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Ma X, Siegelman J, Paik DS, Mulshine JL, St Pierre S, Buckler AJ. Volumes Learned: It Takes More Than Size to "Size Up" Pulmonary Lesions. Acad Radiol 2016; 23:1190-8. [PMID: 27287713 DOI: 10.1016/j.acra.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to review the current understanding and capabilities regarding use of imaging for noninvasive lesion characterization and its relationship to lung cancer screening and treatment. MATERIALS AND METHODS Our review of the state of the art was broken down into questions about the different lung cancer image phenotypes being characterized, the role of imaging and requirements for increasing its value with respect to increasing diagnostic confidence and quantitative assessment, and a review of the current capabilities with respect to those needs. RESULTS The preponderance of the literature has so far been focused on the measurement of lesion size, with increasing contributions being made to determine the formal performance of scanners, measurement tools, and human operators in terms of bias and variability. Concurrently, an increasing number of investigators are reporting utility and predictive value of measures other than size, and sensitivity and specificity is being reported. Relatively little has been documented on quantitative measurement of non-size features with corresponding estimation of measurement performance and reproducibility. CONCLUSIONS The weight of the evidence suggests characterization of pulmonary lesions built on quantitative measures adds value to the screening for, and treatment of, lung cancer. Advanced image analysis techniques may identify patterns or biomarkers not readily assessed by eye and may also facilitate management of multidimensional imaging data in such a way as to efficiently integrate it into the clinical workflow.
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Affiliation(s)
- Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984.
| | - Jenifer Siegelman
- Department of Radiology, Brigham and Women's Hospital, Boston Massachusetts; Department of Radiology (hospital-based), Harvard Medical School, Boston, Massachusetts
| | - David S Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - James L Mulshine
- Department of Internal Medicine, Rush University, Chicago, Illinois
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Henzler T, Shi J, Jafarov H, Schoenberg SO, Manegold C, Fink C, Schmid-Bindert G. Functional CT imaging techniques for the assessment of angiogenesis in lung cancer. Transl Lung Cancer Res 2015; 1:78-83. [PMID: 25806158 DOI: 10.3978/j.issn.2218-6751.2012.01.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/06/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Jingyun Shi
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, China
| | - Hashim Jafarov
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Christian Manegold
- Interdisciplinary Thoracic Oncology, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Germany
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
| | - Gerald Schmid-Bindert
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Germany
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Perspectives of Novel Imaging Techniques for Staging, Therapy Response Assessment, and Monitoring of Surveillance in Lung Cancer: Summary of the Dresden 2013 Post WCLC-IASLC State-of-the-Art Imaging Workshop. J Thorac Oncol 2015; 10:237-49. [DOI: 10.1097/jto.0000000000000412] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Dynamic volume perfusion CT in patients with lung cancer: baseline perfusion characteristics of different histological subtypes. Eur J Radiol 2013; 82:e894-900. [PMID: 24094644 DOI: 10.1016/j.ejrad.2013.08.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 07/27/2013] [Accepted: 08/11/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate dynamic volume perfusion CT (dVPCT) tumor baseline characteristics of three different subtypes of lung cancer in untreated patients. MATERIALS AND METHODS 173 consecutive patients (131 men, 42 women; mean age 61 ± 10 years) with newly diagnosed lung cancer underwent dVPCT prior to biopsy. Tumor permeability, blood flow (BF), blood volume (BV) and mean transit time (MTT) were quantitatively assessed as well as tumor diameter and volume. Tumor subtypes were histologically determined and compared concerning their dVPCT results. dVPCT results were correlated to tumor diameter and volume. RESULTS Histology revealed adenocarcinoma in 88, squamous cell carcinoma in 54 and small cell lung cancer (SCLC) in 31 patients. Tumor permeability was significantly differing between adenocarcinoma, squamous cell carcinoma and SCLC (all p<0.05). Tumor BF and BV were higher in adenocarcinomathan in SCLC (p = 0.001 and p=0.0002 respectively). BV was also higher in squamous cell carcinoma compared to SCLC (p = 0.01). MTT was not differing between tumor subtypes. Regarding all tumors, tumor diameter did not correlate with any of the dVPCT parameters, whereas tumor volume was negatively associated with permeability, BF and BV (r = -0.22, -0.24, -0.24, all p<0.05). In squamous cell carcinoma, tumor diameter und volume correlated with BV (r = 0.53 and r = -0.40, all p<0.05). In SCLC, tumor diameter und volume correlated with MTT (r = 0.46 and r = 0.39, all p<0.05). In adenocarcinoma, no association between morphological and functional tumor characteristics was observed. CONCLUSIONS dVPCT parameters are only partially related to tumor diameter and volume and are significantly differing between lung cancer subtypes.
