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Horn M, Banerjee A, Kasickova L, Volny O, Choi HS, Letteri F, Ohara T, Tanaka K, Connolly S, Ladenvall P, Crowther M, Beyer‐Westendorf J, Shoamanesh A, Demchuk AM, Al Sultan AS. Total intracranial hemorrhage volume measurement summating all compartments best in traumatic and nontraumatic intracranial bleeding. Brain Behav 2024; 14:e3481. [PMID: 38680018 PMCID: PMC11056697 DOI: 10.1002/brb3.3481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND PURPOSE The ANNEXA-4 trial measured hemostatic efficacy of andexanet alfa in patients with major bleeding taking factor Xa inhibitors. A proportion of this was traumatic and nontraumatic intracranial bleeding. Different measurements were applied in the trial including volumetrics to assess for intracranial bleeding depending on the compartment involved. We aimed to determine the most reliable way to measure intracranial hemorrhage (ICrH) volume by comparing individual brain compartment and total ICrH volume. METHODS Thirty patients were randomly selected from the ANNEXA-4 database to assess measurement of ICrH volume by compartment and in total. Total and compartmental hemorrhage volumes were measured by five readers using Quantomo software. Each reader measured baseline hemorrhage volumes twice separated by 1 week. Twenty-eight different ANNEXA-4 subjects were also randomly selected to assess intra-rater reliability of total ICrH volume measurement change at baseline and 12-h follow up, performed by three readers twice to assess hemostatic efficacy categories used in ANNEXA-4. RESULTS Compartmental minimal detectable change percentages (MDC%) ranged between 9.72 and 224.13, with the greatest measurement error occurring in patients with a subdural hemorrhage. Total ICrH volume measurements had the lowest MDC%, which ranged between 6.57 and 33.52 depending on the reader. CONCLUSION Measurement of total ICrH volumes is more accurate than volume by compartment with less measurement error. Determination of hemostatic efficacy was consistent across readers, and within the same reader, as well as when compared to consensus read. Volumetric analysis of intracranial hemostatic efficacy is feasible and reliable when using total ICrH volumes.
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Affiliation(s)
- MacKenzie Horn
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
- Department of RadiologyUniversity of CalgaryCalgaryCanada
| | - Ankur Banerjee
- Department of Medicine, Division of NeurologyUniversity of AlbertaEdmontonCanada
| | | | - Ondrej Volny
- Department of NeurologyUniversity Hospital OstravaOstravaCzech Republic
- Czech National Centre for Evidence‐Based Healthcare and Knowledge Translation, Faculty of MedicineMasaryk UniversityBrnoCzech Republic
- International Clinical Research Center (ICRC)St. Anne's University HospitalBrnoCzech Republic
| | - Hyun Seok Choi
- Department of RadiologySeoul Medical CenterSeoulSouth Korea
| | | | - Tomoyuki Ohara
- Department of NeurologyKyoto Prefectural University of MedicineKyotoJapan
| | - Koji Tanaka
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
| | - Stuart Connolly
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - Mark Crowther
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | | | - Andrew M. Demchuk
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryCanada
- Department of RadiologyUniversity of CalgaryCalgaryCanada
| | - Abdulaziz S. Al Sultan
- Department of Medicine, Division of NeurologyRoyal Columbian HospitalNew WestminsterCanada
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Huang W, Zhang H, Ge Y, Duan S, Ma Y, Wang X, Zhou X, Zhou T, Tu W, Wang Y, Liu S, Dong P, Fan L. Radiomics-based Machine Learning Methods for Volume Doubling Time Prediction of Pulmonary Ground-glass Nodules With Baseline Chest Computed Tomography. J Thorac Imaging 2023; 38:304-314. [PMID: 37423615 DOI: 10.1097/rti.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE Reliable prediction of volume doubling time (VDT) is essential for the personalized management of pulmonary ground-glass nodules (GGNs). We aimed to determine the optimal VDT prediction method by comparing different machine learning methods only based on the baseline chest computed tomography (CT) images. MATERIALS AND METHODS Seven classical machine learning methods were evaluated in terms of their stability and performance for VDT prediction. The VDT, calculated by the preoperative and baseline CT, was divided into 2 groups with a cutoff value of 400 days. A total of 90 GGNs from 3 hospitals constituted the training set, and 86 GGNs from the fourth hospital served as the external validation set. The training set was used for feature selection and model training, and the validation set was used to evaluate the predictive performance of the model independently. RESULTS The eXtreme Gradient Boosting showed the highest predictive performance (accuracy: 0.890±0.128 and area under the ROC curve (AUC): 0.896±0.134), followed by the neural network (NNet) (accuracy: 0.865±0.103 and AUC: 0.886±0.097). While regarding stability, the NNet showed the highest robustness against data perturbation (relative SDs [%] of mean AUC: 10.9%). Therefore, the NNet was chosen as the final model, achieving high accuracy of 0.756 in the external validation set. CONCLUSION The NNet is a promising machine learning method to predict the VDT of GGNs, which would assist in the personalized follow-up and treatment strategies for GGNs reducing unnecessary follow-up and radiation dose.
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Affiliation(s)
- Wenjun Huang
- School of Medical Imaging, Weifang Medical University
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Hanxiao Zhang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu
| | - Yanming Ge
- School of Medical Imaging, Weifang Medical University
- Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang
| | - Shaofeng Duan
- GE Healthcare, Precision Health Institution, Shanghai
| | - Yanqing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province
| | - Xiaoling Wang
- Department of Radiology, Deyang People's Hospital, Deyang, Sichuan Province, China
| | - Xiuxiu Zhou
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Taohu Zhou
- School of Medical Imaging, Weifang Medical University
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Wenting Tu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Yun Wang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Peng Dong
- School of Medical Imaging, Weifang Medical University
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
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He Y, Xiong Z, Tian D, Zhang J, Chen J, Li Z. Natural progression of persistent pure ground-glass nodules 10 mm or smaller: long-term observation and risk factor assessment. Jpn J Radiol 2023; 41:605-616. [PMID: 36607551 DOI: 10.1007/s11604-022-01382-y] [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: 09/09/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Semi-automatic segmentation was used to investigate the natural progression of pure ground-glass nodules (pGGNs) of 5-10 mm in long-term follow-up and to analyze independent risk factors for subsequent growth. MATERIALS AND METHODS A total of 154 pGGNs of 5-10 mm from 132 patients with 698 follow-up CT scans were retrospectively identified. Subsequently, enrolled pGGNs were semiautomatically segmented on initial and follow-up CT to obtain diameter, density and volume, thus calculating mass, volume doubling time (VDT), and mass doubling time (MDT). Kaplan‒Meier analysis and multivariate Cox proportional risk regression were performed to explore independent predictors of pGGN growth. We analyzed growth differences among different pathological results of pGGNs confirmed by surgery. The prognosis was analyzed using the total diameter or solid size of the nodules on the last preoperative CT. RESULTS Among the 85 (55.2%) pGGNs with growth, 5.9%, 51.8%, and 80.0% showed growth within 1, 3, and 5 years, respectively. The median VDT and MDT were 1206.4 (range 349.8-5134.4) days and 1161.3 (range 339.4-6630.4) days, respectively. The multivariate Cox risk regression analysis showed that mean CT attenuation (m-CTA) [hazard ratio (HR) = 2.098, p = 0.010] and roundness index (HR = 1.892, p = 0.021) were independent risk factors for pGGN growth. In total, 67.6% of surgically resected and growing pGGNs were invasive non-mucinous adenocarcinoma (IA), including 2 cases of endpoint events, showing a PSN with solid components of 5.6 mm and a solid nodule with a diameter of 19.9 mm. CONCLUSIONS pGGNs of 5-10 mm showed an indolent clinical course. Follow-up CT imaging of pGGNs in the latter half of the first two years should be a rational management strategy. Small pGGNs with a larger overall m-CTA and roundness index on baseline CT are more likely to grow.
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Affiliation(s)
- Yifan He
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan, Xigang District, Dalian, 116011, China
| | - Ziqi Xiong
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan, Xigang District, Dalian, 116011, China
| | - Di Tian
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan, Xigang District, Dalian, 116011, China
| | - Jingyu Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan, Xigang District, Dalian, 116011, China
| | - Jianzhou Chen
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China
| | - Zhiyong Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan, Xigang District, Dalian, 116011, China.
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Tan M, Ma W, Sun Y, Gao P, Huang X, Lu J, Chen W, Wu Y, Jin L, Tang L, Kuang K, Li M. Prediction of the Growth Rate of Early-Stage Lung Adenocarcinoma by Radiomics. Front Oncol 2021; 11:658138. [PMID: 33937070 PMCID: PMC8082461 DOI: 10.3389/fonc.2021.658138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
Objectives To investigate the value of imaging in predicting the growth rate of early lung adenocarcinoma. Methods From January 2012 to June 2018, 402 patients with pathology-confirmed lung adenocarcinoma who had two or more thin-layer CT follow-up images were retrospectively analyzed, involving 407 nodules. Two complete preoperative CT images and complete clinical data were evaluated. Training and validation sets were randomly assigned according to an 8:2 ratio. All cases were divided into fast-growing and slow-growing groups. Researchers extracted 1218 radiomics features from each volumetric region of interest (VOI). Then, radiomics features were selected by repeatability analysis and Analysis of Variance (ANOVA); Based on the Univariate and multivariate analyses, the significant radiographic features is selected in training set. A decision tree algorithm was conducted to establish the radiographic model, radiomics model and the combined radiographic-radiomics model. Model performance was assessed by the area under the curve (AUC) obtained by receiver operating characteristic (ROC) analysis. Results Sixty-two radiomics features and one radiographic features were selected for predicting the growth rate of pulmonary nodules. The combined radiographic-radiomics model (AUC 0.78) performed better than the radiographic model (0.727) and the radiomics model (0.710) in the validation set. Conclusions The model has good clinical application value and development prospects to predict the growth rate of early lung adenocarcinoma through the combined radiographic-radiomics model.
