P, NIRAmax-P had significant differences between effective (CR + PR) and ineffective (SD + PD) groups. The ROC analysis revealed that NIRAmean-P had the largest AUC and prediction efficacy (AUC = 0.809). Dual-energy CT iodine map could predict the efficacy of neoadjuvant chemotherapy and provides imaging evidence to assist in treatment decisions for hypopharyngeal carcinoma patients.
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Martin SS, Muscogiuri E, Burchett PF, van Assen M, Tessarin G, Vogl TJ, Schoepf UJ, De Cecco CN. Tumorous tissue characterization using integrated 18F-FDG PET/dual-energy CT in lung cancer: Combining iodine enhancement and glycolytic activity. Eur J Radiol 2021; 150:110116. [PMID: 34996651 DOI: 10.1016/j.ejrad.2021.110116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/03/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has become the method of choice for tumor staging in lung cancer patients with improved diagnostic accuracy for the evaluation of lymph node involvement and distant metastasis. Due to its spectral capabilities, dual-energy CT (DECT) employs a material decomposition algorithm enabling precise quantification of iodine concentrations in distinct tissues. This technique enhances the characterization of tumor blood supply and has demonstrated promising results for the assessment of therapy response in patients with lung cancer. Several studies have demonstrated that DECT provides additional value to the PET-based evaluation of glycolytic activity, especially for the evaluation of therapy response and follow-up of patients with lung cancer. The combination of PET and DECT in a single scanner system enables the simultaneous assessment of glycolytic activity and iodine enhancement, offering further insight to the characterization of tumorous tissues. Recently a new approach of a novel integrated PET/DECT was investigated in a pilot study on patients with non-small cell lung cancer (NSCLC). The study showed a moderate correlation between PET-based standard uptake values (SUV) and DECT-based iodine densities in the evaluation of lung tumorous tissue but with limited assessment of lymph nodes. The following review on tumorous tissue characterization using PET and DECT imaging describes the strengths and limitations of this novel technique.
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Affiliation(s)
- Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Emanuele Muscogiuri
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA; Institute of Radiology, University of Rome "Sapienza", Rome, Italy
| | - Philip F Burchett
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Marly van Assen
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Giovanni Tessarin
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA; Department of Medicine-DIMED, Institute of Radiology, University of Padova, Italy
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Carlo N De Cecco
- Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA.
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Kruis MF. Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual-energy CT. J Appl Clin Med Phys 2021; 23:e13468. [PMID: 34743405 PMCID: PMC8803285 DOI: 10.1002/acm2.13468] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 12/11/2022] Open
Abstract
Over the past decade, spectral or dual‐energy CT has gained relevancy, especially in oncological radiology. Nonetheless, its use in the radiotherapy (RT) clinic remains limited. This review article aims to give an overview of the current state of spectral CT and to explore opportunities for applications in RT. In this article, three groups of benefits of spectral CT over conventional CT in RT are recognized. Firstly, spectral CT provides more information of physical properties of the body, which can improve dose calculation. Furthermore, it improves the visibility of tumors, for a wide variety of malignancies as well as organs‐at‐risk OARs, which could reduce treatment uncertainty. And finally, spectral CT provides quantitative physiological information, which can be used to personalize and quantify treatment.
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Kupik O, Metin Y, Eren G, Orhan Metin N, Arpa M. A comparison study of dual-energy spectral CT and 18F-FDG PET/CT in primary tumors and lymph nodes of lung cancer. ACTA ACUST UNITED AC 2021; 27:275-282. [PMID: 33455897 DOI: 10.5152/dir.2021.20016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to investigate whether there is a correlation between dual-energy spectral computed tomography (DESCT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters in primary tumor and metastatic lymph nodes in patients with newly diagnosed lung cancer. METHODS Primary tumor and metastatic lymph nodes of 68 patients diagnosed with lung cancer were evaluated retrospectively with 18F-FDG PET/CT and DESCT imaging. The histologic subtypes were adenocarcinoma (n=29), squamous cell carcinoma (SCC) (n=26), small cell lung cancer (SCLC) (n=11), and large cell neuroendocrine cancer (LCNEC) (n=2). In terms of PET parameters, SUVmax, SUVmean, SULmax, SULmean, SULpeak, and normalized SUL values were obtained for primary tumors and metastatic lymph nodes. In terms of DESCT parameters, maximum and mean iodine content (IC), normalized IC values, iodine enhancement (IE) and normalized IE values were calculated. RESULTS We found no correlation between DESCT and 18F-FDG PET/CT parameters in primary tumors and metastatic lymph nodes. In addition, no correlation was found in the analysis performed in any of the histologic subgroups. In patients with a primary tumor <3 cm, there was a moderate negative correlation between the parameters SUVmax-ICmax (r= -0.456, p = 0.043), SUVmean-ICmax (r= -0.464, p = 0.039) SULmean-ICmax (r= -0.497, p = 0.026), SUVmax-ICmean (r= -0.527, p = 0.020), SULmean-ICmean (r= -0.499, p = 0.025), and SULpeak-ICmean (r= -0.488, p = 0.029). CONCLUSION We consider that DESCT and 18F-FDG PET/CT indicate different characteristics of the tumors and should not supersede each other.