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Hodnett PA, Ko JP. Evaluation and Management of Indeterminate Pulmonary Nodules. Radiol Clin North Am 2012; 50:895-914. [DOI: 10.1016/j.rcl.2012.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT? Eur Radiol 2011; 22:93-103. [DOI: 10.1007/s00330-011-2230-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 06/10/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
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Henzler T, Schmid-Bindert G, Fink C. Pulmonary Nodules and Lung Cancer. DUAL ENERGY CT IN CLINICAL PRACTICE 2011. [DOI: 10.1007/174_2010_53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Nanodelivery of MRI contrast agent enhances sensitivity of detection of lung cancer metastases. Acad Radiol 2009; 16:627-37. [PMID: 19345904 DOI: 10.1016/j.acra.2008.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 12/05/2008] [Accepted: 12/15/2008] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES Early detection of lung cancer can be problematic. Although current imaging methods can identify lung cancers, they are limited in the size of detectable nodules. There is also lack of evidence that these methods can correctly classify nodules <7 mm as malignant because lung cancer can be mimicked in appearance by benign lesions that lower specificity. Therefore, there is a need for enhanced sensitivity/specificity of detection for small lung cancers. MATERIALS AND METHODS We have developed a nanosized ( approximately 100 nm) immunoliposome complex for delivery of molecular medicines to tumors. In this complex, an anti-transferrin receptor single-chain antibody fragment (TfRscFv) decorates the surface of a cationic liposome encapsulating the payload. We have previously shown that this systemically administered complex (scL) selectively targets, and efficiently delivers its payload into, tumor cells. We have also encapsulated the magnetic resonance imaging (MRI) contrast agent gadopentetate dimeglumine ("gad-d") within this complex, resulting in increased resolution and image intensity in a mouse model of primary cancer. Here we examine the ability of the scL-gad-d complex to increase the sensitivity of detection of lung metastases. RESULTS These MRI studies show that the scL-gad-d nanocomplex is able to improve detection, and increase enhancement of, small lung cancers (400 microm and as small as 100 microm) compared to that of uncomplexed gad-d. CONCLUSIONS Because of its tumor targeting specificity, deliver of an MRI contrast agent via this nanocomplex has potential for use as an agent that can identify small lung cancers, thus improving early detection and possibly increasing survival.
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Abstract
Multiple biomedical imaging techniques are used in all phases of cancer management. Imaging forms an essential part of cancer clinical protocols and is able to furnish morphological, structural, metabolic and functional information. Integration with other diagnostic tools such as in vitro tissue and fluids analysis assists in clinical decision-making. Hybrid imaging techniques are able to supply complementary information for improved staging and therapy planning. Image guided and targeted minimally invasive therapy has the promise to improve outcome and reduce collateral effects. Early detection of cancer through screening based on imaging is probably the major contributor to a reduction in mortality for certain cancers. Targeted imaging of receptors, gene therapy expression and cancer stem cells are research activities that will translate into clinical use in the next decade. Technological developments will increase imaging speed to match that of physiological processes. Targeted imaging and therapeutic agents will be developed in tandem through close collaboration between academia and biotechnology, information technology and pharmaceutical industries.
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Affiliation(s)
- Leonard Fass
- GE Healthcare, 352 Buckingham Avenue, Slough, SL1 4ER, UK.
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Yuan R, Vos PM, Cooperberg PL. Computer-aided detection in screening CT for pulmonary nodules. AJR Am J Roentgenol 2006; 186:1280-7. [PMID: 16632719 DOI: 10.2214/ajr.04.1969] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to evaluate the performance of a computer-aided detection (CAD) system for pulmonary nodule detection using low-dose screening CT images. MATERIALS AND METHODS One hundred fifty consecutive low-dose screening CT examinations were independently evaluated by a radiologist and a CAD pulmonary nodule detection system (R2 Technology) designed to identify nodules larger than 4 mm in maximum long-axis diameter. All discrepancies between the two techniques were reviewed by one of another two radiologists working in consensus with the initial interpreting radiologist, and a "true" nodule count was determined. Detected nodules were classified by size, density, and location. The performance of the initial radiologist and the CAD system were compared. RESULTS The radiologist detected 518 nodules and the CAD system, 934 nodules. Of the 1,106 separate nodules detected using the two techniques, 628 were classified as true nodules on consensus review. Of the true nodules present, the radiologist detected 518 (82%) of 628 nodules and the CAD, 456 (73%) of 628 nodules. All 518 radiologist-detected nodules were true nodules, and 456 (49%) of 934 of CAD-detected nodules were true nodules. The radiologist missed 110 true nodules that were only detected by CAD. In six patients, these were the only nodules detected in the examination, changing the imaging follow-up protocol. CAD identified 478 lesions that on consensus review were false-positive nodules, a rate of 3.19 (478/150) per patient. CONCLUSION CAD detected 72.6% of true nodules and detected nodules in six (4%) patients not identified by radiologists, changing the imaging follow-up protocol of these subjects. In this study, the combined review of low-dose CT scans by both the radiologist and CAD was necessary to identify all nodules.