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Affiliation(s)
- Mingyu Tan
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Weiling Ma
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Yingli Sun
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Pan Gao
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Xuemei Huang
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Jinjuan Lu
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Wufei Chen
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Yue Wu
- Department of Thoracic Surgery, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Liang Jin
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
| | - Lin Tang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Ming Li
- Department of Radiology, Huadong Hospital Affiliated With Fudan University, Shanghai, China
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Lu J, Tang H, Yang X, Liu L, Pang M. Diagnostic value and imaging features of multi-detector CT in lung adenocarcinoma with ground glass nodule patients. Oncol Lett 2020; 20:693-698. [PMID: 32565994 PMCID: PMC7285889 DOI: 10.3892/ol.2020.11631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 04/08/2020] [Indexed: 01/11/2023] Open
Abstract
This study investigated the application value and imaging features of multi-detector CT (MDCT) in the treatment of lung adenocarcinoma with ground glass nodules (GGN). The medical data of 168 patients with pulmonary GGN in Shengli Oilfield Central Hospital from January 2013 to June 2015 were analyzed. Patients with microinvasive adenocarcinoma and invasive adenocarcinoma were included in group A (invasive lung adenocarcinoma, n=98), while patients with atypical adenomatous hyperplasia and adenocarcinoma in situ were included in group B (pre-invasive lung adenocarcinoma, n=70). The imaging features of MDCT were compared. ROC curves of the size of nidus and the size of solid component were drawn for the diagnosis of invasive lung adenocarcinoma. Logistic multivariate regression analysis was used to analyze the risk factors that affected invasive lung adenocarcinoma. There were significant differences in nidus, burr, and lobes of the patients between groups A and B. The size of nidus and the size of solid component of the patients in group A were significantly higher than those of the patients in group B. The AUCs of the size of the nidus and the size of the solid component of the invasive lung adenocarcinoma were 0.891 and 0.902, respectively. The AUC of the combined diagnosis was 0.984. Size of the nidus, size of the solid component, nature of the lesion, burr, and lobes were all risk factors for invasive lung adenocarcinoma. In patients with GGN, size of the nidus and size of the solid component can be used as excellent diagnostic parameters for invasive lung adenocarcinoma, and nidus size (≥9.8 mm), size of the solid component (≥0.9 mm), the mixed GGN nature of the nidus, burr and lobes can distinguish invasive lung adenocarcinoma and pre-invasive lesions.
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Affiliation(s)
- Jun Lu
- Department of Radiology, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, P.R. China
| | - Haitao Tang
- Department of Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, P.R. China
| | - Xinguo Yang
- Department of Radiology, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, P.R. China
| | - Lei Liu
- Department of Radiology, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, P.R. China
| | - Minxia Pang
- Department of Radiology, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, P.R. China
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Lee HN, Kim JI, Shin SY. Measurement accuracy of lung nodule volumetry in a phantom study: Effect of axial-volume scan and iterative reconstruction algorithm. Medicine (Baltimore) 2020; 99:e20543. [PMID: 32502015 PMCID: PMC7306330 DOI: 10.1097/md.0000000000020543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An axial-volume scan with adaptive statistical iterative reconstruction-V (ASIR-V) is newly developed. Our goal was to identify the influence of axial-volume scan and ASIR-V on accuracy of automated nodule volumetry.An "adult' chest phantom containing various nodules was scanned using both helical and axial-volume modes at different dose settings using 256-slice CT. All CT scans were reconstructed using 30% and 50% blending of ASIR-V and filtered back projection. Automated nodule volumetry was performed using commercial software. The image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were measured.The axial-volume scan reduced radiation dose by 19.7% compared with helical scan at all radiation dose settings without affecting the accuracy of nodule volumetric measurement (P = .375). Image noise, CNR, and SNR were not significantly different between two scan modes (all, P > .05).The use of axial-volume scan with ASIR-V achieved effective radiation dose reduction while preserving the accuracy of nodule volumetry.
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Affiliation(s)
- Han Na Lee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Jung Im Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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Qi L, Lu W, Yang L, Tang W, Zhao S, Huang Y, Wu N, Wang J. Qualitative and quantitative imaging features of pulmonary subsolid nodules: differentiating invasive adenocarcinoma from minimally invasive adenocarcinoma and preinvasive lesions. J Thorac Dis 2019; 11:4835-4846. [PMID: 31903274 DOI: 10.21037/jtd.2019.11.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To explore the role of qualitative and quantitative imaging features of pulmonary subsolid nodules (SSNs) in differentiating invasive adenocarcinoma (IAC) from minimally invasive adenocarcinoma (MIA) and preinvasive lesions. Methods We reviewed the clinical records of our institute from October 2010 to December 2015 and included 316 resected SSNs from 287 patients: 260 pure ground-glass nodules, 47 part-solid nodules with solid components ≤5 mm, and 9 ground-glass nodules (GGNs) with cystic airspaces. According to the pathologic review results, 307 SSNs in addition to nine GGNs with cystic airspaces were divided into two groups: A, including atypical adenomatous hyperplasia (AAH) (n=15), adenocarcinoma in situ (AIS) (n=56), and MIA (n=41); B, including 195 IACs. Univariate and binary logistic regression analyses were conducted to identify independent risk factors for IAC. Results Univariate analysis showed significant differences between groups regarding patient age, mean diameter, mean and relative computed tomography (CT) values, volume, mass (all P<0.001), and morphological features including lobulated sign (P<0.001), spiculated sign (P=0.028), vacuole sign/air bronchogram (P<0.001), and pleural retraction (P=0.017). Binary logistic regression and receiver operating characteristic analysis indicated the SSN mass as the only independent risk factor of IAC (odds ratio, 1.007; P<0.001), with an optimal cutoff value of 283.2 mg [area under curve (AUC): 0.859; sensitivity: 68.7%; specificity: 92.9%]. Among lepidic, acinar, and papillary adenocarcinomas, we found significant differences for the vacuole sign/air bronchogram (P=0.032) and mean and relative CT values (P<0.001). All nine GGNs with cystic airspaces were IACs. Conclusions The SSN mass with an optimal cutoff value of 283.2 mg may be reliable for differentiating IAC from MIA and preinvasive lesions.
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Affiliation(s)
- Linlin Qi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wenwen Lu
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Lin Yang
- Department of Diagnostic Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shijun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yao Huang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Analysis of CT morphologic features and attenuation for differentiating among transient lesions, atypical adenomatous hyperplasia, adenocarcinoma in situ, minimally invasive and invasive adenocarcinoma presenting as pure ground-glass nodules. Sci Rep 2019; 9:14586. [PMID: 31601919 PMCID: PMC6786988 DOI: 10.1038/s41598-019-50989-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 09/17/2019] [Indexed: 12/17/2022] Open
Abstract
Thin-section computed tomography (TSCT) imaging biomarkers are uncertain to distinguish progressive adenocarcinoma from benign lesions in pGGNs. The purpose of this study was to evaluate the usefulness of TSCT characteristics for differentiating among transient (TRA) lesions, atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC) presenting as pure ground-glass nodules (pGGNs). Between January 2016 and January 2018, 255 pGGNs, including 64 TRA, 22 AAH, 37 AIS, 108 MIA and 24 IAC cases, were reviewed on TSCT images. Differences in TSCT characteristics were compared among these five subtypes of pGGNs. Logistic analysis was performed to identify significant factors for predicting MIA and IAC. Progressive pGGNs were more likely to be round or oval in shape, with clear margins, air bronchograms, vascular and pleural changes, creep growth, and bubble-like lucency than were non-progressive pGGNs. The optimal cut-off values of the maximum diameter for differentiating non-progressive from progressive pGGNs and IAC from non-IAC were 6.5 mm and 11.5 mm, respectively. For the prediction of IAC vs. non-IAC and non-progressive vs. progressive adenocarcinoma, the areas under the receiver operating characteristics curves were 0.865 and 0.783 for maximum diameter and 0.784 and 0.722 for maximum CT attenuation, respectively. The optimal cut-off values of maximum CT attenuation were -532 HU and -574 HU for differentiating non-progressive from progressive pGGNs and IAC from non-IAC, respectively. Maximum diameter, maximum attenuation and morphological characteristics could help distinguish TRA lesions from MIA and IAC but not from AAH. So, CT morphologic characteristics, diameter and attenuation parameters are useful for differentiating among pGGNs of different subtypes.