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Affiliation(s)
- Osman Kupik
- Department of Nuclear Medicine Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Yavuz Metin
- Department of Radiology, Ankara University School of Medicine, Ibni Sina Hospital, Ankara, Turkey
| | - Gülnihan Eren
- Department of Radiation Oncology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Nurgul Orhan Metin
- Department of Radiology, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Medeni Arpa
- Department of Biochemistry, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
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Iwano S, Kamiya S, Ito R, Nakamura S, Naganawa S. Iodine-related attenuation in contrast-enhanced dual-energy computed tomography in small-sized solid-type lung cancers is associated with the postoperative prognosis. Cancer Imaging 2021; 21:7. [PMID: 33413669 PMCID: PMC7791656 DOI: 10.1186/s40644-020-00368-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023] Open
Abstract
Background To investigate the correlation between iodine-related attenuation in contrast-enhanced dual-energy computed tomography (DE-CT) and the postoperative prognosis of surgically resected solid-type small-sized lung cancers. Methods We retrospectively reviewed the DE-CT findings and postoperative course of solid-type lung cancers ≤3 cm in diameter. After injection of iodinated contrast media, arterial phases were scanned using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation (3D-IRA) of primary tumors at the arterial phase was computed using the “lung nodule” application software. The corrected 3D-IRA normalized to the patient’s body weight and contrast medium concentration was then calculated. Results A total of 120 resected solid-type lung cancers ≤3 cm in diameter were selected for analysis (82 males and 38 females; mean age, 67 years). During the observation period (median, 47 months), 32 patients showed postoperative recurrence. Recurrent tumors had significantly lower 3D-IRA and corrected 3D-IRA at early phase compared to non-recurrent tumors (p = 0.046 and p = 0.027, respectively). The area under the receiver operating characteristic curve for postoperative recurrence was 0.624 for the corrected 3D-IRA at early phase (p = 0.025), and the cutoff value was 5.88. Kaplan–Meier curves for disease-free survival indicated that patients showing tumors with 3D-IRA > 5.88 had a significantly better prognosis than those with tumors showing 3D-IRA < 5.88 (p = 0.017). Conclusions The 3D-IRA of small-sized solid-type lung cancers on contrast-enhanced DE-CT was significantly associated with postoperative prognosis, and low 3D-IRA tumors showed a higher TNM stage and a significantly poorer prognosis.
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Affiliation(s)
- Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Shinichiro Kamiya
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Di Felice C, Kikano EG, Young B, Gupta A. Indeterminate pulmonary nodule in lung allograft characterized using dual-energy computed tomography. Radiol Case Rep 2021; 16:132-135. [PMID: 33224399 PMCID: PMC7666370 DOI: 10.1016/j.radcr.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022] Open
Abstract
Pulmonary nodules (PNs) arising in the lung transplant recipient pose a diagnostic challenge for providers. Conventional computed tomography (CT) has improved our ability to detect PNs in this population, but establishing a confident diagnosis with imaging alone remains difficult. Dual-energy spectral detector CT is a novel, emerging technology that provides insight into the radiographic behavior of PNs, and has potential in differentiating benign from malignant morphologies. Herein, we report a case of a PN in a lung transplant recipient whose initial diagnostic work-up was inconclusive, but then had the diagnosis rendered using a spectral detector CT.
