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Zheng Y, Li H, Zhang K, Luo Q, Ding C, Han X, Shi H. Dual-energy CT-based radiomics for predicting pathological grading of invasive lung adenocarcinoma. Clin Radiol 2024; 79:e1226-e1234. [PMID: 39098469 DOI: 10.1016/j.crad.2024.07.009] [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: 10/09/2023] [Revised: 06/04/2024] [Accepted: 07/09/2024] [Indexed: 08/06/2024]
Abstract
AIMS The purpose of the study was to build a radiomics model using Dual-energy CT (DECT) to predict pathological grading of invasive lung adenocarcinoma. MATERIALS AND METHODS The retrospective study enrolled 107 patients (80 low-grade and 27 high-grade) with invasive lung adenocarcinoma before surgery. Clinical features, radiographic characteristics, and quantitative parameters were measured. Virtual monoenergetic images at 50kev and 150kev were reconstructed for extracting DECT radiomics features. To select features for constructing models, Pearson's correlation analysis, intraclass correlation coefficients, and least absolute shrinkage and selection operator penalized logistic regression were performed. Four models, including the DECT radiomics model, the clinical-DECT model, the conventional CT radiomics model, and the mixed model, were established. Area under the curve (AUC) and decision curve analysis were used to measure the performance and the clinical value of the models. RESULTS The radiomics model based on DECT exhibited outstanding performance in predicting tumor differentiation, with an AUC of 0.997 and 0.743 in the training and testing sets, respectively. Incorporating tumor density, lobulation, and effective atomic number at AP, the clinical-DECT model showed a comparable performance with an AUC of 0.836 in both the training and testing sets. In comparison to the conventional CT radiomics model (AUC of 0.998 in the training and 0.529 in the testing set) and the mixed model (AUC of 0.988 in the training and 0.707 in the testing set), the DECT radiomics model demonstrated a greater AUC value and provided patients with a more significant net benefit in the testing set. CONCLUSIONS In contrast to the conventional CT radiomics model, the DECT radiomics model produced greater predictive performance in pathological grading of invasive lung adenocarcinoma.
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Affiliation(s)
- Y Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - H Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - K Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - Q Luo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - C Ding
- Bayer Healthcare, No. 399, West Haiyang Road, Shanghai 200126, China.
| | - X Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
| | - H Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, Hubei Province 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Liu BC, Ma HY, Huang J, Luo YW, Zhang WB, Deng WW, Liao YT, Xie CM, Li Q. Does dual-layer spectral detector CT provide added value in predicting spread through air spaces in lung adenocarcinoma? A preliminary study. Eur Radiol 2024; 34:4176-4186. [PMID: 37973632 DOI: 10.1007/s00330-023-10440-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/29/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To examine the predictive value of dual-layer spectral detector CT (DLCT) for spread through air spaces (STAS) in clinical lung adenocarcinoma. METHODS A total of 225 lung adenocarcinoma cases were retrospectively reviewed for demographic, clinical, pathological, traditional CT, and spectral parameters. Multivariable logistic regression analysis was carried out based on three logistic models, including a model using traditional CT features (traditional model), a model using spectral parameters (spectral model), and an integrated model combining traditional CT and spectral parameters (integrated model). Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were performed to assess these models. RESULTS Univariable analysis showed significant differences between the STAS and non-STAS groups in traditional CT features, including nodule density (p < 0.001), pleural indentation types (p = 0.006), air-bronchogram sign (p = 0.031), the presence of spiculation (p < 0.001), long-axis diameter of the entire nodule (LD) (p < 0.001), and consolidation/tumor ratio (CTR) (p < 0.001). Multivariable analysis revealed that LD > 20 mm (odds ratio [OR] = 2.271, p = 0.025) and CTR (OR = 24.208, p < 0.001) were independent predictors in the traditional model, while electronic density (ED) in the venous phase was an independent predictor in the spectral (OR = 1.062, p < 0.001) and integrated (OR = 1.055, p < 0.001) models. The area under the curve (AUC) for the integrated model (0.84) was the highest (spectral model, 0.83; traditional model, 0.80), and the difference between the integrated and traditional models was statistically significant (p = 0.015). DCA showed that the integrated model had superior clinical value versus the traditional model. CONCLUSIONS DLCT has added value for STAS prediction in lung adenocarcinoma. CLINICAL RELEVANCE STATEMENT Spectral CT has added value for spread through air spaces prediction in lung adenocarcinoma so may impact treatment planning in the future. KEY POINTS • Electronic density may be a potential spectral index for predicting spread through air spaces in lung adenocarcinoma. • A combination of spectral and traditional CT features enhances the performance of traditional CT for predicting spread through air spaces.
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Affiliation(s)
- Bao-Cong Liu
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Hui-Yun Ma
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Jin Huang
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Ying-Wei Luo
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wen-Biao Zhang
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China
| | - Wei-Wei Deng
- Clinical & Technical Support, Philips Healthcare, Shanghai, People's Republic of China
| | - Yu-Ting Liao
- Clinical & Technical Support, Philips Healthcare, Shanghai, People's Republic of China
| | - Chuan-Miao Xie
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
| | - Qiong Li
- State Key Laboratory of Oncology in South China, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China.
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Deng L, Yang J, Zhang M, Zhu K, Jing M, Zhang Y, Zhang B, Han T, Zhou J. Whole-lesion iodine map histogram analysis versus single-slice spectral CT parameters for determining novel International Association for the Study of Lung Cancer grade of invasive non-mucinous pulmonary adenocarcinomas. Diagn Interv Imaging 2024; 105:165-173. [PMID: 38072730 DOI: 10.1016/j.diii.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 05/05/2024]
Abstract
PURPOSE The purpose of this study was to evaluate and compare the performances of whole-lesion iodine map histogram analysis to those of single-slice spectral computed tomography (CT) parameters in discriminating between low-to-moderate grade invasive non-mucinous pulmonary adenocarcinoma (INMA) and high-grade INMA according to the novel International Association for the Study of Lung Cancer grading system of INMA. MATERIALS AND METHODS Sixty-one patients with INMA (34 with low-to-moderate grade [i.e., grade I and grade II] and 27 with high grade [i.e., grade III]) were evaluated with spectral CT. There were 28 men and 33 women, with a mean age of 56.4 ± 10.5 (standard deviation) years (range: 29-78 years). The whole-lesion iodine map histogram parameters (mean, standard deviation, variance, skewness, kurtosis, entropy, and 1st, 10th, 25th, 50th, 75th, 90th, and 99th percentile) were measured for each INMA. In other sessions, by placing regions of interest at representative levels of the tumor and normalizing them, spectral CT parameters (iodine concentration and normalized iodine concentration) were obtained. Discriminating capabilities of spectral CT and histogram parameters were assessed and compared using area under the ROC curve (AUC) and logistic regression models. RESULTS The 1st, 10th, and 25th percentiles of the iodine map histogram analysis, and iodine concentration and normalized iodine concentration of single-slice spectral CT parameters were significantly different between high-grade and low-to-moderate grade INMAs (P < 0.001 to P = 0.002). The 1st percentile of histogram parameters (AUC, 0.84; 95% confidence interval [CI]: 0.73-0.92) and iodine concentration (AUC, 0.78; 95% CI: 0.66-0.88) from single-slice spectral CT parameters had the best performance for discriminating between high-grade and low-to-moderate grade INMAs. At ROC curve analysis no significant differences in AUC were found between histogram parameters (AUC = 0.86; 95% CI: 0.74-0.93) and spectral CT parameters (AUC = 0.81; 95% CI: 0.74-0.93) (P = 0.60). CONCLUSION Both whole-lesion iodine map histogram analysis and single-slice spectral CT parameters help discriminate between low-to-moderate grade and high-grade INMAs according to the novel International Association for the Study of Lung Cancer grading system, with no differences in diagnostic performances.
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Affiliation(s)
- Liangna Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Jingjing Yang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Mingtao Zhang
- Second Clinical School, Lanzhou University, Lanzhou 730000, China; Department of Orthopedics, Lanzhou University Second Hospital, 730000, China
| | - Kaibo Zhu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Mengyuan Jing
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Yuting Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Bin Zhang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Tao Han
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730000, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou 730000, China; Second Clinical School, Lanzhou University, Lanzhou 730000, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730000, China.