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Qi LL, Wu BT, Tang W, Zhou LN, Huang Y, Zhao SJ, Liu L, Li M, Zhang L, Feng SC, Hou DH, Zhou Z, Li XL, Wang YZ, Wu N, Wang JW. Long-term follow-up of persistent pulmonary pure ground-glass nodules with deep learning-assisted nodule segmentation. Eur Radiol 2019; 30:744-755. [PMID: 31485837 DOI: 10.1007/s00330-019-06344-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/16/2019] [Accepted: 06/27/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the natural history of persistent pulmonary pure ground-glass nodules (pGGNs) with deep learning-assisted nodule segmentation. METHODS Between January 2007 and October 2018, 110 pGGNs from 110 patients with 573 follow-up CT scans were included in this retrospective study. pGGN automatic segmentation was performed on initial and all follow-up CT scans using the Dr. Wise system based on convolution neural networks. Subsequently, pGGN diameter, density, volume, mass, volume doubling time (VDT), and mass doubling time (MDT) were calculated automatically. Enrolled pGGNs were categorized into growth, 52 (47.3%), and non-growth, 58 (52.7%), groups according to volume growth. Kaplan-Meier analyses with the log-rank test and Cox proportional hazards regression analysis were conducted to analyze the cumulative percentages of pGGN growth and identify risk factors for growth. RESULTS The mean follow-up period of the enrolled pGGNs was 48.7 ± 23.8 months. The median VDT of the 52 pGGNs having grown was 1448 (range, 339-8640) days, and their median MDT was 1332 (range, 290-38,912) days. The 12-month, 24.7-month, and 60.8-month cumulative percentages of pGGN growth were 10%, 25.5%, and 51.1%, respectively, and they significantly differed among the initial diameter, volume, and mass subgroups (all p < 0.001). The growth pattern of pGGNs may conform to the exponential model. Lobulated sign (p = 0.044), initial mean diameter (p < 0.001), volume (p = 0.003), and mass (p = 0.023) predicted pGGN growth. CONCLUSIONS Persistent pGGNs showed an indolent course. Deep learning can assist in accurately elucidating the natural history of pGGNs. pGGNs with lobulated sign and larger initial diameter, volume, and mass are more likely to grow. KEY POINTS • The pure ground-glass nodule (pGGN) segmentation accuracy of the Dr. Wise system based on convolution neural networks (CNNs) was 96.5% (573/594). • The median volume doubling time (VDT) of 52 pure ground-glass nodules (pGGNs) having grown was 1448 days (range, 339-8640 days), and their median mass doubling time (MDT) was 1332 days (range, 290-38,912 days). The mean time to growth in volume was 854 ± 675 days (range, 116-2856 days). • The 12-month, 24.7-month, and 60.8-month cumulative percentages of pGGN growth were 10%, 25.5%, and 51.1%, respectively, and they significantly differed among the initial diameter, volume, and mass subgroups (all p values < 0.001). The growth pattern of pure ground-glass nodules may conform to exponential model.
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Affiliation(s)
- Lin-Lin Qi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Bo-Tong Wu
- School of Electronic Engineering and Computer Science, Peking University, No. 5 Yiheyuan Rd., Haidian District, Beijing, 100871, China.,Peng Cheng Laboratory, Vanke Cloud City Phase I Building 8, Xili Street, Nanshan District, Shenzhen, 518055, Guangdong, China.,Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Li-Na Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yao Huang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shi-Jun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Li Liu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shi-Chao Feng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Dong-Hui Hou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Zhen Zhou
- School of Electronic Engineering and Computer Science, Peking University, No. 5 Yiheyuan Rd., Haidian District, Beijing, 100871, China.,Peng Cheng Laboratory, Vanke Cloud City Phase I Building 8, Xili Street, Nanshan District, Shenzhen, 518055, Guangdong, China.,Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Xiu-Li Li
- Peng Cheng Laboratory, Vanke Cloud City Phase I Building 8, Xili Street, Nanshan District, Shenzhen, 518055, Guangdong, China.,Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Yi-Zhou Wang
- School of Electronic Engineering and Computer Science, Peking University, No. 5 Yiheyuan Rd., Haidian District, Beijing, 100871, China.,Peng Cheng Laboratory, Vanke Cloud City Phase I Building 8, Xili Street, Nanshan District, Shenzhen, 518055, Guangdong, China.,Deepwise AI Lab, Deepwise Inc., No. 8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China. .,PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Jian-Wei Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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10
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Borghesi A, Michelini S, Scrimieri A, Golemi S, Maroldi R. Solid Indeterminate Pulmonary Nodules of Less Than 300 mm 3: Application of Different Volume Doubling Time Cut-offs in Clinical Practice. Diagnostics (Basel) 2019; 9:diagnostics9020062. [PMID: 31226780 PMCID: PMC6627535 DOI: 10.3390/diagnostics9020062] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/01/2019] [Accepted: 06/19/2019] [Indexed: 12/26/2022] Open
Abstract
In the British Thoracic Society guidelines for incidental pulmonary nodules, volumetric analysis has become the recommended method for growth assessment in solid indeterminate pulmonary nodules (SIPNs) <300 mm3. In these guidelines, two different volume doubling time (VDT) cut-offs, 400 and 600 days, were proposed to differentiate benign from malignant nodules. The present study aims to evaluate the performance of these VDT cut-offs in a group of SIPNs <300 mm3 which were incidentally detected in a routine clinical setting. During a 7-year period, we retrospectively selected 60 patients with a single SIPN <300 mm3. For each SIPN, the volume and VDT were calculated using semiautomatic software throughout the follow-up period, and the performance of the 400- and 600-day VDT cut-offs was compared. In the selected sample, there were 38 benign and 22 malignant nodules. In this group of nodules, the sensitivity, negative predictive value and accuracy of the 600-day VDT cut-off were higher than those of the 400-day VDT cut-off. Therefore, in the management of SIPNs <300 mm3 which were incidentally detected in a clinical setting, the 600-day VDT cut-off was better at differentiating benign from malignant nodules than the 400-day VDT cut-off, by reducing the number of false negatives.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Silvia Michelini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124 Brescia, Italy.
| | - Alessandra Scrimieri
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Salvatore Golemi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
| | - Roberto Maroldi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy.
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11
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Weber NM, Koo CW, Yu L, Bartholmai BJ, Halaweish AF, McCollough CH, Fletcher JG. Breathe New Life Into Your Chest CT Exams: Using Advanced Acquisition and Postprocessing Techniques. Curr Probl Diagn Radiol 2019; 48:152-160. [DOI: 10.1067/j.cpradiol.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 11/22/2022]
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12
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Accuracy of Pulmonary Nodule Volumetry at Different Exposure Parameters in Low-Dose Computed Tomography. J Comput Assist Tomogr 2019; 43:926-930. [DOI: 10.1097/rct.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Fang R, Yang Y, Han H, Fu X, Dong L, Xie B, Lu W, Ma C, Cui F, Hu J, Wang J. Analysis of risk factors for stage I lung adenocarcinoma using low-dose high-resolution computed tomography. Oncol Lett 2018; 16:2483-2489. [PMID: 30013641 PMCID: PMC6036570 DOI: 10.3892/ol.2018.8921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/26/2018] [Indexed: 12/02/2022] Open
Abstract
Risk factors for stage I lung adenocarcinoma were analyzed using low-dose high-resolution computed tomography (CT). The patients were divided into case group (stage I lung adenocarcinoma patients) and control group (benign pulmonary nodules patients). All patients were subjected to low-dose high-resolution CT. Multiple linear regression was performed to analyze the CT imaging features of the two groups. Stage I lung adenocarcinoma patients were significantly associated with nodular site (X3, upper left lobe) [95% CI (1.796, 54.695), p=0.008], nodule type (X4) (p<0.001), nodule size (X5) [95% CI (0.614, 0.803), p<0.001], spicule sign (X7) [95% CI (0.029, 0.580), p=0.008], lobulation sign (X8) [95% CI (0.048, 0.673), p=0.011]. The stepwise regression equation is: Logistic (p) =-12.009 + 2.294X3 - 0.327X4 - 0.354X5 - 2.042X7 - 1.713X8. Risk factors of low-dose and high-resolution CT imaging for patients with stage I lung adenocarcinoma are nodular site (upper left lobe), nodule type, nodule size, spicule sign, and lobulation sign.
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Affiliation(s)
- Rui Fang
- Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, P.R. China
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang 310018, P.R. China
| | - Yong Yang
- Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, P.R. China
| | - Haicheng Han
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang 310018, P.R. China
| | - Xiaoqing Fu
- Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, P.R. China
| | - Liwen Dong
- Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, P.R. China
| | - Baisheng Xie
- Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, P.R. China
| | - Wei Lu
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China
| | - Chenyang Ma
- The Third Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310053, P.R. China
| | - Feng Cui
- Guangxing Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310007, P.R. China
| | - Jian Hu
- The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jun Wang
- Peking University People's Hospital, Beijing 100044, P.R. China
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14
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Garzelli L, Goo JM, Ahn SY, Chae KJ, Park CM, Jung J, Hong H. Improving the prediction of lung adenocarcinoma invasive component on CT: Value of a vessel removal algorithm during software segmentation of subsolid nodules. Eur J Radiol 2018; 100:58-65. [DOI: 10.1016/j.ejrad.2018.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 11/15/2017] [Accepted: 01/15/2018] [Indexed: 12/17/2022]
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15
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Aherne EA, Plodkowski AJ, Montecalvo J, Hayan S, Zheng J, Capanu M, Adusumilli PS, Travis WD, Ginsberg MS. What CT characteristics of lepidic predominant pattern lung adenocarcinomas correlate with invasiveness on pathology? Lung Cancer 2018; 118:83-89. [PMID: 29572008 DOI: 10.1016/j.lungcan.2018.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society lung adenocarcinoma classification in 2011 defined three lepidic predominant patterns including adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma. We sought to correlate the radiology and pathology findings and identify any computed tomography (CT) features which can be associated with invasive growth. MATERIALS AND METHODS An institutional review board approved, retrospective study was conducted evaluating 63 patients with resected, pathologically confirmed, adenocarcinomas with predominant lepidic patterns. Preoperative CT images of the nodules were assessed using quantitative and qualitative radiographic descriptors while blinded to pathologic sub-classification and size. Maximum diameter was measured after evaluation of the axial, sagittal and coronal planes. Radiologic - pathologic associations were examined using Fisher's exact test, the Kruskal-Wallis test and the Spearman correlation coefficient (ρ). RESULTS AND CONCLUSION Increasing maximum diameter of the whole lesion (ground glass and solid component) on CT was significantly associated with invasiveness (p = .003), as was the maximum pathologic specimen diameter (p = .008). Larger diameter of the solid component on CT was also found in lepidic predominant adenocarcinoma compared to minimally invasive adenocarcinoma (median 10.5 vs 2 mm, p = .005). More invasive tumors had higher visual estimated percentage solid component compared to whole lesion measurement on CT (p = .014). CT and pathologic measurements were positively correlated, although only moderately (ρ = .66) for the maximum whole lesion size and fair (ρ = .49) for solid/invasive component maximum measurements. Larger whole lesion size and solid component size of lepidic predominant pattern adenocarcinomas are associated with lesion invasiveness, although radiologic and pathologic lesion measurements are only fair-moderately positively correlated.