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Affiliation(s)
- Christopher Di Felice
- Department of Pulmonary and Critical Care Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Elias George Kikano
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Benjamin Young
- Department of Pulmonary and Critical Care Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Amit Gupta
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH 44106, USA
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Cicero G, Ascenti G, Albrecht MH, Blandino A, Cavallaro M, D'Angelo T, Carerj ML, Vogl TJ, Mazziotti S. Extra-abdominal dual-energy CT applications: a comprehensive overview. Radiol Med 2020; 125:384-397. [PMID: 31925704 DOI: 10.1007/s11547-019-01126-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
Abstract
Unlike conventional computed tomography, dual-energy computed tomography is a relatively novel technique that exploits ionizing radiations at different energy levels. The separate radiation sets can be achieved through different technologies, such as dual source, dual layers or rapid switching voltage. Body tissue molecules vary for their specific atomic numbers and electron density, and the interaction with different sets of radiations results in different attenuations, allowing to their final distinction. In particular, iodine recognition and quantification have led to important information about intravenous contrast medium delivery within the body. Over the years, useful post-processing algorithms have also been validated for improving tissue characterization. For instance, contrast resolution improvement and metal artifact reduction can be obtained through virtual monoenergetic images, dose reduction by virtual non-contrast reconstructions and iodine distribution highlighting through iodine overlay maps. Beyond the evaluation of the abdominal organs, dual-energy computed tomography has also been successfully employed in other anatomical districts. Although lung perfusion is one of the most investigated, this evaluation has been extended to narrowly fields of application, such as musculoskeletal, head and neck, vascular and cardiac. The potential pool of information provided by dual-energy technology is already wide and not completely explored, yet. Therefore, its performance continues to raise increasing interest from both radiologists and clinicians.
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Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.
| | - Giorgio Ascenti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Moritz H Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Alfredo Blandino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Marco Cavallaro
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy.,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Maria Ludovica Carerj
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, 98100, Messina, Italy
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Kawaguchi K, Fukui T, Goto M, Nakamura S, Hakiri S, Ozeki N, Kato T, Mori S, Hashimoto K, Iwano S, Yokoi K. Evaluation of intra-tumoral blood feeding to predict the effect of induction therapy in patients with locally advanced lung cancer. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:291-301. [PMID: 31239597 PMCID: PMC6556454 DOI: 10.18999/nagjms.81.2.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There is little known about predictors of the effects of induction therapy in locally advanced lung cancer, including superior sulcus tumors. We analyzed whether intra-tumoral blood feeding could predict a pathologic complete response (pCR). Patients who underwent induction therapy followed by surgery for locally advanced lung cancer were retrospectively reviewed. The intra-tumoral blood feeding was defined by the CT value (HU, Hounsfield unit), which was calculated by subtracting the non-enhanced value from the contrast-enhanced value (divided into the early and delayed phase) at the maximum diameter of the tumor on dynamic CT. The cases were classified, according to the efficacy of induction therapy, into the pCR and residual tumor (pRT) group. There were 38 cases of T3 and 12 of T4; the induction therapy consisted of chemoradiotherapy in 39 patients, chemotherapy in 6, and radiotherapy in 5. A pCR was obtained in 15 (30%) patients. The mean CT values of the early and delayed phases in the pCR group were 14.8 and 30.7 HU, while those in the pRT were 15.3 and 32.2 HU, respectively. A logistic regression analysis revealed that a smaller tumor size (< 42 mm) was a non-significant predictor of a pCR (p = 0.09); the maximum standardized uptake value on FDG-PET and the CT values on the early and delayed phases of dynamic CT were not associated with the achievement of a pCR. In conclusion, intra-tumoral blood feeding of the locally advanced lung cancer did not predict the effects of induction therapy, whereas smaller sized tumors tended to show a better response.