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Affiliation(s)
- Ren Yuan
- Department of Radiology, Vancouver General Hospital, Vancouver, British Columbia, V5Z 1M9 Canada
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Abstract
With the emergence of multidetector-row computed tomography (CT) it is now possible to image both structure and function via use of a single imaging modality. Breath-hold spiral CT provides detail of the airway and vascular trees along with texture reflective of the state of the lung parenchyma. Use of stable xenon gas wash-in and/or wash-out methods using an axial mode of the CT scanner whereby images are acquired through gating to the respiratory cycle provide detailed images of regional ventilation with isotropic voxel dimensions now on the order of 0.4 mm. Axial scanning during a breath hold and gating to the electrocardiogram during the passage of a sharp bolus injection of iodinated contrast agent provide detailed images of regional pulmonary perfusion. These dynamic CT methods for the study of regional lung function are discussed in the context of other methods that have been used to study heterogeneity of lung function.
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Affiliation(s)
- Eric A Hoffman
- Department of Radiology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52240, USA.
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Abstract
The influence of MSCT on nodule detection and characterization will be discussed. The objective is to improve understanding of the clinical issues involved in nodule detection, characterization, and management in light of technological advances. Topics to be covered are noninvasive characterization techniques, such as morphologic and density inspection on CT, nodule enhancement techniques, CT-PET, temporal nodule size assessment, and computer aided diagnosis for both detection and characterization.
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Affiliation(s)
- Jane P Ko
- Thoracic Imaging Section, Department of Radiology, New York University Medical Center, New York 10016, USA.
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Abstract
X-ray CT technology has been available for more than 30 years, yet continued technological advances have kept CT imaging at the forefront of medical imaging innovation. Consequently, the number of clinical CT applications has increased steadily. Other imaging modalities might be superior to CT imaging for some specific applications, but no other single modality is more often used in chest imaging today. Future technological developments in the area of high-resolution detectors, high-capacity x-ray tubes, advanced reconstruction algorithms, and improved visualization techniques will continue to expand the imaging capability. Future CT imaging technology will combine improved imaging capability with advanced and specific computer-assisted tools, which will expand the usefulness of CT imaging in many areas.
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Affiliation(s)
- Deborah Walter
- Computed Tomography Systems and Applications Laboratory, GE Global Research Center, One Research Circle, Niskayuna, NY 12309, USA.
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Ko JP, Rusinek H, Jacobs EL, Babb JS, Betke M, McGuinness G, Naidich DP. Small pulmonary nodules: volume measurement at chest CT--phantom study. Radiology 2003; 228:864-70. [PMID: 12954901 DOI: 10.1148/radiol.2283020059] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three-dimensional methods for quantifying pulmonary nodule volume at computed tomography (CT) and the effect of imaging variables were studied by using a realistic phantom. Two fixed-threshold methods, a partial-volume method (PVM) and a variable method, were used to calculate volumes of 40 plastic nodules (largest dimension, <5 mm: 20 nodules with solid attenuation and 20 with ground-glass attenuation) of known volume. Tube current times (20 and 120 mAs), reconstruction algorithms (high and low frequency), and nodule characteristics were studied. Higher precision was associated with use of a PVM with predetermined pure nodule attenuation, high-frequency algorithm, and diagnostic CT technique (120 mAs). A PVM is promising for volume quantification and follow-up of nodules.
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Affiliation(s)
- Jane P Ko
- Department of Radiology, Section of Thoracic Imaging, New York University Medical Center, 560 1st Ave, New York, NY 10016, USA.
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Abstract
The solitary pulmonary nodule will be found increasingly by the use of newer imaging techniques, including computed tomography (CT) screening. The aim must be to have an approach that avoids unnecessary surgery or biopsy with their attendant risks. Plain films characterisation, CT assessment, including densitometry and enhancement, and growth patterns are discussed and evaluated. The use of Bayes theorem to guide these assessment strategies is also described.
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Affiliation(s)
- A W K Tang
- Department of Radiology, Leeds Teaching Hospitals, Leeds, UK
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