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Affiliation(s)
- Emily A Aherne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Joseph Montecalvo
- Department of Histopathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Sumar Hayan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Prasad S Adusumilli
- Department of Cardiothoracic Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - William D Travis
- Department of Histopathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States.
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16
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Kakinuma R, Muramatsu Y, Yamamichi J, Gomi S, Oubel E, Moriyama N. Evaluation of the 95% limits of agreement of the volumes of 5-year clinically stable solid nodules for the development of a follow-up system for indeterminate solid nodules in CT lung cancer screening. J Thorac Dis 2018; 10:175-189. [PMID: 29600047 DOI: 10.21037/jtd.2017.11.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study sought to evaluate the 95% limits of agreement of the volumes of 5-year clinically stable solid nodules for the development of a follow-up system for indeterminate solid nodules. Methods The volumes of 226 solid nodules that had been clinically stable for 5 years were measured in 186 patients (53 female never-smokers, 36 male never-smokers, 51 males with <30 pack-years, and 46 males with ≥30 pack-years) using a three-dimensional semiautomated method. Volume changes were evaluated using three methods: percent change, proportional change and growth rate. The 95% limits of agreement were evaluated using the Bland-Altman method. Results The 95% limits of agreement were as follows: range of percent change, from ±34.5% to ±37.8%; range of proportional change, from ±34.1% to ±36.8%; and range of growth rate, from ±39.2% to ±47.4%. Percent change-based, proportional change-based, and growth rate-based diagnoses of an increase or decrease in ten solid nodules were made at a mean of 302±402, 367±455, and 329±496 days, respectively, compared with a clinical diagnosis made at 809±616 days (P<0.05). Conclusions The 95% limits of agreement for volume change in 5-year stable solid nodules may enable the detection of an increase or decrease in the solid nodule at an earlier stage than that enabled by a clinical diagnosis, possibly contributing to the development of a follow-up system for reducing the number of additional Computed tomography (CT) scans performed during the follow-up period.
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Affiliation(s)
- Ryutaro Kakinuma
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Cancer Screening Center, National Cancer Center, Tokyo, Japan.,Department of Pulmonology, Tokyo General Hospital, Tokyo, Japan
| | - Yukio Muramatsu
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Department of Radiology, E-Medical Tokyo, Tokyo, Japan
| | - Junta Yamamichi
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Global Healthcare IT Project, Medical Equipment Group, Canon Inc., Tokyo, Japan
| | - Shiho Gomi
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Estanislao Oubel
- MEDIAN Technologies, Valbonne Sophia Antipolis, Valbonne, France
| | - Noriyuki Moriyama
- Division of Cancer Screening, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan.,Department of Radiology, Tokyo Midtown Medical Center, Tokyo, Japan
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17
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Larici AR, Farchione A, Franchi P, Ciliberto M, Cicchetti G, Calandriello L, del Ciello A, Bonomo L. Lung nodules: size still matters. Eur Respir Rev 2017; 26:26/146/170025. [DOI: 10.1183/16000617.0025-2017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 10/28/2017] [Indexed: 12/18/2022] Open
Abstract
The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.
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18
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Lepidic Predominant Pulmonary Lesions (LPL): CT-based Distinction From More Invasive Adenocarcinomas Using 3D Volumetric Density and First-order CT Texture Analysis. Acad Radiol 2017; 24:1604-1611. [PMID: 28844845 DOI: 10.1016/j.acra.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to differentiate pathologically defined lepidic predominant lesions (LPL) from more invasive adenocarcinomas (INV) using three-dimensional (3D) volumetric density and first-order texture histogram analysis of surgically excised stage 1 lung adenocarcinomas. MATERIALS AND METHODS This retrospective study was institutional review board approved and Health Insurance Portability and Accountability Act compliant. Sixty-four cases of pathologically proven stage 1 lung adenocarcinoma surgically resected between September 2006 and October 2015, including LPL (n = 43) and INV (n = 21), were evaluated using high-resolution computed tomography. Quantitative measurements included nodule volume, percent solid volume (% solid), and first-order texture histogram analysis including skewness, kurtosis, entropy, and mean nodule attenuation within each histogram quartile. Binomial logistic regression models were used to identify the best set of parameters distinguishing LPL from INV. RESULTS Univariate analysis of 3D volumetric density and histogram features was statistically significant between LPL and INV groups (P < .05). Accuracy of a binomial logistic model to discriminate LPL from INV based on size and % solid was 85.9%. With optimized probability cutoff, the model achieves 81% sensitivity, 76.7% specificity, and area under the receiver operating characteristic curve of 0.897 (95% confidence interval, 0.821-0.973). An additional model based on size and mean nodule attenuation of the third quartile (Hu_Q3) of the histogram achieved similar accuracy of 81.3% and area under the receiver operating characteristic curve of 0.877 (95% confidence interval, 0.790-0.964). CONCLUSIONS Both 3D volumetric density and first-order texture analysis of stage 1 lung adenocarcinoma allow differentiation of LPL from more invasive adenocarcinoma with overall accuracy of 85.9%-81.3%, based on multivariate analyses of either size and % solid or size and Hu_Q3, respectively.
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19
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Gavrielides MA, Berman BP, Supanich M, Schultz K, Li Q, Petrick N, Zeng R, Siegelman J. Quantitative assessment of nonsolid pulmonary nodule volume with computed tomography in a phantom study. Quant Imaging Med Surg 2017; 7:623-635. [PMID: 29312867 DOI: 10.21037/qims.2017.12.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background To assess the volumetric measurement of small (≤1 cm) nonsolid nodules with computed tomography (CT), focusing on the interaction of state of the art iterative reconstruction (IR) methods and dose with nodule densities, sizes, and shapes. Methods Twelve synthetic nodules [5 and 10 mm in diameter, densities of -800, -630 and -10 Hounsfield units (HU), spherical and spiculated shapes] were scanned within an anthropomorphic phantom. Dose [computed tomography scan dose index (CTDIvol)] ranged from standard (4.1 mGy) to below screening levels (0.3 mGy). Data was reconstructed using filtered back-projection and two state-of-the-art IR methods (adaptive and model-based). Measurements were extracted with a previously validated matched filter-based estimator. Analysis of accuracy and precision was based on evaluation of percent bias (PB) and the repeatability coefficient (RC) respectively. Results Density had the most important effect on measurement error followed by the interaction of density with nodule size. The nonsolid -630 HU nodules had high accuracy and precision at levels comparable to solid (-10 HU) nonsolid, regardless of reconstruction method and with CTDIvol as low as 0.6 mGy. PB was <5% and <11% for the 10- and 5-mm in nominal diameter -630 HU nodules respectively, and RC was <5% and <12% for the same nodules. For nonsolid -800 HU nodules, PB increased to <11% and <30% for the 10- and 5-mm nodules respectively, whereas RC increased slightly overall but varied widely across dose and reconstruction algorithms for the 5-mm nodules. Model-based IR improved measurement accuracy for the 5-mm, low-density (-800, -630 HU) nodules. For other nodules the effect of reconstruction method was small. Dose did not affect volumetric accuracy and only affected slightly the precision of 5-mm nonsolid nodules. Conclusions Reasonable values of both accuracy and precision were achieved for volumetric measurements of all 10-mm nonsolid nodules, and for the 5-mm nodules with -630 HU or higher density, when derived from scans acquired with below screening dose levels as low as 0.6 mGy and regardless of reconstruction algorithm.
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Affiliation(s)
- Marios A Gavrielides
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Benjamin P Berman
- Division of Radiological Health, Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Mark Supanich
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kurt Schultz
- Toshiba Medical Research Institute USA, Inc., Center for Medical Research and Development, Illinois, USA
| | - Qin Li
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Nicholas Petrick
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rongping Zeng
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, , Office of In Vitro Diagnostics and Radiological Health, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jenifer Siegelman
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachussetts, USA
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20
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Peng M, Yu G, Zhang C, Li C, Wang J. Three-dimensional substructure measurements for the differential diagnosis of ground glass nodules. BMC Pulm Med 2017. [PMID: 28629453 PMCID: PMC5477248 DOI: 10.1186/s12890-017-0438-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We analyzed the differences between maximum and peak computed tomography (CT) numbers (M-P), respectively representing the densities of the solid center and the main periphery of ground-glass nodules (GGNs), and the average change in M-P velocity (V(M-P)) during follow-up to differentiate between pre-invasive (PIA) and invasive adenocarcinoma (IAC). METHODS Data of 102 patients were retrospectively collected and analyzed in our study including 43 PIAs and 59 IACs. Diameters, total volumes, and the maximum and peak CT numbers in CT number histograms were measured and followed for at least 3 months. This study was registered retrospectively. RESULTS The M-P values for IACs were higher than those for PIAs (p = 0.001), with an area under the curve (AUC) of 0.810 and a threshold of 489.5 Hounsfield units (HU) in ROC analysis. The V(M-P) values for IACs were smaller than those for PIAs (p = 0.04), with an AUC of 0.805 and a threshold of 11.01 HU/day. CONCLUSIONS M-P and V(M-P) values may help distinguish IACs from PIAs by representing the changes in the sub-structural densities of GGNs during follow-up.
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Affiliation(s)
- Mingzheng Peng
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School Of Medicine, Room 703, No. 3 Building, 693 Zhizaoju Road, Shanghai, 200011, China
| | - Gang Yu
- Department of Anesthesiology, Binzhou Central Hospital, Binzhou Medical College, Binzhou, China
| | - Chengzhong Zhang
- Department of Radiology, Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuidi Li
- School of Biomedical Engineering, MED-X Research Institute of Shanghai Jiao Tong University, Shanghai, China
| | - Jinwu Wang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School Of Medicine, Room 703, No. 3 Building, 693 Zhizaoju Road, Shanghai, 200011, China. .,School of Biomedical Engineering, MED-X Research Institute of Shanghai Jiao Tong University, Shanghai, China.