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Affiliation(s)
- Koji Kawaguchi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Goto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shota Nakamura
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shuhei Hakiri
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Ozeki
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taketo Kato
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Mori
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kumiko Hashimoto
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ge X, Yu J, Wang Z, Xu Y, Pan C, Jiang L, Yang Y, Yuan K, Liu W. Comparative study of dual energy CT iodine imaging and standardized concentrations before and after chemoradiotherapy for esophageal cancer. BMC Cancer 2018; 18:1120. [PMID: 30445955 PMCID: PMC6240303 DOI: 10.1186/s12885-018-5058-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/07/2018] [Indexed: 12/24/2022] Open
Abstract
Background To compare dual energy CT iodine imaging and standardized iodine concentration before and after chemoradiotherapy (CRT) for esophageal cancer and evaluate the efficacy of CRT for EC by examining DECT iodine maps and standard CT values. Methods The clinical data of 45 patients confirmed by pathology with newly diagnosed esophageal cancer who underwent concurrent CRT from February 2012 to January 2017 in our department of radiology were collected. All patients underwent dual-source dual-energy CT (DECT) before and after CRT. Normalized iodine concentration (NIC) and normalized CT (NCT) corresponding to the overall cancer lesion and its maximum cross-sectional area were observed and compared. Additionally, 30 healthy individuals were compared as control group. After treatment, the patients were divided into two groups according to RECIST1.1: treatment effective group and ineffective group. Results There were 33 patients (CR 9, PR 24) in the effective group and 12 patients (SD 12, PD 0) in the ineffective group. There was no significant difference in the NIC-A, NIC-V, NCT-A and NCT-A indexes between the effective group (B group) and the ineffective group (C group) before treatment (P > 0.05). After the treatment, the above-mentioned indexes in the effective group of patients were significantly lower than before treatment, and compared with the ineffective group, the NIC-A, NIC-V, NCT-A and NCT-V values of the effective group were significantly lower than those of ineffective group (P < 0.05). After treatment, the NIC-V and NCT-V in the ineffective group were lower than before treatment, and the difference was statistically significant (P < 0.05). However, their NIC-A and NCT-A were not statistically different from those before treatment (P > 0.05). Conclusion Using DECT iodine map, the changes of NIC and NIC before and after CRT in patients with esophageal cancer can evaluate the effect of CRT, and does not increase the radiation dose, so it is suitable for clinical use.
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Affiliation(s)
- Xiaomin Ge
- Department of Radiology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 29 Xinglong Road, Tianning District, Changzhou, Jiangsu, China
| | - Jingping Yu
- Department of Radiotherapy, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, 213003, China
| | - Zhongling Wang
- Department of Radiology, Shanghai First People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200080, China
| | - Yiqun Xu
- Department of Radiology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 29 Xinglong Road, Tianning District, Changzhou, Jiangsu, China
| | - Changjie Pan
- Department of Radiology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 29 Xinglong Road, Tianning District, Changzhou, Jiangsu, China
| | - Lu Jiang
- Department of Radiology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 29 Xinglong Road, Tianning District, Changzhou, Jiangsu, China
| | - Yanling Yang
- Department of Radiology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 29 Xinglong Road, Tianning District, Changzhou, Jiangsu, China
| | - Kai Yuan
- Thoracic Surgery Department, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, 213003, China
| | - Wei Liu
- Department of Radiology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, No. 29 Xinglong Road, Tianning District, Changzhou, Jiangsu, China.
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Konert T, van de Kamer JB, Sonke JJ, Vogel WV. The developing role of FDG PET imaging for prognostication and radiotherapy target volume delineation in non-small cell lung cancer. J Thorac Dis 2018; 10:S2508-S2521. [PMID: 30206495 DOI: 10.21037/jtd.2018.07.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Advancements in functional imaging technology have allowed new possibilities in contouring of target volumes, monitoring therapy, and predicting treatment outcome in non-small cell lung cancer (NSCLC). Consequently, the role of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has expanded in the last decades from a stand-alone diagnostic tool to a versatile instrument integrated with computed tomography (CT), with a prominent role in lung cancer radiotherapy. This review outlines the most recent literature on developments in FDG PET imaging for prognostication and radiotherapy target volume delineation (TVD) in NSCLC. We also describe the challenges facing the clinical implementation of these developments and present new ideas for future research.
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Affiliation(s)
- Tom Konert
- Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen B van de Kamer
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Nuclear Medicine Department, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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De Cecco CN, Burchett P, van Assen M, Ravenel J, Cooper SL, Li H, Bradshaw ML, Rieter WJ, Joseph Schoepf U, Gordon L. Rationale and design of a prospective study on the first integrated PET/dual-energy CT system for staging and image-based radiation therapy planning of lung cancer. Eur Radiol Exp 2018. [PMCID: PMC6092731 DOI: 10.1186/s41747-018-0047-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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