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Hartley-Blossom ZJ, Digumarthy SR. Dual-Energy Computed Tomography Applications in Lung Cancer. Radiol Clin North Am 2023; 61:987-994. [PMID: 37758365 DOI: 10.1016/j.rcl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
This article examines the intrathoracic applications for dual-energy computed tomography (DECT), focusing on lung cancer. The topics covered include the image data sets, methods for iodine quantification, and clinical applications. The applications of DECT are to differentiate benign and malignant lung nodules, determining the grade of lung cancer and expression of ki-67 expression. Iodine quantification has role in assessment of treatment response in both the primary tumor and nodal metastases.
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Affiliation(s)
- Zachary J Hartley-Blossom
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Subba R Digumarthy
- Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Madani MH, Riess JW, Brown LM, Cooke DT, Guo HH. Imaging of lung cancer. Curr Probl Cancer 2023:100966. [PMID: 37316337 DOI: 10.1016/j.currproblcancer.2023.100966] [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: 02/21/2023] [Revised: 04/29/2023] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality globally. Imaging is essential in the screening, diagnosis, staging, response assessment, and surveillance of patients with lung cancer. Subtypes of lung cancer can have distinguishing imaging appearances. The most frequently used imaging modalities include chest radiography, computed tomography, magnetic resonance imaging, and positron emission tomography. Artificial intelligence algorithms and radiomics are emerging technologies with potential applications in lung cancer imaging.
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Affiliation(s)
- Mohammad H Madani
- Department of Radiology, University of California, Davis, Sacramento, CA.
| | - Jonathan W Riess
- Division of Hematology/Oncology, Department of Internal Medicine, UC Davis Medical Center, UC Davis Comprehensive Cancer Center, Sacramento, CA
| | - Lisa M Brown
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, CA
| | - David T Cooke
- Division of General Thoracic Surgery, Department of Surgery, UC Davis Health, Sacramento, CA
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
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Ghetti C, Ortenzia O, Bertolini M, Sceni G, Sverzellati N, Silva M, Maddalo M. Lung dual energy CT: Impact of different technological solutions on quantitative analysis. Eur J Radiol 2023; 163:110812. [PMID: 37068414 DOI: 10.1016/j.ejrad.2023.110812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE To evaluated the accuracy of spectral parameters quantification of four different CT scanners in dual energy examinations of the lung using a dedicated phantom. METHOD Measurements were made with different technologies of the same vendor: one dual source CT scanner (DSCT), one TwinBeam (i.e. split filter) and two sequential acquisition single source scanners (SSCT). Angular separation of Calcium and Iodine signals were calculated from scatter plots of low-kVp versus high-kVp HUs. Electron density (ρe), effective atomic number (Zeff) and Iodine concentration (Iconc) were measured using Syngo.via software. Accuracy (A) of ρe, Zeff and Iconc was evaluated as the absolute percentage difference (D%) between reference values and measured ones, while precision (P) was evaluated as the variability σ obtained by repeating the measurement with different acquisition/reconstruction settings. RESULTS Angular separation was significantly larger for DSCT (α = 9.7°) and for sequential SSCT (α = 9.9°) systems. TwinBeam was less performing in material separation (α = 5.0°). The lowest average A was observed for TwinBeam (Aρe = [4.7 ± 1.0], AZ = [9.1 ± 3.1], AIconc = [19.4 ± 4.4]), while the best average A was obtained for Flash (Aρe = [1.8 ± 0.4], AZ = [3.5 ± 0.7], AIconc = [7.3 ± 1.8]). TwinBeam presented inferior average P (Pρe = [0.6 ± 0.1], PZ = [1.1 ± 0.2], PIconc = [10.9 ± 4.9]), while other technologies demonstrate a comparable average. CONCLUSIONS Different technologies performed material separation and spectral parameter quantification with different degrees of accuracy and precision. DSCT performed better while TwinBeam demonstrated not excellent performance. Iodine concentration measurements exhibited high variability due to low Iodine absolute content in lung nodules, thus limiting its clinical usefulness in pulmonary applications.
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Affiliation(s)
- Caterina Ghetti
- Medical Physics Unit - University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Ornella Ortenzia
- Medical Physics Unit - University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Marco Bertolini
- Medical Physics Unit - AUSL-IRCCS of Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Giada Sceni
- Medical Physics Unit - AUSL-IRCCS of Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy
| | - Nicola Sverzellati
- Unit of Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Mario Silva
- Unit of Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Michele Maddalo
- Medical Physics Unit - University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
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Accurate Image Reconstruction in Dual-Energy CT with Limited-Angular-Range Data Using a Two-Step Method. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120775. [PMID: 36550981 PMCID: PMC9774445 DOI: 10.3390/bioengineering9120775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Dual-energy CT (DECT) with scans over limited-angular ranges (LARs) may allow reductions in scan time and radiation dose and avoidance of possible collision between the moving parts of a scanner and the imaged object. The beam-hardening (BH) and LAR effects are two sources of image artifacts in DECT with LAR data. In this work, we investigate a two-step method to correct for both BH and LAR artifacts in order to yield accurate image reconstruction in DECT with LAR data. From low- and high-kVp LAR data in DECT, we first use a data-domain decomposition (DDD) algorithm to obtain LAR basis data with the non-linear BH effect corrected for. We then develop and tailor a directional-total-variation (DTV) algorithm to reconstruct from the LAR basis data obtained basis images with the LAR effect compensated for. Finally, using the basis images reconstructed, we create virtual monochromatic images (VMIs), and estimate physical quantities such as iodine concentrations and effective atomic numbers within the object imaged. We conduct numerical studies using two digital phantoms of different complexity levels and types of structures. LAR data of low- and high-kVp are generated from the phantoms over both single-arc (SA) and two-orthogonal-arc (TOA) LARs ranging from 14∘ to 180∘. Visual inspection and quantitative assessment of VMIs obtained reveal that the two-step method proposed can yield VMIs in which both BH and LAR artifacts are reduced, and estimation accuracy of physical quantities is improved. In addition, concerning SA and TOA scans with the same total LAR, the latter is shown to yield more accurate images and physical quantity estimations than the former. We investigate a two-step method that combines the DDD and DTV algorithms to correct for both BH and LAR artifacts in image reconstruction, yielding accurate VMIs and estimations of physical quantities, from low- and high-kVp LAR data in DECT. The results and knowledge acquired in the work on accurate image reconstruction in LAR DECT may give rise to further understanding and insights into the practical design of LAR scan configurations and reconstruction procedures for DECT applications.
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Langguth P, Aludin S, Horr A, Campbell GM, Lebenatus A, Salehi Ravesh M, Schunk D, Austein F, Larsen N, Syrek H, Both M, Jansen O, Sedaghat S. Iodine uptake of adrenal glands: A novel and reliable spectral dual-layer computed tomographic-derived biomarker for acute septic shock. Eur J Radiol 2022; 156:110492. [PMID: 36108480 DOI: 10.1016/j.ejrad.2022.110492] [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: 06/03/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Septic shock is a potentially fatal condition. This study aims to assess whether iodine uptake and iodine density of abdominal organs on dual-layer spectral detector computed tomography (SDCT) could serve as a new imaging biomarker for patients in septic shock. METHODS Here, 95 patients who received contrast-enhanced abdominal CT examinations were included and separated into two groups: group A - septic shock; group B - no shock condition. Preselected abdominal (right and left adrenal gland, right and left kidney, infrarenal inferior vena cava (IVC), pancreas, spleen, and liver) localizations were independently evaluated by two radiologists, who measured iodine concentrations (mg/ml) and Hounsfield units (HU). RESULTS In all, 1520 measurements of iodine concentrations in mg/ml and HU were performed, with 27 patients in group A and 68 in group B. Iodine concentrations in mg/ml and HU correlated significantly in all organs measured. The corresponding correlation coefficient (r) ranged from 0.809 (pancreas) to 0.963 (right kidney). Inter-rater reliability (IRR) was very good for mg/ml (κ = 0.8; p < 0.01) and good for HU (κ = 0.773; p < 0.01) measurements. The mean iodine concentration and HU of the adrenal glands in septic and nonseptic patients was 4.88 ± 1.16 mg/ml/153 ± 36 HU and 2.67 ± 1.07 mg/ml/112 ± 41 HU, respectively. Iodine concentrations in the adrenal glands were significantly higher in group A than in group B patients (p < 0.01). The other organs remained unaffected and no significant difference was observed between patients in group A and B. Patients in group A presented significantly more often with an iodine uptake of >3.5 mg/ml of one adrenal gland (sensitivity = 0.926, specificity = 0.849, AUC = 0.951) or/and a combined concentration of >7 mg/ml of both adrenal glands (sensitivity = 0.889, specificity = 0.836, AUC = 0.928). CONCLUSION SDCT-derived iodine concentration of the adrenal glands could serve as a novel imaging biomarker for patients in acute septic shock. Our data suggest that an iodine uptake of >3.5 mg/ml of at least one adrenal gland or a combined iodine uptake of >7 mg/ml in both adrenal glands identifies patients in this condition.