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21
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Borghesi A, Farina D, Michelini S, Ferrari M, Benetti D, Fisogni S, Tironi A, Maroldi R. Pulmonary adenocarcinomas presenting as ground-glass opacities on multidetector CT: three-dimensional computer-assisted analysis of growth pattern and doubling time. Diagn Interv Radiol 2017; 22:525-533. [PMID: 27682741 DOI: 10.5152/dir.2016.16110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to evaluate the growth pattern and doubling time (DT) of pulmonary adenocarcinomas exhibiting ground-glass opacities (GGOs) on multidetector computed tomography (CT). METHODS The growth pattern and DT of 22 pulmonary adenocarcinomas exhibiting GGOs were retrospectively analyzed using three-dimensional semiautomatic software. Analysis of each lesion was based on calculations of volume and mass changes and their respective DTs throughout CT follow-up. Three-dimensional segmentation was performed by a single radiologist on each CT scan. The same observer and another radiologist independently repeated the segmentation at the baseline and the last CT scan to determine the variability of the measurements. The relationships among DTs, histopathology, and initial CT features of the lesions were also analyzed. RESULTS Pulmonary adenocarcinomas presenting as GGOs exhibited different growth patterns: some lesions grew rapidly and some grew slowly, whereas others alternated between periods of growth, stability, or shrinkage. A significant increase in volume and mass that exceeded the coefficient of repeatability of interobserver variability was observed in 72.7% and 84.2% of GGOs, respectively. The volume-DTs and mass-DTs were heterogeneous throughout the follow-up CT scan (range, -4293 to 21928 and -3113 to 17020 days, respectively), and their intra- and interobserver variabilities were moderately high. The volume-DTs and mass-DTs were not correlated with the initial CT features of GGOs; however, they were significantly shorter in invasive adenocarcinomas (P = 0.002 and P = 0.001, respectively). CONCLUSION Pulmonary adenocarcinomas exhibiting GGOs show heterogeneous growth patterns with a trend toward a progressive increase in size. DTs may be useful for predicting tumor aggressiveness.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Italy.
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22
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Zheng W, Wang Q, Wang Y, Guo F, Wang X, Yu T. [Threshold Segmentation of Pulmonary Subsolid Nodules on CT Images:
Detection and Quantification of the Solid Component]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:341-345. [PMID: 28532542 PMCID: PMC5973070 DOI: 10.3779/j.issn.1009-3419.2017.05.07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The detection and quantification of solid components in pulmonary subsolid nodules (SSN) are of vital importance on differential diagnosis, pathological speculation and prognosis prediction. However, no objective and wide-accepted criterion has been built up to now. The purpose of this study is to explore the optimal threshold that can be used for the detection and quantification of solid components in SSNs by using threshold segmentation method on computed tomography (CT) images. METHODS CT images of 102 SSNs were retrospectively analyzed. To establish a reference standard, the observers made judgments on whether the solid component existed in every SSN and did manual measurements of the volume of solid component with the help of software. Threshold segmentations of every nodule were then performed using different threshold settings and all of the measured volumes were assumed to be solid volumes, then solid-to-total volume ratios were calculated. The results were compared with the reference standards using the receiver operating characteristic curve and Wilcoxon test. RESULTS The application of thresholds as -250 HU or -300 HU resulted in high diagnostic value on the detection of solid component, with area under curve values as 0.982 and 0.977, respectively; the cut-off values of solid-to-total volume ratio were 1.10% and 6.14%, respectively; the median volumes of solid components were 202.7 mm3 (598.2 mm3), 247.1 mm3(696.0 mm3), which were not significantly different from the reference standard[199.5 mm3 (743.1 mm3)](P=0.125,1, 0.061,3). CONCLUSIONS Threshold segmentation on chest CT images is valuable to detect and quantify the solid component on SSNs, the thresholds as -250 HU and -300 HU are recommended.
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Affiliation(s)
- Wensong Zheng
- Medical Imaging Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Qing Wang
- Medical Imaging Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Ying Wang
- Medical Imaging Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Fangfang Guo
- Medical Imaging Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xinyue Wang
- Medical Imaging Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Tielian Yu
- Medical Imaging Department, Tianjin Medical University General Hospital, Tianjin 300052, China
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Ma X, Siegelman J, Paik DS, Mulshine JL, St Pierre S, Buckler AJ. Volumes Learned: It Takes More Than Size to "Size Up" Pulmonary Lesions. Acad Radiol 2016; 23:1190-8. [PMID: 27287713 DOI: 10.1016/j.acra.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to review the current understanding and capabilities regarding use of imaging for noninvasive lesion characterization and its relationship to lung cancer screening and treatment. MATERIALS AND METHODS Our review of the state of the art was broken down into questions about the different lung cancer image phenotypes being characterized, the role of imaging and requirements for increasing its value with respect to increasing diagnostic confidence and quantitative assessment, and a review of the current capabilities with respect to those needs. RESULTS The preponderance of the literature has so far been focused on the measurement of lesion size, with increasing contributions being made to determine the formal performance of scanners, measurement tools, and human operators in terms of bias and variability. Concurrently, an increasing number of investigators are reporting utility and predictive value of measures other than size, and sensitivity and specificity is being reported. Relatively little has been documented on quantitative measurement of non-size features with corresponding estimation of measurement performance and reproducibility. CONCLUSIONS The weight of the evidence suggests characterization of pulmonary lesions built on quantitative measures adds value to the screening for, and treatment of, lung cancer. Advanced image analysis techniques may identify patterns or biomarkers not readily assessed by eye and may also facilitate management of multidimensional imaging data in such a way as to efficiently integrate it into the clinical workflow.
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Affiliation(s)
- Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984.
| | - Jenifer Siegelman
- Department of Radiology, Brigham and Women's Hospital, Boston Massachusetts; Department of Radiology (hospital-based), Harvard Medical School, Boston, Massachusetts
| | - David S Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - James L Mulshine
- Department of Internal Medicine, Rush University, Chicago, Illinois
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24
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Ko JP, Suh J, Ibidapo O, Escalon JG, Li J, Pass H, Naidich DP, Crawford B, Tsai EB, Koo CW, Mikheev A, Rusinek H. Lung Adenocarcinoma: Correlation of Quantitative CT Findings with Pathologic Findings. Radiology 2016; 280:931-9. [DOI: 10.1148/radiol.2016142975] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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25
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Si MJ, Tao XF, Du GY, Cai LL, Han HX, Liang XZ, Zhao JM. Thin-section computed tomography-histopathologic comparisons of pulmonary focal interstitial fibrosis, atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma with pure ground-glass opacity. Eur J Radiol 2016; 85:1708-1715. [PMID: 27666606 DOI: 10.1016/j.ejrad.2016.07.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/04/2016] [Accepted: 07/17/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To retrospectively compare focal interstitial fibrosis (FIF), atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), and minimally invasive adenocarcinoma (MIA) with pure ground-glass opacity (GGO) using thin-section computed tomography (CT). MATERIALS AND METHODS Sixty pathologically confirmed cases were reviewed including 7 cases of FIF, 17 of AAH, 23of AIS, and 13 of MIA. All nodules kept pure ground glass appearances before surgical resection and their last time of thin-section CT imaging data before operation were collected. Differences of patient demographics and CT features were compared among these four types of lesions. RESULTS FIF occurred more frequently in males and smokers while the others occurred more frequently in female nonsmokers. Nodule size was significant larger in MIA (P<0.001, cut-off value=7.5mm). Nodule shape (P=0.045), margin characteristics (P<0.001), the presence of pleural indentation (P=0.032), and vascular ingress (P<0.001) were significant factors that differentiated the 4 groups. A concave margin was only demonstrated in a high proportion of FIF at 85.7% (P=0.002). There were no significant differences (all P>0.05) in age, malignant history, attenuation value, location, and presence of bubble-like lucency. CONCLUSION A nodule size >7.5mm increases the possibility of MIA. A concave margin could be useful for differentiation of FIF from the other malignant or pre-malignant GGO nodules. The presence of spiculation or pleural indentation may preclude the diagnosis of AAH.
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Affiliation(s)
- Ming-Jue Si
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
| | - Xiao-Feng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
| | - Guang-Ye Du
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
| | - Ling-Ling Cai
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
| | - Hong-Xiu Han
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
| | - Xi-Zi Liang
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
| | - Jiang-Min Zhao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 280, Mohe Road, Shanghai 201999, China.
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26
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Cohen JG, Goo JM, Yoo RE, Park SB, van Ginneken B, Ferretti GR, Lee CH, Park CM. The effect of late-phase contrast enhancement on semi-automatic software measurements of CT attenuation and volume of part-solid nodules in lung adenocarcinomas. Eur J Radiol 2016; 85:1174-80. [DOI: 10.1016/j.ejrad.2016.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/14/2016] [Accepted: 03/29/2016] [Indexed: 11/25/2022]
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27
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Cohen JG, Goo JM, Yoo RE, Park CM, Lee CH, van Ginneken B, Chung DH, Kim YT. Software performance in segmenting ground-glass and solid components of subsolid nodules in pulmonary adenocarcinomas. Eur Radiol 2016; 26:4465-4474. [DOI: 10.1007/s00330-016-4317-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 02/14/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
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28
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Gavrielides MA, Li Q, Zeng R, Myers KJ, Sahiner B, Petrick N. Volume estimation of multidensity nodules with thoracic computed tomography. J Med Imaging (Bellingham) 2016; 3:013504. [PMID: 26844235 DOI: 10.1117/1.jmi.3.1.013504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/18/2015] [Indexed: 11/14/2022] Open
Abstract
This work focuses on volume estimation of "multidensity" lung nodules in a phantom computed tomography study. Eight objects were manufactured by enclosing spherical cores within larger spheres of double the diameter but with a different density. Different combinations of outer-shell/inner-core diameters and densities were created. The nodules were placed within an anthropomorphic phantom and scanned with various acquisition and reconstruction parameters. The volumes of the entire multidensity object as well as the inner core of the object were estimated using a model-based volume estimator. Results showed percent volume bias across all nodules and imaging protocols with slice thicknesses [Formula: see text] ranging from [Formula: see text] to 6.6% for the entire object (standard deviation ranged from 1.5% to 7.6%), and within [Formula: see text] to 5.7% for the inner-core measurement (standard deviation ranged from 2.0% to 17.7%). Overall, the estimation error was larger for the inner-core measurements, which was expected due to the smaller size of the core. Reconstructed slice thickness was found to substantially affect volumetric error for both tasks; exposure and reconstruction kernel were not. These findings provide information for understanding uncertainty in volumetry of nodules that include multiple densities such as ground glass opacities with a solid component.
