1
|
Tanaka R, Samei E, Segars WP, Abadi E, Matsumoto I, Tamura M, Takata M, Yamashiro T. Assessment of pleural invasion and adhesion of lung tumors with dynamic chest radiography: A virtual clinical imaging study. Med Phys 2021; 48:1616-1623. [PMID: 33533481 DOI: 10.1002/mp.14750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/30/2020] [Accepted: 01/27/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Accurate preoperative assessment of tumor invasion/adhesion is crucial for planning appropriate operative procedures. Recent advances in digital radiography allow a motion analysis of lung tumors with dynamic chest radiography (DCR) with total exposure dose comparable to that of conventional chest radiography. The aim of this study was to investigate the feasibility of preoperative evaluation of pleural invasion/adhesion of lung tumors with DCR through a virtual clinical imaging study, using a four-dimensional (4D) extended cardiac-torso (XCAT) computational phantom. METHODS An XCAT phantom of an adult man (50th percentile in height and weight) with simulated respiratory and cardiac motions was generated to use as a virtual patient. To simulate lung tumors with and without pleural invasion, a 30-mm diameter tumor sphere was inserted into each lobe of the phantom. The virtual patient during respiration was virtually projected using an x-ray simulator in posteroanterior (PA) and oblique directions, and sequential bone suppression (BS) images were created. The measurement points (tumor, rib, and diaphragm) were automatically tracked on simulated images by a template matching technique. We calculated five quantitative metrics related to the movement distance and directions of the targeted tumor and evaluated whether DCR could distinguish between tumors with and without pleural invasion/adhesion. RESULTS Precise tracking of the targeted tumor was achieved on the simulated BS images without undue influence of rib shadows. There was a significant difference in all five quantitative metrics between the lung tumors with and without pleural invasion both on the oblique and PA projection views (P < 0.05). Quantitative metrics related to the movement distance were effective for tumors in the middle and lower lobes, while, those related to the movement directions were effective for tumors close to the frontal chest wall on the oblique projection view. The oblique views were useful for the evaluation of the space between the chest wall and a moving tumor. CONCLUSION DCR could help distinguish between tumors with and without pleural invasion/adhesion based on the two-dimensional movement distance and direction using oblique and PA projection views. With anticipated improved image: processing to evaluate the respiratory displacement of lung tumors in the upper lobe or behind the heart, DCR holds promise for clinical assessment of tumor invasion/adhesion in the parietal pleura.
Collapse
Affiliation(s)
- Rie Tanaka
- College of Medical, Pharmaceutical & Health Sciences, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa, Ishikawa, 920-0942, Japan
| | - Ehsan Samei
- Carl E Ravin Advanced Imaging Labs, Department of Radiology, Duke University, Durham, NC, 27705, United States
| | - William Paul Segars
- Carl E Ravin Advanced Imaging Labs, Department of Radiology, Duke University, Durham, NC, 27705, United States
| | - Ehsan Abadi
- Carl E Ravin Advanced Imaging Labs, Department of Radiology, Duke University, Durham, NC, 27705, United States
| | - Isao Matsumoto
- Department of Thoracic Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Masaya Tamura
- Department of Thoracic Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Munehisa Takata
- Department of Thoracic Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| |
Collapse
|
2
|
[Preoperative 4D-CT Provided Helpful Evaluation of Aorta Invasion of Left Lower Lobe Lung Cancer]. J UOEH 2021; 42:365-369. [PMID: 33268616 DOI: 10.7888/juoeh.42.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 73-year-old woman was diagnosed by bronchoscopic examination with primary left lung cancer (Adenocarcinoma, cT3N0M0, stage IIB), which was closely adjacent to the descending aorta in contrast enhanced computed tomography (CT). This CT did not reveal any invasion of a tumor into the descending aorta, and a dynamic fourth dimension CT (4D-CT) indicated that there was no invasion of the aorta by this tumor, so we decided to perform surgery. The operative procedure was a left lower lobectomy and lymph node dissection with the use of a thoracoscope. An intraoperative finding was that the tumor had not invaded the aorta. There are few reports about the evaluation of vascular invasion using the dynamic 4D-CT. We consider that the dynamic 4D-CT gave very useful information about vascular invasion.