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Affiliation(s)
- P Langguth
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
| | - S Aludin
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A Horr
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - A Lebenatus
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M Salehi Ravesh
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - D Schunk
- Department for Interdisciplinary Emergency, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - F Austein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Larsen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - H Syrek
- Mediri GmbH, Heidelberg, Germany
| | - M Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - O Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - S Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Department of Radiology, University of California San Diego, San Diego, CA, United States
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Vulasala SSR, Wynn GC, Hernandez M, Kadambi I, Gopireddy DR, Bhosale P, Virarkar MK. Dual-Energy Imaging of the Chest. Semin Ultrasound CT MR 2022; 43:311-319. [PMID: 35738816 DOI: 10.1053/j.sult.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dual-energy computed tomography (DECT) is a contemporary development by which the tissue can be characterized beyond conventional computed tomography. It improves tissue differentiation by exploiting the X-ray absorptive property of the tissues. Although still in its early stages, DECT utilization in pulmonary and cardiovascular pathologies is emerging. It includes applications such as pulmonary embolism, pulmonary hypertension, myocardial perfusion, and coronary artery assessment. This article discusses DECT principles and their current and emerging applications in thoracic imaging.
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Affiliation(s)
- Sai Swarupa R Vulasala
- Research Assistant, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Gregory Carl Wynn
- Associate Professor, Division of Cardiovascular and Thoracic Imaging, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Mauricio Hernandez
- Radiology Research Manager II, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States.
| | - Isiri Kadambi
- Observer, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Dheeraj Reddy Gopireddy
- Associate Professor & Associate Chair, Clinical Operations, and Quality Assurance., Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
| | - Priya Bhosale
- Professor, Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, 77030, United States
| | - Mayur K Virarkar
- Assistant Professor, Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, 32209, United States
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Azour L, Ko JP, O'Donnell T, Patel N, Bhattacharji P, Moore WH. Combined whole-lesion radiomic and iodine analysis for differentiation of pulmonary tumors. Sci Rep 2022; 12:11813. [PMID: 35821374 PMCID: PMC9276812 DOI: 10.1038/s41598-022-15351-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/22/2022] [Indexed: 12/24/2022] Open
Abstract
Quantitative radiomic and iodine imaging features have been explored for diagnosis and characterization of tumors. In this work, we invistigate combined whole-lesion radiomic and iodine analysis for the differentiation of pulmonary tumors on contrast-enhanced dual-energy CT (DECT) chest images. 100 biopsy-proven solid lung lesions on contrast-enhanced DECT chest exams within 3 months of histopathologic sampling were identified. Lesions were volumetrically segmented using open-source software. Lesion segmentations and iodine density volumes were loaded into a radiomics prototype for quantitative analysis. Univariate analysis was performed to determine differences in volumetric iodine concentration (mean, median, maximum, minimum, 10th percentile, 90th percentile) and first and higher order radiomic features (n = 1212) between pulmonary tumors. Analyses were performed using a 2-sample t test, and filtered for false discoveries using Benjamini–Hochberg method. 100 individuals (mean age 65 ± 13 years; 59 women) with 64 primary and 36 metastatic lung lesions were included. Only one iodine concentration parameter, absolute minimum iodine, significantly differed between primary and metastatic pulmonary tumors (FDR-adjusted p = 0.015, AUC 0.69). 310 (FDR-adjusted p = 0.0008 to p = 0.0491) radiomic features differed between primary and metastatic lung tumors. Of these, 21 features achieved AUC ≥ 0.75. In subset analyses of lesions imaged by non-CTPA protocol (n = 72), 191 features significantly differed between primary and metastatic tumors, 19 of which achieved AUC ≥ 0.75. In subset analysis of tumors without history of prior treatment (n = 59), 40 features significantly differed between primary and metastatic tumors, 11 of which achieved AUC ≥ 0.75. Volumetric radiomic analysis provides differentiating capability beyond iodine quantification. While a high number of radiomic features differentiated primary versus metastatic pulmonary tumors, fewer features demonstrated good individual discriminatory utility.
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Affiliation(s)
- Lea Azour
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA. .,NYU Langone Health, New York, NY, USA.
| | - Jane P Ko
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.,NYU Langone Health, New York, NY, USA
| | | | - Nihal Patel
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.,NYU Langone Health, New York, NY, USA
| | - Priya Bhattacharji
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - William H Moore
- Center for Biomedical Imaging, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.,NYU Langone Health, New York, NY, USA
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11
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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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12
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Murphy DJ, Ryan DT. The Lung-to-Tumor Interface for the Evaluation of Tumor Hypoxia. Radiology 2021; 302:457-459. [PMID: 34783599 DOI: 10.1148/radiol.2021211926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - David T Ryan
- From the Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
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13
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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: 19] [Impact Index Per Article: 6.3] [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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14
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Martin SS, van Assen M, Burchett P, Monti CB, Schoepf UJ, Ravenel J, Rieter WJ, Vogl TJ, Costello P, Gordon L, De Cecco CN. Prospective Evaluation of the First Integrated Positron Emission Tomography/Dual-Energy Computed Tomography System in Patients With Lung Cancer. J Thorac Imaging 2021; 36:382-388. [PMID: 34029282 DOI: 10.1097/rti.0000000000000597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this pilot study was to prospectively evaluate the first integrated positron emission tomography (PET)/dual-energy computed tomography (DECT) system performance in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS In this single-center, prospective trial, consecutive patients with NSCLC referred for a PET study between May 2017 and June 2018 were enrolled. All patients received contrast-enhanced imaging on a clinical PET/DECT system. Data analysis included PET-based standard uptake values (SUVmax) and DECT-based iodine densities of tumor masses, lymph nodes, and distant metastases. Results were analyzed using correlation tests and receiver operating characteristics curves. RESULTS The study population was composed of 21 patients (median age 62 y, 14 male patients). A moderate positive correlation was found between iodine density values (2.2 mg/mL) and SUVmax (10.5) in tumor masses (ρ=0.53, P<0.01). Iodine density values (2.3 mg/mL) and SUVmax (5.4) of lymph node metastases showed a weak positive correlation (ρ=0.23, P=0.14). In addition, iodine quantification analysis provided no added value in differentiating between pathologic and nonpathologic lymph nodes with an area under the curve (AUC) of 0.55 using PET-based SUVmax as the reference standard. A weak positive correlation was observed between iodine density (2.2 mg/mL) and SUVmax in distant metastases (14.9, ρ=0.23, P=0.52). CONCLUSIONS The application of an integrated PET/DECT system in lung cancer might provide additional insights in the assessment of tumor masses. However, the added value of iodine density quantification for the evaluation of lymph nodes and distant metastases seems limited.
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Affiliation(s)
- Simon S Martin
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marly van Assen
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Emory University, Atlanta, GA
| | - Philip Burchett
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milano, Italy
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - James Ravenel
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - William J Rieter
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philip Costello
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Leonie Gordon
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
| | - Carlo N De Cecco
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC
- Department of Radiology and Imaging Sciences, Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Emory University, Atlanta, GA
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Clinicopathological and computed tomographic features associated with occult lymph node metastasis in patients with peripheral solid non-small cell lung cancer. Eur J Radiol 2021; 144:109981. [PMID: 34624648 DOI: 10.1016/j.ejrad.2021.109981] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the value of combining clinicopathological characteristics with computed tomographic (CT) features of tumours for predicting occult lymph node metastasis (OLNM) in peripheral solid non-small cell lung cancer (PS-NSCLC). METHODS The study included 478 NSCLC clinically N0 (cN0) patients who underwent lobectomy and systemic lymph node dissection from January 2014 to August 2019. Patients were classified into OLNM and negative lymph node metastasis (NLNM) groups. The CT features of non-metastatic and metastatic lymph nodes with a largest short-diameter > 5 mm were compared in the OLNM group. Thereafter, the clinicopathological characteristics and CT morphological features of tumours were compared between both groups. Multivariable logistic regression analysis and receiver-operating characteristic curve were developed. RESULTS CT images detected 103 metastatic and 705 non-metastatic lymph nodes, and no significant differences in CT features of lymph nodes were found in all 161 OLNM patients (P > 0.05). For both groups, sex, carcinoembryonic antigen and pathological type differed significantly (all P < 0.05), while tumour size, necrosis, calcification, vascular convergence, pleural involvement, and the shortest interval of tumour-pleura differed significantly on CT images (all P < 0.05). Multivariable logistic regression analysis showed that carcinoembryonic antigen > 5.00 ng/ml, adenocarcinoma, absence of vascular convergence, and pleural involvement of Type II (one linear or cord-like pleural tag or tumour abut to the pleura with a broad base observed on both lung and mediastinal window images) were independent predicting factors of OLNM. CONCLUSIONS CT findings of lymph nodes can provide limited value and integrating clinicopathological characteristics with the CT morphological features of tumours is helpful in predicting OLNM in patients with PS-NSCLC.