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Affiliation(s)
- Marios A Gavrielides
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Qin Li
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Rongping Zeng
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Kyle J Myers
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Berkman Sahiner
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
| | - Nicholas Petrick
- U.S. Food and Drug Administration , Division of Imaging, Diagnostics, and Software Reliability (DIDSR), Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, 10903 New Hampshire Avenue, Building 62, Room 4126, Silver Spring, Maryland 20993, United States
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29
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Advanced imaging tools in pulmonary nodule detection and surveillance. Clin Imaging 2016; 40:296-301. [PMID: 26916752 DOI: 10.1016/j.clinimag.2016.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/27/2016] [Accepted: 01/29/2016] [Indexed: 11/23/2022]
Abstract
Lung cancer is a leading cause of death worldwide. The National Lung Screening Trial has demonstrated that lung cancer screening can reduce lung cancer specific and all cause mortality. With approval of national coverage for lung cancer screening, it is expected that an increase in exams related to pulmonary nodule detection and surveillance will ensue. Advanced imaging technologies for nodule detection and surveillance will be more important than ever. While computed tomography (CT) remains the modality of choice, other emerging modalities such as magnetic resonance imaging provides viable alternatives to CT.
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30
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Prognostic Value of Semiautomatic CT Volumetry in Patients With Stage I Non–Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy. J Comput Assist Tomogr 2016; 40:343-50. [DOI: 10.1097/rct.0000000000000368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Peng M, Li Z, Hu H, Liu S, Xu B, Zhu W, Han Y, Xiong L, Lin Q. Pulmonary ground-glass nodules diagnosis: mean change rate of peak CT number as a discriminative factor of pathology during a follow-up. Br J Radiol 2015; 89:20150556. [PMID: 26562098 DOI: 10.1259/bjr.20150556] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to analyse the peak CT number (PEAK) in CT number histogram of ground-glass nodules (GGN), meaning the most frequent density of pixels in the image of pulmonary nodule, based on three-dimensional (3D) reconstructive model pre-operatively, and the mean rate of PEAK change (V-PEAK) during a follow-up of GGN for differential diagnosis between pre-invasive adenocarcinoma (PIA) and invasive adenocarcinoma (IAC). METHODS CT number histogram of pixels in GGN was made automatically by 3D measurement software. Diameter, total volume, PEAK and V-PEAK were measured from CT data sets of different groups classified by pathology, subtype and number of GGN, respectively. RESULTS Among all 102 cases, 47 were PIA, including atypical adenomatous hyperplasia (n = 29) and adenocarcinoma in situ (n = 18), and 55 were IAC, including minimally IAC (MIA, n = 4). By Wilcoxon test, PEAK of IAC was significantly higher than that of PIA (p < 0.001). By receiver operating curve analysis, area under the curve (AUC) was 0.857 and threshold -820.50 Hounsfield units (HU) for differentiation between PIA and IAC. V-PEAK of IAC was unexpectedly remarkably smaller than that of PIA (p < 0.001) with AUC and threshold being 0.810 and -0.829 HU day(-1), respectively. CONCLUSION Pre-operative PEAK and V-PEAK, which interpret and evaluate the change of volume and density of pulmonary nodule simultaneously from both exterior and interior perspectives, can help to distinguish IAC from PIA. ADVANCES IN KNOWLEDGE This study provided researchers of GGN another perspective, taking both volume and density of nodules into consideration for pathological evaluation.
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Affiliation(s)
- Mingzheng Peng
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhao Li
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyang Hu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sida Liu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binbin Xu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenzhuo Zhu
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yudong Han
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liwen Xiong
- 2 Department of Respiration, Shanghai Chest Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Lin
- 1 Department of Thoracic Surgery, Shanghai First People's Hospital Affiliated to The Shanghai Jiao Tong University School of Medicine, Shanghai, China
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32
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Buckler AJ, Danagoulian J, Johnson K, Peskin A, Gavrielides MA, Petrick N, Obuchowski NA, Beaumont H, Hadjiiski L, Jarecha R, Kuhnigk JM, Mantri N, McNitt-Gray M, Moltz JH, Nyiri G, Peterson S, Tervé P, Tietjen C, von Lavante E, Ma X, St Pierre S, Athelogou M. Inter-Method Performance Study of Tumor Volumetry Assessment on Computed Tomography Test-Retest Data. Acad Radiol 2015; 22:1393-408. [PMID: 26376841 PMCID: PMC4609285 DOI: 10.1016/j.acra.2015.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/31/2015] [Accepted: 08/07/2015] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Tumor volume change has potential as a biomarker for diagnosis, therapy planning, and treatment response. Precision was evaluated and compared among semiautomated lung tumor volume measurement algorithms from clinical thoracic computed tomography data sets. The results inform approaches and testing requirements for establishing conformance with the Quantitative Imaging Biomarker Alliance (QIBA) Computed Tomography Volumetry Profile. MATERIALS AND METHODS Industry and academic groups participated in a challenge study. Intra-algorithm repeatability and inter-algorithm reproducibility were estimated. Relative magnitudes of various sources of variability were estimated using a linear mixed effects model. Segmentation boundaries were compared to provide a basis on which to optimize algorithm performance for developers. RESULTS Intra-algorithm repeatability ranged from 13% (best performing) to 100% (least performing), with most algorithms demonstrating improved repeatability as the tumor size increased. Inter-algorithm reproducibility was determined in three partitions and was found to be 58% for the four best performing groups, 70% for the set of groups meeting repeatability requirements, and 84% when all groups but the least performer were included. The best performing partition performed markedly better on tumors with equivalent diameters greater than 40 mm. Larger tumors benefitted by human editing but smaller tumors did not. One-fifth to one-half of the total variability came from sources independent of the algorithms. Segmentation boundaries differed substantially, not ony in overall volume but also in detail. CONCLUSIONS Nine of the 12 participating algorithms pass precision requirements similar to what is indicated in the QIBA Profile, with the caveat that the present study was not designed to explicitly evaluate algorithm profile conformance. Change in tumor volume can be measured with confidence to within ±14% using any of these nine algorithms on tumor sizes greater than 10 mm. No partition of the algorithms was able to meet the QIBA requirements for interchangeability down to 10 mm, although the partition comprising best performing algorithms did meet this requirement for a tumor size of greater than approximately 40 mm.
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Affiliation(s)
| | | | | | - Adele Peskin
- National Institute of Standards and Technology, Boulder, Colorado
| | | | | | | | | | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Rudresh Jarecha
- Perceptive Informatics, Sundew Properties SEZ Pvt Ltd Mindspace, Hyderabad, Andhra Pradesh, India
| | - Jan-Martin Kuhnigk
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | | | - Michael McNitt-Gray
- Department of Radiology, University of California at Los Angeles, Los Angeles, California
| | - Jan H Moltz
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | | | | | | | - Christian Tietjen
- Siemens AG, Healthcare Sector, Imaging and Therapy Division, Forchheim, Germany
| | | | - Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
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33
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Ridge CA, Yildirim A, Boiselle PM, Franquet T, Schaefer-Prokop CM, Tack D, Gevenois PA, Bankier AA. Differentiating between Subsolid and Solid Pulmonary Nodules at CT: Inter- and Intraobserver Agreement between Experienced Thoracic Radiologists. Radiology 2015; 278:888-96. [PMID: 26458208 DOI: 10.1148/radiol.2015150714] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To quantify the reproducibility and accuracy of experienced thoracic radiologists in differentiating between subsolid and solid pulmonary nodules at CT. MATERIALS AND METHODS The institutional review board of Beth Israel Deaconess Medical Center approved this multicenter study. Six thoracic radiologists, with a mean of 21 years of experience in thoracic radiology (range, 17-22 years), selected images of 10 solid and 10 subsolid nodules to create a database of 120 nodules; this selection served as the reference standard. Each radiologist then interpreted 120 randomly ordered nodules in two different sessions that were separated by a minimum of 3 weeks. The radiologists classified whether or not each nodule was subsolid. Inter- and intraobserver agreement was assessed with a κ statistic. The number of correct classifications was calculated and correlated with nodule size by using Bland-Altman plots. The relationship between disagreement and nodule morphologic characteristics was analyzed by calculating the intraclass correlation coefficient. RESULTS Interobserver agreement (κ) was 0.619 (range, 0.469-0.745; 95% confidence interval (CI): 0.576, 0.663) and 0.670 (range, 0.440-0.839; 95% CI: 0.608, 0.733) for interpretation sessions 1 and 2, respectively. Intraobserver agreement (κ) was 0.792 (95% CI: 0.750, 0.833). Averaged for interpretation sessions, correct classification was achieved by all radiologists for 58% (70 of 120) of nodules. Radiologists agreed with their initial determination (the reference standard) in 77% of cases (range, 45%-100%). Nodule size weakly correlated with correct classification (long axis: Spearman rank correlation coefficient, rs = 0.161 and P = .049; short axis: rs = 0.128 and P = .163). CONCLUSION The reproducibility and accuracy of thoracic radiologists in classifying whether or not a nodule is subsolid varied in the retrospective study. This inconsistency may affect surveillance recommendations and prognostic determinations.