Collapse
|
3
|
Nagatani Y, Hashimoto M, Nitta N, Oshio Y, Yamashiro T, Sato S, Tsukagoshi S, Moriya H, Kimoto T, Igarashi T, Ushio N, Sonoda A, Otani H, Hanaoka J, Murata K. Continuous quantitative measurement of the main bronchial dimensions and lung density in the lateral position by four-dimensional dynamic-ventilation CT in smokers and COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:3845-3856. [PMID: 30568436 PMCID: PMC6267741 DOI: 10.2147/copd.s178836] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to measure changes in lung density and airway dimension in smokers in the lateral position using four-dimensional dynamic-ventilation computed tomography (CT) during free breathing and to evaluate their correlations with spirometric values. Materials and methods Preoperative pleural adhesion assessments included dynamic-ventilation CT of 42 smokers (including 22 patients with COPD) in the lateral position, with the unoperated lung beneath (dependent lung). The scanned lungs' mean lung density (MLD) and the bilateral main bronchi's luminal areas (Ai) were measured automatically (13-18 continuous image frames, 0.35 seconds/frame). Calculations included cross-correlation coefficients (CCCs) between the MLD and Ai time curves, and correlations between the quantitative measurements and spirometric values were evaluated by using Spearman's rank coefficient. Results The ΔMLD1.05 (from the peak inspiration frame to the third expiratory frame, 1.05 seconds later) in the nondependent lung negatively correlated with FEV1/FVC (r=-0.417, P<0.01), suggesting that large expiratory movement of the nondependent lung would compensate limited expiratory movement of the dependent lung due to COPD. The ΔAi1.05 negatively correlated with the FEV1/FVC predicted in both the lungs (r=-0.465 and -0.311, P<0.05), suggesting that early expiratory collapses of the main bronchi indicate severe airflow limitation. The CCC correlated with FEV1/FVC in the dependent lung (r=-0.474, P<0.01), suggesting that reduced synchrony between the proximal airway and lung occurs in patients with severe airflow limitation. Conclusion In COPD patients, in the lateral position, the following abnormal dynamic-ventilation CT findings are associated with airflow limitation: enhanced complementary ventilation in the nondependent lung, early expiratory airway collapses, and reduced synchrony between airway and lung movements in the dependent lung.
Collapse
Affiliation(s)
- Yukihiro Nagatani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Masayuki Hashimoto
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Yasuhiko Oshio
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan,
| | - Shigetaka Sato
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | | | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima, Fukushima 960-8611, Japan
| | - Tatsuya Kimoto
- Healthcare IT Development Center, Canon Medical Systems, Otawara, Tochigi 324-8550, Japan
| | - Tomoyuki Igarashi
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Noritoshi Ushio
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hideji Otani
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Jun Hanaoka
- Department of Surgery, Division of General Thoracic Surgery, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| |
Collapse
|
4
|
Yamashiro T, Moriya H, Tsubakimoto M, Matsuoka S, Murayama S. Continuous quantitative measurement of the proximal airway dimensions and lung density on four-dimensional dynamic-ventilation CT in smokers. Int J Chron Obstruct Pulmon Dis 2016; 11:755-64. [PMID: 27110108 PMCID: PMC4835141 DOI: 10.2147/copd.s100658] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Four-dimensional dynamic-ventilation computed tomography (CT) imaging demonstrates continuous movement of the airways and lungs, which cannot be depicted with conventional CT. We aimed to investigate continuous changes in lung density and airway dimensions and to assess the correlation with spirometric values in smokers. Materials and methods This retrospective study was approved by the Institutional Review Board, and informed consent was waived. Twenty-one smokers including six patients with COPD underwent four-dimensional dynamic-ventilation CT during free breathing (160 mm in length). The mean lung density (MLD) of the scanned lung and luminal areas (Ai) of fixed points in the trachea and the right proximal bronchi (main bronchus, upper bronchus, bronchus intermedius, and lower bronchus) were continuously measured. Concordance between the time curve of the MLD and that of the airway Ai values was expressed by cross-correlation coefficients. The associations between these quantitative measurements and the forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) values were assessed by Spearman’s rank correlation analysis. Results On the time curve for the MLD, the Δ-MLD1.05 values between the peak inspiratory frame to the later third frame (1.05 seconds later) were strongly correlated with the FEV1/FVC (ρ=0.76, P<0.0001). The cross-correlation coefficients between the airway Ai and MLD values were significantly correlated with the FEV1/FVC (ρ=−0.56 to −0.66, P<0.01), except for the right upper bronchus. This suggested that the synchrony between the airway and lung movement was lost in patients with severe airflow limitation. Conclusion Respiratory changes in the MLD and synchrony between the airway Ai and the MLD measured with dynamic-ventilation CT were correlated with patient’s spirometric values.
Collapse
Affiliation(s)
- Tsuneo Yamashiro
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroshi Moriya
- Department of Radiology, Ohara General Hospital, Fukushima-shi, Fukushima, Japan
| | - Maho Tsubakimoto
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Shin Matsuoka
- Department of Radiology, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan
| |
Collapse
|