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16
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Lennartz S, Mager A, Große Hokamp N, Schäfer S, Zopfs D, Maintz D, Reinhardt HC, Thomas RK, Caldeira L, Persigehl T. Texture analysis of iodine maps and conventional images for k-nearest neighbor classification of benign and metastatic lung nodules. Cancer Imaging 2021; 21:17. [PMID: 33499939 PMCID: PMC7836145 DOI: 10.1186/s40644-020-00374-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 12/18/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The purpose of this study was to analyze if the use of texture analysis on spectral detector CT (SDCT)-derived iodine maps (IM) in addition to conventional images (CI) improves lung nodule differentiation, when being applied to a k-nearest neighbor (KNN) classifier. METHODS 183 cancer patients who underwent contrast-enhanced, venous phase SDCT of the chest were included: 85 patients with 146 benign lung nodules (BLN) confirmed by either prior/follow-up CT or histopathology and 98 patients with 425 lung metastases (LM) verified by histopathology, 18F-FDG-PET-CT or unequivocal change during treatment. Semi-automatic 3D segmentation of BLN/LM was performed, and volumetric HU attenuation and iodine concentration were acquired. For conventional images and iodine maps, average, standard deviation, entropy, kurtosis, mean of the positive pixels (MPP), skewness, uniformity and uniformity of the positive pixels (UPP) within the volumes of interests were calculated. All acquired parameters were transferred to a KNN classifier. RESULTS Differentiation between BLN and LM was most accurate, when using all CI-derived features combined with the most significant IM-derived feature, entropy (Accuracy:0.87; F1/Dice:0.92). However, differentiation accuracy based on the 4 most powerful CI-derived features performed only slightly inferior (Accuracy:0.84; F1/Dice:0.89, p=0.125). Mono-parametric lung nodule differentiation based on either feature alone (i.e. attenuation or iodine concentration) was poor (AUC=0.65, 0.58, respectively). CONCLUSIONS First-order texture feature analysis of contrast-enhanced staging SDCT scans of the chest yield accurate differentiation between benign and metastatic lung nodules. In our study cohort, the most powerful iodine map-derived feature slightly, yet insignificantly increased classification accuracy compared to classification based on conventional image features only.
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Affiliation(s)
- Simon Lennartz
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Alina Mager
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Nils Große Hokamp
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - David Zopfs
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Hans Christian Reinhardt
- Clinic I of Internal Medicine, University Hospital Cologne, 50931, Cologne, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University Duisburg-Essen, German Cancer Consortium (DKTK partner site Essen), Essen, Germany
| | - Roman K Thomas
- Department of Translational Genomics, Center of Integrated Oncology Cologne-Bonn, Medical Faculty, University of Cologne, 50931, Cologne, Germany
| | - Liliana Caldeira
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Persigehl
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
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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: 6] [Impact Index Per Article: 2.0] [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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Sauter AP, Ostmeier S, Nadjiri J, Deniffel D, Rummeny EJ, Pfeiffer D. Iodine concentration of healthy lymph nodes of neck, axilla, and groin in dual-energy computed tomography. Acta Radiol 2020; 61:1505-1511. [PMID: 32064891 DOI: 10.1177/0284185120903448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Lymph nodes (LN) are examined in every computed tomography (CT) scan. Until now, an evaluation is only possible based on morphological criteria. With dual-energy CT (DECT) systems, iodine concentration (IC) can be measured which could conduct in an improved diagnostic evaluation of LNs. PURPOSE To define standard values for IC of cervical, axillary, and inguinal LNs in DECT. MATERIAL AND METHODS Imaging data of 297 patients who received a DECT scan of the neck, thorax, abdomen-pelvis, or a combination of those in a portal-venous phase were retrospectively collected from the institutional PACS. No present history of malignancy, inflammation, or trauma in the examined region was present. For each examined region, the data of 99 patients were used. The IC of the three largest LNs, the main artery, the main vein, and a local muscle of the examined area was measured, respectively. RESULTS Normalization of the IC of LNs to the artery, vein, muscle, or a combination of those did not lead to a decreased value-range. The smallest range and confidence interval (CI) of IC was found when using absolute values of IC for each region. Hereby, mean values (95% CI) for IC of LN were found: 2.09 mg/mL (2.00-2.18 mg/mL) for neck, 1.24 mg/mL (1.16-1.33 mg/mL) for axilla, and 1.11 mg/mL (1.04-1.17 mg/mL) for groin. CONCLUSION The present study suggests standard values for IC of LNs in dual-layer CT could be used to differentiate between healthy and pathological lymph nodes, considering the used contrast injection protocol.
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Affiliation(s)
- Andreas P Sauter
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Sophie Ostmeier
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Jonathan Nadjiri
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Dominik Deniffel
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Ernst J Rummeny
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Daniela Pfeiffer
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
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Histological subtypes of solid-dominant invasive lung adenocarcinoma: differentiation using dual-energy spectral CT. Clin Radiol 2020; 76:77.e1-77.e7. [PMID: 33121736 DOI: 10.1016/j.crad.2020.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/21/2020] [Indexed: 01/15/2023]
Abstract
AIM To investigate the value of dual-energy spectral computed tomography (DESCT) for evaluating the histological subtypes of solid-dominant invasive lung adenocarcinoma (SILADC). MATERIALS AND METHODS Sixty-seven patients with SILADC were enrolled. All patients underwent DESCT and were divided into Group I (those with a lepidic/acinar/papillary predominant pattern) and Group II (those with a solid/micropapillary predominant pattern) based on their correlation with prognosis. Patient clinicopathological characteristics, DESCT morphological features, and quantitative parameters of the tumours were compared between both groups. Multiparametric analysis was performed using binary logistic regression with DESCT findings. Receiver operating characteristic (ROC) curves were used to assess the diagnostic performance of single-parameter and multiparametric analysis. RESULTS Patient gender, lymph nodes status, pathological TNM stage, and histological differentiation significantly differed between the two groups (all p<0.05). Moreover, significant differences were observed between both groups in DESCT morphological features including tumour size, necrosis, calcification, air bronchogram, and vascular convergence sign, and quantitative parameters including K40-65 keV, effective atomic number, and water concentration on unenhanced CT and iodine concentration in the arterial and venous phases (all p<0.05). Multiparametric analysis showed that tumour size, air bronchogram, K40-65 keV and effective atomic number on unenhanced CT were the most effective variations for predicting the histological subtypes of SILADC and obtained an area under the ROC curve (AUC) of 0.906. CONCLUSIONS DESCT was useful for differentiating histological subtypes with different prognosis of SILADC.
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Huang WH, Jhan KJ, Yang CC. Investigating the feasibility of generating dual-energy CT from one 120-kVp CT scan: a phantom study. J Appl Clin Med Phys 2020; 22:126-137. [PMID: 33426800 PMCID: PMC7882117 DOI: 10.1002/acm2.13148] [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: 08/26/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction This study aimed to investigate the feasibility of generating pseudo dual‐energy CT (DECT) from one 120‐kVp CT by using convolutional neural network (CNN) to derive additional information for quantitative image analysis through phantom study. Methods Dual‐energy scans (80/140 kVp) and single‐energy scans (120 kVp) were performed for five calibration phantoms and two evaluation phantoms on a dual‐source DECT scanner. The calibration phantoms were used to generate training dataset for CNN optimization, while the evaluation phantoms were used to generate testing dataset. A CNN model which takes 120‐kVp images as input and creates 80/140‐kVp images as output was built, trained, and tested by using Caffe CNN platform. An in‐house software to quantify contrast enhancement and synthesize virtual monochromatic CT (VMCT) for CNN‐generated pseudo DECT was implemented and evaluated. Results The CT numbers in 80‐kVp pseudo images generated by CNN are differed from the truth by 11.57, 16.67, 13.92, 12.23, 10.69 HU for syringes filled with iodine concentration of 2.19, 4.38, 8.75, 17.5, 35 mg/ml, respectively. The corresponding results for 140‐kVp CT are 3.09, 9.10, 7.08, 9.81, 7.59 HU. The estimates of iodine concentration calculated based on the proposed method are differed from the truth by 0.104, 0.603, 0.478, 0.698, 0.795 mg/ml for syringes filled with iodine concentration of 2.19, 4.38, 8.75, 17.5, 35 mg/ml, respectively. With regards to image quality enhancement, VMCT synthesized by using pseudo DECT shows the best contrast‐to‐noise ratio at 40 keV. Conclusion In conclusion, the proposed method should be a practicable strategy for iodine quantification in contrast enhanced 120‐kVp CT without using specific scanner or scanning procedure.