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Affiliation(s)
- Carole A Ridge
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Afra Yildirim
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Phillip M Boiselle
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Tomas Franquet
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Cornelia M Schaefer-Prokop
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Denis Tack
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Pierre Alain Gevenois
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
| | - Alexander A Bankier
- From the Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (C.A.R.); Department of Radiology, Gevher Nesibe Hospital, University of Erciyes, Kayseri, Turkey (A.Y.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (P.M.B., A.A.B.); Department of Radiology, Hospital de Sant Pau, Barcelona, Spain (T.F.); Department of Radiology, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Universitair Medisch Centrum St. Radboud, Nijmegen, the Netherlands (C.M.S.P.); Department of Radiology, Epicura Hospital, Clinique Louis Caty, Baudour, Belgium (D.T.); and Department of Radiology, Erasmus Hospital, University of Brussels, Brussels, Belgium (P.A.G.)
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Li Z, Ye B, Bao M, Xu B, Chen Q, Liu S, Han Y, Peng M, Lin Z, Li J, Zhu W, Lin Q, Xiong L. Radiologic Predictors for Clinical Stage IA Lung Adenocarcinoma with Ground Glass Components: A Multi-Center Study of Long-Term Outcomes. PLoS One 2015; 10:e0136616. [PMID: 26339917 PMCID: PMC4560441 DOI: 10.1371/journal.pone.0136616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/27/2015] [Indexed: 01/15/2023] Open
Abstract
Objective This study was to define preoperative predictors from radiologic findings for the pathologic risk groups based on long-term surgical outcomes, in the aim to help guide individualized patient management. Methods We retrospectively reviewed 321 consecutive patients with clinical stage IA lung adenocarcinoma with ground glass component on computed tomography (CT) scanning. Pathologic diagnosis for resection specimens was based on the 2011 IASLC/ATS/ERS classification of lung adenocarcinoma. Patients were classified into different pathologic risk grading groups based on their lymph node status, local regional recurrence and overall survival. Radiologic characteristics of the pulmonary nodules were re-evaluated by reconstructed three-dimension CT (3D-CT). Univariate and multivariate analysis identifies independent radiologic predictors from tumor diameter, total volume (TV), average CT value (AVG), and solid-to-tumor (S/T) ratio. Receiver operating characteristic curves (ROC) studies were carried out to determine the cutoff value(s) for the predictor(s). Univariate cox regression model was used to determine the clinical significance of the above findings. Results A total of 321 patients with clinical stage IA lung adenocarcinoma with ground glass components were included in our study. Patients were classified into two pathologic low- and high- risk groups based on their distinguished surgical outcomes. A total of 134 patients fell into the low-risk group. Univariate and multivariate analyses identified AVG (HR: 32.210, 95% CI: 3.020–79.689, P<0.001) and S/T ratio (HR: 12.212, 95% CI: 5.441–27.408, P<0.001) as independent predictors for pathologic risk grading. ROC curves studies suggested the optimal cut-off values for AVG and S/T ratio were-198 (area under the curve [AUC] 0.921), 2.9 (AUC 0.996) and 54% (AUC 0.907), respectively. The tumor diameter and TV were excluded for the low AUCs (0.778 and 0.767). Both the cutoff values of AVG and S/T ratio were correlated with pathologic risk classification (p<0.001). Univariate Cox regression model identified clinical risk classification (RR: 3.011, 95%CI: 0.796–7.882, P = 0.095) as a good predictor for recurrence-free survival (RFS) in patients with clinical stage IA lung adenocarcinoma. Statistical significance of 5-year OS and RFS was noted among clinical low-, moderate- and high-risk groups (log-rank, p = 0.024 and 0.010). Conclusions The AVG and the S/T ratio by reconstructed 3D-CT are important preoperative radiologic predictors for pathologic risk grading. The two cutoff values of AVG and S/T ratio are recommended in decision-making for patients with clinical stage IA lung adenocarcinoma with ground glass components.
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Affiliation(s)
- Zhao Li
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Bo Ye
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Minwei Bao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Binbin Xu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Qinyi Chen
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Sida Liu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Yudong Han
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Mingzhen Peng
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Zhifeng Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Jingpei Li
- Department of Thoracic Surgery, Guangzhou Medical University First Affiliated Hospital, Guangdong Province, China
| | - Wenzhuo Zhu
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
| | - Qiang Lin
- Department of Thoracic Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of medicine, Shanghai, China
- * E-mail: (QL); (LWX)
| | - Liwen Xiong
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- * E-mail: (QL); (LWX)
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Peng M, Peng F, Zhang C, Wang Q, Li Z, Hu H, Liu S, Xu B, Zhu W, Han Y, Lin Q. Preoperative Prediction of Ki-67 Labeling Index By Three-dimensional CT Image Parameters for Differential Diagnosis Of Ground-Glass Opacity (GGO). PLoS One 2015; 10:e0129206. [PMID: 26061252 PMCID: PMC4465676 DOI: 10.1371/journal.pone.0129206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/07/2015] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to predict Ki-67 labeling index (LI) preoperatively by three-dimensional (3D) CT image parameters for pathologic assessment of GGO nodules. Diameter, total volume (TV), the maximum CT number (MAX), average CT number (AVG) and standard deviation of CT number within the whole GGO nodule (STD) were measured by 3D CT workstation. By detection of immunohistochemistry and Image Software Pro Plus 6.0, different Ki-67 LI were measured and statistically analyzed among preinvasive adenocarcinoma (PIA), minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC). Receiver operating characteristic (ROC) curve, Spearman correlation analysis and multiple linear regression analysis with cross-validation were performed to further research a quantitative correlation between Ki-67 labeling index and radiological parameters. Diameter, TV, MAX, AVG and STD increased along with PIA, MIA and IAC significantly and consecutively. In the multiple linear regression model by a stepwise way, we obtained an equation: prediction of Ki-67 LI=0.022*STD+0.001* TV+2.137 (R=0.595, R’s square=0.354, p<0.001), which can predict Ki-67 LI as a proliferative marker preoperatively. Diameter, TV, MAX, AVG and STD could discriminate pathologic categories of GGO nodules significantly. Ki-67 LI of early lung adenocarcinoma presenting GGO can be predicted by radiologic parameters based on 3D CT for differential diagnosis.
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Affiliation(s)
- Mingzheng Peng
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Fei Peng
- Department of Nephrology, People's Hospital of Hunan Province Affiliated to Hunan Normal University School Of Medicine, Changsha, Hunan Province, China
| | - Chengzhong Zhang
- Department of Radiology, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Qingguo Wang
- Department of Radiology, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Zhao Li
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Haiyang Hu
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Sida Liu
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Binbin Xu
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Wenzhuo Zhu
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Yudong Han
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
| | - Qiang Lin
- Department of Thoracic Surgery, Shanghai First People’s Hospital Affiliated to The Shanghai Jiao Tong University School Of Medicine, Shanghai, China
- * E-mail:
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Pulmonary Nodules With Ground-Glass Opacity Can Be Reliably Measured With Low-Dose Techniques Regardless of Iterative Reconstruction: Results of a Phantom Study. AJR Am J Roentgenol 2015; 204:1242-7. [DOI: 10.2214/ajr.14.13820] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Cohen JG, Reymond E, Lederlin M, Medici M, Lantuejoul S, Laurent F, Arbib F, Jankowski A, Moreau-Gaudry A, Ferretti GR. Differentiating pre- and minimally invasive from invasive adenocarcinoma using CT-features in persistent pulmonary part-solid nodules in Caucasian patients. Eur J Radiol 2015; 84:738-44. [PMID: 25623825 DOI: 10.1016/j.ejrad.2014.12.031] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To retrospectively investigate the diagnostic value of pre-operative CT-features between pre/minimally invasive and invasive lesions in part-solid persistent pulmonary ground glass nodules in a Caucasian population. MATERIALS AND METHODS Retrospective review of two pre-operative CTs for 31 nodules in 30 patients. There were 10 adenocarcinomas in situ, 1 minimally invasive adenocarcinoma, 20 invasive adenocarcinomas. We analyzed the correlation between histopathology and the following CT-features: maximal axial diameter, maximal orthogonal axial diameter, height, density, size of solid component, air bronchogram, pleural retraction, nodule mass, disappearance rate and their evolution during follow-up. RESULTS In univariate analysis, invasive adenocarcinomas had a higher maximal height, density, solid component size, mass, a lower disappearance rate and presented more often with pleural retraction (p<0.05). After logistic regression performed with the uncorrelated parameters using a method of selection of variables, only the size of solid component remained significant, with 100% sensitivity for invasive adenocarcinoma when larger than 5mm. CONCLUSION Preoperative CT-features can help differentiating in situ and minimally invasive adenocarcinomas from invasive adenocarcinomas in Caucasian patients. A solid component larger than 5mm in diameter had 100% sensitivity for the diagnosis of invasive adenocarcinoma.