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Affiliation(s)
- Wen-Hui Huang
- Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Kai-Jie Jhan
- Department of Nuclear Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ching-Ching Yang
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
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Hering DA, Kröger K, Bauer RW, Eich HT, Haverkamp U. Comparison of virtual non-contrast dual-energy CT and a true non-contrast CT for contouring in radiotherapy of 3D printed lung tumour models in motion: a phantom study. Br J Radiol 2020; 93:20200152. [PMID: 33002387 DOI: 10.1259/bjr.20200152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES This work aims to investigate whether virtual non-contrast (VNC) dual-energy CT(DECT) of contrasted lung tumours can be used as an alternative for true non-contrast (TNC) images in radiotherapy. Two DECT techniques and a TNC CT were compared and influences on gross tumour volume (GTV) volume and CT number from motion artefacts in three-dimensional printed lung tumour models (LTM) in amotion phantom were examined. METHODS Two spherical LTMs (diameter 3.0 cm) with different inner shapes were created in a three-dimensional printer. The inner shapes contained water or iodine (concentration 5 mg ml-1) and were scanned with a dual-source DECT (ds-DECT), single-source sequential DECT (ss-DECT) and TNC CT in a respiratory motion phantom (15 breaths/min, amplitude 1.5 cm). CT number and volume of LTMs were measured. Therefore, two GTVs were contoured. RESULTS Deviations in GTV volume (outer shape) of LTMs in motion for contrast-enhanced ss-DECT and ds-DECT VNC images compared to TNC images are not significant (p > 0.05). Relative GTV volume and CT number deviations (inner shapes) of LTMs in motion were 6.6 ± 0.6% and 104.4 ± 71.2 HU between ss-DECT and TNC CT and -8.4 ± 10.6% and 25.5 ± 58.5 HU between ds-DECT and TNC, respectively. CONCLUSION ss-DECT VNC images could not sufficiently subtract iodine from water in LTMs inmotion, whereas ds-DECT VNC images might be a valid alternative to a TNC CT. ADVANCES IN KNOWLEDGE ds-DECT provides a contrasted image for contouring and a non-contrasted image for radiotherapy treatment planning for LTM in motion.
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Affiliation(s)
| | - Kai Kröger
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
| | - Ralf W Bauer
- RNS, Private Radiology and Radiation Therapy Group, Wiesbaden, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital of Muenster, Muenster, Germany
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Spectral CT in Lung Cancer: Usefulness of Iodine Concentration for Evaluation of Tumor Angiogenesis and Prognosis. AJR Am J Roentgenol 2020; 215:595-602. [PMID: 32569515 DOI: 10.2214/ajr.19.22688] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE. The purpose of this study was to investigate the correlation between iodine concentration (IC) derived from spectral CT and angiogenesis and the relationships between IC and clinical-pathologic features associated with lung cancer prognosis. SUBJECTS AND METHODS. Sixty patients with lung cancer were enrolled and underwent spectral CT. The IC, IC difference (ICD), and normalized IC (NIC) of tumors were measured in the arterial phase, venous phase (VP), and delayed phase. The microvessel densities (MVDs) of CD34-stained specimens were evaluated. Correlation analysis was performed for IC and MVD. The relationships between the IC index showing the best correlations with MVD and clinical-pathologic findings of pathologic types, histologic differentiation, tumor size, lymph node status, pathologic TNM stage, and intratumoral necrosis were investigated. RESULTS. The mean (± IQR) MVD of all tumors was 42.00 ± 27.50 vessels per field at ×400 magnification, with two MVD distribution types. The MVD of lung cancer correlated positively with the IC, ICD, and NIC on three-phase contrast-enhanced scanning (r range, 0.581-0.800; all p < 0.001), and the IC in the VP showed the strongest correlation with MVD (r = 0.800; p < 0.001). The correlations between IC and MVD, ICD and MVD, and NIC and MVD varied depending on whether the same scanning phase or same IC index was used. The IC in the VP showed statistically significant differences in the pathologic types of adenocarcinoma and squamous cell carcinoma, histologic differentiation, tumor size, and status of intratumoral necrosis of lung cancer (p < 0.05), but was not associated with nodal metastasis and pathologic TNM stages (p > 0.05). CONCLUSION. IC indexes derived from spectral CT, especially the IC in the VP, were useful indicators for evaluating tumor angiogenesis and prognosis.
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Kahn J, Kocher MR, Waltz J, Ravenel JG. Advances in Lung Cancer Imaging. Semin Roentgenol 2020; 55:70-78. [PMID: 31964483 DOI: 10.1053/j.ro.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jacob Kahn
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC
| | - Madison R Kocher
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC
| | - Jeffrey Waltz
- Department of Radiology and Radiological Sciences, Medical University of South Carolina, Charleston, SC
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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: 42] [Impact Index Per Article: 10.5] [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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Lennartz S, Abdullayev N, Zopfs D, Borggrefe J, Neuhaus VF, Persigehl T, Haneder S, Große Hokamp N. Intra-individual consistency of spectral detector CT-enabled iodine quantification of the vascular and renal blood pool. Eur Radiol 2019; 29:6581-6590. [DOI: 10.1007/s00330-019-06266-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 01/15/2023]
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Spectral CT and its specific values in the staging of patients with non-small cell lung cancer: technical possibilities and clinical impact. Clin Radiol 2019; 74:456-466. [PMID: 30905380 DOI: 10.1016/j.crad.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 02/12/2019] [Indexed: 12/25/2022]
Abstract
AIM To investigate how spectral computed tomography (SCT) values impact the staging of non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS One hundred and thirteen patients with confirmed NSCLC were included in a prospective cohort study. All patients underwent single-phase contrast-enhanced SCT (using the fast tube voltage switching technique, 80-140 kV). SCT values (iodine content [IC], spectral slope pitch, and radiodensity increase) of malignant tissue (primary and metastases) and lymph nodes (LNs) were measured. Adrenal masses were evaluated in a virtual non-contrast series (VNS). If pulmonary embolism was present, pulmonary perfusion was analysed as an additional finding. RESULTS Fifty-two untreated primary NSCLC lesions were evaluable. Lung adenocarcinoma had significantly higher normalised IC (NIC: 19.37) than squamous cell carcinoma (NIC: 12.03; p=0.035). Pulmonary metastases were not significantly different from benign lung nodules. A total of 126 LNs were analysed and histologically proven metastatic LNs (2.08 mg/ml) had significantly lower IC than benign LNs (2.58 mg/ml; p=0.023). Among 34 adrenal masses, VNS identified adenomas with high sensitivity (91%) and specificity (100%). In two patients, a perfusion defect due to pulmonary embolism was detected in the iodine images. CONCLUSION SCT may contribute to the differentiation of histological NSCLC subtypes and improve the identification of LN metastases. VNS differentiates adrenal adenoma from metastasis. In case of pulmonary embolism, iodine imaging can visualise associated pulmonary perfusion defects.
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Al-Najami I, Mahmoud Sheta H, Baatrup G. Differentiation between malignant and benign rectal tumors by dual-energy computed tomography - a feasibility study. Acta Oncol 2019; 58:S55-S59. [PMID: 30764692 DOI: 10.1080/0284186x.2019.1574404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION To assess the performance of Dual Energy Computed Tomography (DECT) in the differentiation between benign and malignant tumors in the rectum. MATERIAL AND METHODS We enrolled 8 subjects with rectal tumors suspected to be an early rectal cancer during colonoscopy. All subjects underwent Computed Tomography (CT), Magnetic Resonance Imaging (MRI) and Endorectal Ultrasound (ERUS) for staging. Furthermore, all subjects underwent fast switching of tube voltage between 80 and 140 kVp DECT of the pelvis. The 8 subjects had histopathological verified benign adenomas after transanal endoscopic microsurgery resection (TEM). The 8 subjects were matched with 8 consecutively selected subjects with histopathologically verified malignant rectal tumors. The DECT images were analyzed to assess the difference between malignant and benign rectal tumors. All DECT images were reviewed by experienced radiologists. In each DECT scanning, we applied three regions of interest (ROIs) for the acquisition of the DECT unique quantitative parameters. The mean atomic mass (effective Z value), iodine concentration, dual energy ratio (DER) and dual-energy index (DEI) was determined in both groups. RESULTS The comparison of the 2 groups showed a significant difference in effective Z and a nonsignificant difference regarding iodine concentration, DER, and DEI in the two groups. CONCLUSION Dual-energy CT demonstrated a difference in the mean atomic mass in benign colorectal tumors in comparison to malignant colorectal tumors.
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Affiliation(s)
- Issam Al-Najami
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hussam Mahmoud Sheta
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medical Research, OUH Svendborg Hospital, Svendborg, Denmark
| | - Gunnar Baatrup
- Department of Surgery, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Lennartz S, Le Blanc M, Zopfs D, Große Hokamp N, Abdullayev N, Laukamp KR, Haneder S, Borggrefe J, Maintz D, Persigehl T. Dual-Energy CT-derived Iodine Maps: Use in Assessing Pleural Carcinomatosis. Radiology 2019; 290:796-804. [PMID: 30644812 DOI: 10.1148/radiol.2018181567] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the use of spectral CT for differentiation between noncalcified benign pleural lesions and pleural carcinomatosis. Materials and Methods In this retrospective study, patients who underwent contrast agent-enhanced late venous phase spectral CT of the chest between June 1, 2016, and July 1, 2018 with histopathologic and/or imaging confirmation of noncalcified pleural lesions were evaluated. Conventional images, iodine overlay (IO) images, and virtual monoenergetic images at 40 keV (hereafter, VMI40keV) were reconstructed from contrast-enhanced spectral chest CT. Four blinded radiologists determined lesion presence and indicated lesion conspicuity and diagnostic certainty. Hounsfield unit attenuation from conventional images and iodine concentration (IC) (in milligrams per milliliter) from IO images were determined. Area under the receiver operating characteristics curve determined thresholds for quantitative lesion differentiation and cutoff values were validated in an independent data set. Results Eighty-four patients were included (mean age, 66.2 years; 54 men and 30 women; 44 patients with cancer with confirmed pleural carcinomatosis and 40 patients with benign pleural lesions). The area under the receiver operating characteristics curve for IC was greater than that of conventional Hounsfield units (0.96 vs 0.91; P ≤ .05, respectively). The optimal IC threshold was 1.3 mg/mL, with comparable sensitivity and specificity when applied to the test data set. The sensitivities to depict pleural carcinomatosis with spectral reconstructions versus conventional CT were 96% (199 of 208) and 83% (172 of 208), respectively, with specificities of 84% (161 of 192) and 63% (120 of 192), respectively (P ≤ .001 each). Conclusion Compared with conventional images, spectral CT with iodine maps improved both quantitative and qualitative determination of pleural carcinomatosis versus noncalcified benign pleural lesions. © RSNA, 2019 See also the editorial by K. S. Lee and H. Y. Lee .
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Affiliation(s)
- Simon Lennartz
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Markus Le Blanc
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - David Zopfs
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Nils Große Hokamp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Nuran Abdullayev
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Kai Roman Laukamp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Stefan Haneder
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Jan Borggrefe
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - David Maintz
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
| | - Thorsten Persigehl
- From the Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Cologne, Germany (S.L., M.L.B., D.Z., N.G.H., N.A., K.R.L., S.H., J.B., D.M., T.P.); and Department of Radiology, Case Western Reserve University and University Hospitals, Cleveland, Ohio (N.G.H., K.R.L.)
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Lee DH, Lee YH, Seo HS, Lee KY, Suh S, Ryoo I, You S, Kim B, Yang K. Dual‐energy CT iodine quantification for characterizing focal thyroid lesions. Head Neck 2018; 41:1024-1031. [DOI: 10.1002/hed.25524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Do Hyung Lee
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Young Hen Lee
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Hyung Suk Seo
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Ki Yeol Lee
- Department of RadiologyAnsan Hospital, Korea University College of Medicine Ansan Republic of Korea
| | - Sang‐il Suh
- Department of RadiologyGuro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Inseon Ryoo
- Department of RadiologyGuro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Sung‐Hye You
- Department of RadiologyAnam Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Byungjun Kim
- Department of RadiologyAnam Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Kyung‐Sook Yang
- Department of BiostatisticsKorea University College of Medicine Seoul Republic of Korea
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Chen X, Fang M, Dong D, Wei X, Liu L, Xu X, Jiang X, Tian J, Liu Z. A Radiomics Signature in Preoperative Predicting Degree of Tumor Differentiation in Patients with Non-small Cell Lung Cancer. Acad Radiol 2018; 25:1548-1555. [PMID: 29572049 DOI: 10.1016/j.acra.2018.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 02/18/2018] [Accepted: 02/25/2018] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES Poorly differentiated non-small cell lung cancer (NSCLC) indicated a poor prognosis and well-differentiated NSCLC indicates a noninvasive nature and good prognosis. The purpose of this study was to build and validate a radiomics signature to predict the degree of tumor differentiation (DTD) for patients with NSCLC. MATERIALS AND METHODS A total of 487 patients with pathologically diagnosed NSCLC were retrospectively included in our study. Five hundred ninety-one radiomics features were extracted from each tumor from the contrast-enhanced computed tomography images. A minimum redundancy maximum relevance algorithm and a logistic regression model were used for dimension reduction, feature selection, and radiomics signature building. The performance of the radiomics signature was assessed using receiver operating characteristic analysis, and the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy were calculated to quantify the association between a signature and DTD. An independent validation set contained 184 consecutive patients with NSCLC. RESULTS A nine-radiomics-feature-based signature was built and it could differentiate low and high DTDs in the training set (AUC = 0.763, sensitivity = 0.750, specificity = 0.665, and accuracy = 0.687), and the radiomics signature had good discrimination performance in the validation set (AUC = 0.782, sensitivity = 0.608, specificity = 0.752, and accuracy = 0.712). CONCLUSIONS A radiomics signature based on contrast-enhanced computed tomography imaging is a potentially useful imaging biomarker for differentiating low from high DTD in patients with NSCLC.
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Affiliation(s)
- Xin Chen
- The Second School of Clinical Medicine, Southern Medical University, 1023 Shatai Nan Road, Guangzhou, 510515, China; Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China; Department of Radiology, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, 1 Panfu Road, Guangzhou, China
| | - Mengjie Fang
- University of Chinese Academy of Sciences, 95 Zhongguancun Dong Road, Beijing, 100190, China
| | - Di Dong
- University of Chinese Academy of Sciences, 95 Zhongguancun Dong Road, Beijing, 100190, China
| | - Xinhua Wei
- Department of Radiology, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, 1 Panfu Road, Guangzhou, China
| | - Lingling Liu
- Department of Radiology, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, 1 Panfu Road, Guangzhou, China
| | - Xiangdong Xu
- Department of Radiology, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, 1 Panfu Road, Guangzhou, China
| | - Xinqing Jiang
- Department of Radiology, Guangzhou First People's Hospital, The Second Affiliated Hospital of South China University of Technology, 1 Panfu Road, Guangzhou, China
| | - Jie Tian
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China; University of Chinese Academy of Sciences, 95 Zhongguancun Dong Road, Beijing, 100190, China.
| | - Zaiyi Liu
- The Second School of Clinical Medicine, Southern Medical University, 1023 Shatai Nan Road, Guangzhou, 510515, China; Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, China.
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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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Effect of CT Acquisition Parameters on Iodine Density Measurement at Dual-Layer Spectral CT. AJR Am J Roentgenol 2018; 211:748-754. [PMID: 30085834 DOI: 10.2214/ajr.17.19381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We aimed to evaluate the effect of tube voltage, tube current-time product, and iterative reconstruction on iodine quantification using a dual-layer spectral CT scanner. MATERIALS AND METHODS Two mediastinal iodine phantoms, each containing six tubes of different iodine concentrations (0, 1, 2.5, 5, 10, and 20 mg I/mL; the two phantoms had tubes with contrast media diluted in water and in 10% amino acid solution, respectively), were inserted into an anthropomorphic chest phantom and scanned with varying acquisition parameters (120 and 140 kVp; 20, 40, 60, 80, 100, 150, and 200 mAs; and spectral reconstruction levels 0 and 6). Thereafter, iodine density was measured (in milligrams of iodine per milliliter) using a dedicated software program, and the effect of acquisition parameters on iodine density and on its relative measurement error (RME) was analyzed using a linear mixed-effects model. RESULTS Tube voltages (all, p < 0.001) and tube current-time products (p < 0.05, depending on the interaction terms for iodine density; p = 0.023 for RME) had statistically significant effects on iodine density and RME. However, the magnitude of their effects was minimal. That is, estimated differences between tube voltage settings ranged from 0 to 0.8 mg I/mL for iodine density and from 1.0% to 4.2% for RME. For tube current-time product, alteration of 100 mAs caused changes in iodine density and RME of approximately 0.1 mg I/mL and 0.6%, respectively. Spectral level was not an affecting factor for iodine quantification (p = 0.647 for iodine density and 0.813 for RME). CONCLUSION Iodine quantification using dual-layer spectral CT was feasible irrespective of CT acquisition parameters because their effects on iodine density and RME were minimal.
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Dual-Energy Computed Tomography-Based Iodine Quantitation for Response Evaluation of Lung Cancers to Chemoradiotherapy/Radiotherapy: A Comparison With Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-Based Positron Emission Tomography/Computed Tomography Response Evaluation Criterion in Solid Tumors. J Comput Assist Tomogr 2018; 42:614-622. [PMID: 29613988 DOI: 10.1097/rct.0000000000000734] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the correlation between dual-energy computed tomography (DECT)-based iodine quantitation and fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging for response evaluation of lung cancers to treatment. METHODS In this prospective study, a total of 32 pairs of DECT and F-FDG PET/CT imaging acquired consecutively from 13 patients with primary or metastatic lung cancers receiving either radiotherapy alone or chemoradiotherapy were analyzed. Imaging examinations were performed before, immediately, and no later than 6 months after treatment for response evaluation. Iodine-related parameters including the total iodine uptake (TIU) and vital volume (VIV) from DECT and metabolic metrics such as the standardized uptake value normalized to lean body mass (SULpeak), metabolic tumor volume (MTV), and the total lesion glycolysis (TLG) from F-FDG-PET/CT were generated and measured by semiautomatic approaches. Dual-energy CT and PET/CT metrics were calculated and followed up with comparison with response evaluation criteria in solid tumors (RECIST). RESULTS Analysis of pretreatment imaging data revealed a strong correlation between DECT metrics (RECIST, TIU, and VIV) and F-FDG PET/CT metrics (MTV, TLG) with coefficients of R ranging from 0.86 to 0.90 (P < 0.01). With the delivery of treatment, all measured DECT and PET/CT metrics significantly decreased whereas the descending amplitude in RECIST was significantly smaller than that of the remaining parameters (P < 0.05). During follow-up examinations, both metrics followed a similar changing pattern. Overall, strong consistency was found between RECIST, TIU, VIV and SULpeak, MTV, TLG (R covers 0.78-0.96, P < 0.05). CONCLUSIONS Semiautomatic iodine-related quantitation in DECT correlated well with metabolism-based measurements in F-FDG PET/CT, suggesting that DECT-based iodine quantitation might be a feasible substitute for assessment of lung cancer response to chemoradiotherapy/radiotherapy with comparison with F-FDG PET/CT.
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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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Morgan DE. The Role of Dual-Energy Computed Tomography in Assessment of Abdominal Oncology and Beyond. Radiol Clin North Am 2018; 56:565-585. [PMID: 29936948 DOI: 10.1016/j.rcl.2018.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The added value and strength of dual energy computed tomography for the evaluation of oncologic patients revolve around the use of lower energy reconstructed images and iodine material density images. Lower keV simulated monoenergetic images optimize soft tissue tumor to nontumoral attenuation differences and increase contrast to noise ratios to improve lesion detection. Iodine material density images or maps are helpful from a qualitative standpoint for image interpretation because they result in improved detection and characterization of tumors and lymph node involvement, and from a quantitative assessment by enabling interrogation of specific properties of tissues to predict and assess therapeutic response.
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Affiliation(s)
- Desiree E Morgan
- Department of Radiology University of Alabama at Birmingham, 619 19th Street South, JTN 456, Birmingham, AL 35249-6830, USA.
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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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Comparison of Iodine Density Measurement Among Dual-Energy Computed Tomography Scanners From 3 Vendors. Invest Radiol 2018; 53:321-327. [DOI: 10.1097/rli.0000000000000446] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Lin LY, Zhang Y, Suo ST, Zhang F, Cheng JJ, Wu HW. Correlation between dual-energy spectral CT imaging parameters and pathological grades of non-small cell lung cancer. Clin Radiol 2018; 73:412.e1-412.e7. [DOI: 10.1016/j.crad.2017.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/02/2017] [Indexed: 02/07/2023]
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Dai C, Cao Y, Jia Y, Ding Y, Sheng R, Zeng M, Zhou J. Differentiation of renal cell carcinoma subtypes with different iodine quantification methods using single-phase contrast-enhanced dual-energy CT: areal vs. volumetric analyses. Abdom Radiol (NY) 2018; 43:672-678. [PMID: 28721478 DOI: 10.1007/s00261-017-1253-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the possibility of iodine quantification during a single nephrographic phase in characterizing renal cell carcinoma (RCC) subtypes and if there is a difference between areal and volumetric iodine quantification methods. MATERIALS AND METHODS This retrospective study included 110 patients with 113 histopathologically confirmed RCCs scanned by dual-energy CT at the nephrographic phase before surgeries. For each lesion, an areal measurement of the iodine concentration with maximum enhancement (I max enhan) and the iodine concentration with maximum area among slices (I max area), as well as a volumetric iodine concentration of the whole-tumor (I volume), were evaluated by two independent radiologists. The diagnostic performances in a single nephrographic phase for characterizing RCC subtypes were evaluated, and three iodine quantification methods were compared with each other. RESULTS There were significant differences (clear cell vs. papillary and clear cell vs. chromophobe RCC) and no significant differences (papillary vs. chromophobe RCC) at the nephrographic phase in all three methods. The area under the receiver operating characteristic (ROC) curve (AUC) derived from the I max enhan for discriminating clear cell from papillary RCC was significantly higher than that derived from the I max area (P = 0.0357) and the I volume (P = 0.0206), and no significant differences existed among the three methods in distinguishing clear cell RCC from chromophobe RCC. The reliability of all three parameters was very high with an interclass correlation coefficient (ICC) exceeding 0.8. CONCLUSIONS Iodine quantification in a single nephrographic phase can be used to differentiate RCC subtypes preoperatively, and the areal maximum enhancement iodine quantification would probably be the most appropriate approach.
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Affiliation(s)
- Chenchen Dai
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yingli Cao
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yan Jia
- Siemens Healthineer, No. 278, Zhouzhu Road, Pudong New District, Shanghai, 201318, China
| | - Yuqin Ding
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Ruofan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Institute of Medical Imaging, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jianjun Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Institute of Medical Imaging, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, 200032, China.
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Ito R, Iwano S, Shimamoto H, Umakoshi H, Kawaguchi K, Ito S, Kato K, Naganawa S. A comparative analysis of dual-phase dual-energy CT and FDG-PET/CT for the prediction of histopathological invasiveness of non-small cell lung cancer. Eur J Radiol 2017; 95:186-191. [PMID: 28987666 DOI: 10.1016/j.ejrad.2017.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/07/2017] [Accepted: 08/11/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare dual-phase dual-energy CT (DE-CT) with FDG-PET/CT for predicting histopathological locoregional invasiveness of non-small cell lung cancers (NSCLCs). MATERIALS AND METHODS We selected 63 consecutive patients with NSCLC lesions (37 males, 26 females; age range, 44-85 years; mean age, 69 years) who were evaluated preoperatively by both DE-CT and PET/CT at our institution. Postoperative microscopic invasiveness (lymphatic permeation, vascular invasion, and/or pleural involvement) was reviewed, and we defined locoregionally invasive tumors as those that had at least one positive finding of microscopic invasiveness. DE-CT scanning in the arterial and delayed phases was performed after injection of iodinated contrast media using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation of primary tumors in the arterial and delayed phases was quantified automatically using "syngo Dual Energy Lung Nodules" application software, and the ratio of arterial phase to delayed phase enhancement (A/D ratio) was calculated. The A/D ratio and SUVmax on PET/CT were evaluated with respect to postoperative invasiveness by univariate logistic regression analysis. RESULTS The A/D ratio was significantly correlated with lymphatic permeation, vascular invasion, and pleural involvement (p=0.011, p=0.021, and p=0.010, respectively). In contrast, the SUVmax was significantly correlated with pleural involvement (p=0.020) but not with lymphatic permeation or vascular invasion (p=0.088 and p=0.100, respectively). In the subgroup of patients with lesion diameters ≤2cm, the A/D ratio was significantly correlated with locoregional invasiveness (p=0.040), while the SUVmax was not (p=0.121). CONCLUSION For the prediction of microscopic invasiveness of NSCLCs, the diagnostic performance of dual-phase DE-CT may be comparable to that of FDG-PET/CT.
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Affiliation(s)
- Rintaro Ito
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Shingo Iwano
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan.
| | - Hironori Shimamoto
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Hiroyasu Umakoshi
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Koji Kawaguchi
- Nagoya University Graduate School of Medicine, Department of Thoracic Surgery, Japan
| | - Shinji Ito
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
| | - Katsuhiko Kato
- Nagoya University Graduate School of Medicine, Department of Radiological and Medical Laboratory Sciences, Japan
| | - Shinji Naganawa
- Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan
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Iwano S. Planning video-assisted thoracic surgery segmentectomy using three dimensional computed tomography angiography and bronchography with a virtual safety margin. J Vis Surg 2017; 3:82. [PMID: 29078645 DOI: 10.21037/jovs.2017.04.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/09/2017] [Indexed: 12/27/2022]
Abstract
In segmentectomy using video-assisted thoracic surgery (VATS), surgeons view the operative field on a 2-dimensional video monitor. The lack of ability to palpate organs directly frequently leads to difficulties in evaluating anatomic relations. Three-dimensional computed tomography angiography and bronchography (3D-CTAB) using a virtual 3D safety margin enables thoracic surgeons to recognize the distance and positional relation between the primary tumor and intersegmental veins. It also helps with surgical planning, allowing the surgeon to secure an adequate safety margin around the primary tumor. We report two patients with double primary lung cancer who underwent segmentectomy based on preoperative simulation 3D-CTAB with a virtual 3D safety margin.
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Affiliation(s)
- Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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González-Pérez V, Arana E, Barrios M, Bartrés A, Cruz J, Montero R, González M, Deltoro C, Martínez-Pérez E, De Aguiar-Quevedo K, Arrarás M. Differentiation of benign and malignant lung lesions: Dual-Energy Computed Tomography findings. Eur J Radiol 2016; 85:1765-1772. [DOI: 10.1016/j.ejrad.2016.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/29/2022]
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Aoki M, Akimoto H, Sato M, Hirose K, Kawaguchi H, Hatayama Y, Seino H, Kakehata S, Tsushima F, Fujita H, Fujita T, Fujioka I, Tanaka M, Miura H, Ono S, Takai Y. Impact of pretreatment whole-tumor perfusion computed tomography and 18F-fluorodeoxyglucose positron emission tomography/computed tomography measurements on local control of non-small cell lung cancer treated with stereotactic body radiotherapy. JOURNAL OF RADIATION RESEARCH 2016; 57:533-540. [PMID: 27296251 PMCID: PMC5045076 DOI: 10.1093/jrr/rrw045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/23/2016] [Indexed: 05/08/2023]
Abstract
This study aimed to investigate the correlation between the average iodine density (AID) detected by dual-energy computed tomography (DE-CT) and the maximum standardized uptake value (SUVmax) yielded by [18F] fluorodeoxyglucose positron emission tomography (18F-FDG PET) for non-small cell lung cancer (NSCLC) treated with stereotactic body radiotherapy (SBRT). Seventy-four patients with medically inoperable NSCLC who underwent both DE-CT and 18F-FDG PET/CT before SBRT (50‒60 Gy in 5‒6 fractions) were followed up after a median interval of 24.5 months. Kaplan-Meier analysis was used to determine associations between local control (LC) and variables, including AID, SUVmax, tumor size, histology, and prescribed dose. The median AID and SUVmax were 18.64 (range, 1.18-45.31) (100 µg/cm3) and 3.2 (range, 0.7-17.6), respectively. No correlation was observed between AID and SUVmax Two-year LC rates were 96.2% vs 75.0% (P = 0.039) and 72.0% vs 96.2% (P = 0.002) for patients classified according to high vs low AID or SUVmax, respectively. Two-year LC rates for patients with adenocarcinoma vs squamous cell carcinoma vs unknown cancer were 96.4% vs 67.1% vs 92.9% (P = 0.008), respectively. Multivariate analysis identified SUVmax as a significant predictor of LC. The 2-year LC rate was only 48.5% in the subgroup of lower AID and higher SUVmax vs >90% (range, 94.4-100%) in other subgroups (P = 0.000). Despite the short follow-up period, a reduction in AID and subsequent increase in SUVmax correlated significantly with local failure in SBRT-treated NSCLC patients. Further studies involving larger populations and longer follow-up periods are needed to confirm these results.
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Affiliation(s)
- Masahiko Aoki
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Hiroyoshi Akimoto
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Mariko Sato
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Katsumi Hirose
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10 Yatsuyamada, 963-8052 Koriyama, Fukushima, Japan
| | - Hideo Kawaguchi
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Yoshiomi Hatayama
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Hiroko Seino
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Shinya Kakehata
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Fumiyasu Tsushima
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Hiromasa Fujita
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Tamaki Fujita
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Ichitaro Fujioka
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Mitsuki Tanaka
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Hiroyuki Miura
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Shuichi Ono
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
| | - Yoshihiro Takai
- Department of Radiology and Radiation Oncology, Graduate School of Medicine, Hirosaki University, 5 Zaifu-cho, 036-8562 Hirosaki, Aomori, Japan
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Shimamoto H, Iwano S, Umakoshi H, Kawaguchi K, Naganawa S. Evaluation of locoregional invasiveness of small-sized non-small cell lung cancers by enhanced dual-energy computed tomography. Cancer Imaging 2016; 16:18. [PMID: 27455976 PMCID: PMC4960863 DOI: 10.1186/s40644-016-0077-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/19/2016] [Indexed: 12/26/2022] Open
Abstract
Background To investigate the correlation between iodine-related attenuation of dual-energy computed tomography (DE-CT) and the histopathological invasiveness of surgically resected primary non-small cell lung cancers (NSCLCs) ≤ 3 cm in diameter. Methods We selected 63 consecutive NSCLC lesions from 60 patients (32 males, 28 females; age range, 39–85 years; mean age, 68 years). 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 “lung nodule” application software. The corrected 3D-IRA normalized to the patient’s body weight and contrast medium concentration was then calculated. Single-factor analysis of variance (ANOVA) was used for comparison among tumor differentiation grade groups. Univariate and multivariate logistic regression analysis was used for the correlation between locoregional invasive tumor and clinical factors. Results Resected tumors were histopathologically classified into well-differentiated (G1; n = 24), moderately-differentiated (G2; n = 28), and poorly-differentiated (G3; n = 11) groups by degree of tumor differentiation. The mean ± standard deviation of the 3D-IRA was 56.1 ± 22.6 HU in G1 tumours, 48.5 ± 23.9 HU in G2 tumours, and 28.4 ± 15.8 HU in G3 tumours; significant differences were observed between groups by ANOVA. (p = 0.005). Univariate logistic analysis showed that the 3D-IRA and corrected 3D-IRAs were significantly correlated with locoregional invasive tumors (p = 0.002 and p < 0.001, respectively). Multivariate logistic analysis revealed that only the corrected 3D-IRA was significantly correlated with tumor invasiveness (p = 0.003), while gender, clinical size, and solid/subsolid type were not (p = 0.950, p = 0.057 and p = 0.456, respectively). Conclusions The 3D-IRA of small-sized NSCLCs was significantly associated with and invasiveness. Low 3D-IRA tumors tended to have greater invasiveness than high 3D-IRA tumors.
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Affiliation(s)
- Hironori Shimamoto
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shingo Iwano
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Hiroyasu Umakoshi
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Koji Kawaguchi
- 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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