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Affiliation(s)
- Julien G Cohen
- Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France.
| | - Emilie Reymond
- Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France
| | - Mathieu Lederlin
- Service de Radiologie, Université Segalen Bordeaux, Centre Hospitalier Universitaire de Bordeaux, 12 rue Dubernat, 33404 Bordeaux Cedex, France
| | - Maud Medici
- Centre d'Investigation Clinique - Innovation Technologique (CIC-IT), Pavillon Taillefer, 38706 La Tronche Cedex, France
| | - Sylvie Lantuejoul
- Departement d'Anatomie et Cytologie Pathologique (DACP), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France
| | - François Laurent
- Service de Radiologie, Université Segalen Bordeaux, Centre Hospitalier Universitaire de Bordeaux, 12 rue Dubernat, 33404 Bordeaux Cedex, France
| | - François Arbib
- Departement de Pneumologie, Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France
| | - Adrien Jankowski
- Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France
| | - Alexandre Moreau-Gaudry
- Centre d'Investigation Clinique - Innovation Technologique (CIC-IT), Pavillon Taillefer, 38706 La Tronche Cedex, France
| | - Gilbert R Ferretti
- Clinique Universitaire de Radiologie et Imagerie Médicale (CURIM), Université Joseph Fourier, Centre Hospitalier Universitaire de Grenoble, CS 10217, 38043 Grenoble Cedex 9, France
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Li Q, Gavrielides MA, Zeng R, Myers KJ, Sahiner B, Petrick N. Volume estimation of low-contrast lesions with CT: a comparison of performances from a phantom study, simulations and theoretical analysis. Phys Med Biol 2015; 60:671-88. [PMID: 25555240 DOI: 10.1088/0031-9155/60/2/671] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Measurements of lung nodule volume with multi-detector computed tomography (MDCT) have been shown to be more accurate and precise compared to conventional lower dimensional measurements. Quantifying the size of lesions is potentially more difficult when the object-to-background contrast is low as with lesions in the liver. Physical phantom and simulation studies are often utilized to analyze the bias and variance of lesion size estimates because a ground truth or reference standard can be established. In addition, it may also be useful to derive theoretical bounds as another way of characterizing lesion sizing methods. The goal of this work was to study the performance of a MDCT system for a lesion volume estimation task with object-to-background contrast less than 50 HU, and to understand the relation among performances obtained from phantom study, simulation and theoretical analysis. We performed both phantom and simulation studies, and analyzed the bias and variance of volume measurements estimated by a matched-filter-based estimator. We further corroborated results with a theoretical analysis to estimate the achievable performance bound, which was the Cramer-Rao's lower bound (CRLB) of minimum variance for the size estimates. Results showed that estimates of non-attached solid small lesion volumes with object-to-background contrast of 31-46 HU can be accurate and precise, with less than 10.8% in percent bias and 4.8% in standard deviation of percent error (SPE), in standard dose scans. These results are consistent with theoretical (CRLB), computational (simulation) and empirical phantom bounds. The difference between the bounds is rather small (for SPE less than 1.9%) indicating that the theoretical- and simulation-based performance bounds can be good surrogates for physical phantom studies.
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Affiliation(s)
- Qin Li
- Division of Imaging, Diagnostics, and Software Reliability, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
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Gardiner N, Jogai S, Wallis A. The revised lung adenocarcinoma classification-an imaging guide. J Thorac Dis 2014; 6:S537-46. [PMID: 25349704 DOI: 10.3978/j.issn.2072-1439.2014.04.05] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/02/2014] [Indexed: 01/08/2023]
Abstract
Advances in our understanding of the pathology, radiology and clinical behaviour of peripheral lung adenocarcinomas facilitated a more robust terminology and classification of these lesions. The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society (IASLC/ATS/ERS) classification introduced new terminology to better reflect this heterogeneous group of adenocarcinomas formerly known as bronchoalveolar cell carcinoma (BAC). There is now a clear distinction between pre-invasive, minimally invasive and frankly invasive lesions. The radiographic appearance of these ranges from pure ground glass nodules to solid mass lesions. Radiologists must be aware of the new classification in order to work alongside multidisciplinary colleagues to allow accurate staging and treatment. This article reviews the new classification of lung adenocarcinomas. Management options of these lesions with particular focus on radiological implications of the new classification will be reviewed.
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Affiliation(s)
- Natasha Gardiner
- 1 Specialty Registrar in Clinical Radiology, Wessex Deanery, UK ; 2 Consultant Histopathologist, University Hospital Southampton NHS Foundation Trust, UK ; 3 Consultant Radiologist, Portsmouth Hospitals NHS Trust, UK
| | - Sanjay Jogai
- 1 Specialty Registrar in Clinical Radiology, Wessex Deanery, UK ; 2 Consultant Histopathologist, University Hospital Southampton NHS Foundation Trust, UK ; 3 Consultant Radiologist, Portsmouth Hospitals NHS Trust, UK
| | - Adam Wallis
- 1 Specialty Registrar in Clinical Radiology, Wessex Deanery, UK ; 2 Consultant Histopathologist, University Hospital Southampton NHS Foundation Trust, UK ; 3 Consultant Radiologist, Portsmouth Hospitals NHS Trust, UK
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Massion PP, Walker RC. Indeterminate pulmonary nodules: risk for having or for developing lung cancer? Cancer Prev Res (Phila) 2014; 7:1173-8. [PMID: 25348855 DOI: 10.1158/1940-6207.capr-14-0364] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This perspective discusses the report by Pinsky and colleagues, which addresses whether noncalcified pulmonary nodules identified on CT screening carry short- and long-term risk for lung cancer. We are facing challenges related to distinguishing a large majority of benign nodules from malignant ones and among those a majority of aggressive from indolent cancers. Key questions in determining individual probabilities of disease, given their history, findings on CT, and upcoming biomarkers of risk, remain most challenging. Reducing the false positives associated with current low-dose computed tomography practices and identification of individuals who need therapy and at what time during tumor surveillance could reduce costs and morbidities associated with unnecessary interventions.
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Affiliation(s)
- Pierre P Massion
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, Tennessee. Thoracic Program, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee. Veterans Affairs Medical Center, Nashville, Tennessee.
| | - Ronald C Walker
- Thoracic Program, Vanderbilt-Ingram Comprehensive Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee. Veterans Affairs Medical Center, Nashville, Tennessee. Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee
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Kołaczyk K, Walecka A, Grodzki T, Alchimowicz J, Smereczyński A, Kiedrowicz R. The assessment of the role of baseline low-dose CT scan in patients at high risk of lung cancer. Pol J Radiol 2014; 79:210-8. [PMID: 25057333 PMCID: PMC4106928 DOI: 10.12659/pjr.890103] [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: 11/25/2013] [Accepted: 03/05/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules. MATERIAL/METHODS We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55-65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions. RESULTS Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm. CONCLUSIONS The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.
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Affiliation(s)
- Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology PUM, Independent Public Clinical Hospital No. 1, Szczecin, Poland
| | - Anna Walecka
- Department of Diagnostic Imaging and Interventional Radiology PUM, Independent Public Clinical Hospital No. 1, Szczecin, Poland
| | - Tomasz Grodzki
- Clinical Division of Thoracic Surgery PUM, Specialist Hospital, prof. Alfred Sokołowski Scales, Szczecin, Poland
| | - Jacek Alchimowicz
- Clinical Division of Thoracic Surgery PUM, Specialist Hospital, prof. Alfred Sokołowski Scales, Szczecin, Poland
| | - Andrzej Smereczyński
- Department of Gastroenterology PUM, Independent Public Clinical Hospital No. 1, Szczecin, Poland
| | - Radosław Kiedrowicz
- Department of Cardiology PUM, Independent Public Clinical Hospital No. 2, Szczecin, Poland
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Doo KW, Kang EY, Yong HS, Woo OH, Lee KY, Oh YW. Accuracy of lung nodule volumetry in low-dose CT with iterative reconstruction: an anthropomorphic thoracic phantom study. Br J Radiol 2014; 87:20130644. [PMID: 25026866 DOI: 10.1259/bjr.20130644] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess accuracy of lung nodule volumetry in low-dose CT with application of iterative reconstruction (IR) according to nodule size, nodule density and CT tube currents, using artificial lung nodules within an anthropomorphic thoracic phantom. METHODS Eight artificial nodules (four diameters: 5, 8, 10 and 12 mm; two CT densities: -630 HU that represents ground-glass nodule and +100 HU that represents solid nodule) were randomly placed inside a thoracic phantom. Scans were performed with tube current-time product to 10, 20, 30 and 50 mAs. Images were reconstructed with IR and filtered back projection (FBP). We compared volume estimates to a reference standard and calculated the absolute percentage error (APE). RESULTS The APE of all nodules was significantly lower when IR was used than with FBP (7.5 ± 4.7% compared with 9.0 ±6.9%; p < 0.001). The effect of IR was more pronounced for smaller nodules (p < 0.001). IR showed a significantly lower APE than FBP in ground-glass nodules (p < 0.0001), and the difference was more pronounced at the lowest tube current (11.8 ± 5.9% compared with 21.3 ± 6.1%; p < 0.0001). The effect of IR was most pronounced for ground-glass nodules in the lowest CT tube current. CONCLUSION Lung nodule volumetry in low-dose CT by application of IR showed reliable accuracy in a phantom study. Lung nodule volumetry can be reliably applicable to all lung nodules including small, ground-glass nodules even in ultra-low-dose CT with application of IR. ADVANCES IN KNOWLEDGE IR significantly improved the accuracy of lung nodule volumetry compared with FBP particularly for ground-glass (-630 HU) nodules. Volumetry in low-dose CT can be utilized in patient with lung nodule work-up, and IR has benefit for small, ground-glass lung nodules in low-dose CT.
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Affiliation(s)
- K W Doo
- 1 Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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Song YS, Park CM, Park SJ, Lee SM, Jeon YK, Goo JM. Volume and mass doubling times of persistent pulmonary subsolid nodules detected in patients without known malignancy. Radiology 2014; 273:276-84. [PMID: 24927472 DOI: 10.1148/radiol.14132324] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate volume doubling time (VDT) and mass doubling time (MDT) of persistent pulmonary subsolid nodules (SSNs) followed-up with low-dose (LD) computed tomography (CT) in patients without a history of malignancy. MATERIALS AND METHODS This retrospective institutional review board-approved study, with waiver of patient informed consent, included 97 SSNs in 97 patients (45 men, 52 women; median age, 58 years; range, 37-87 years) in whom at least two LD CT scans were obtained, with 3-month or longer follow-up interval and median follow-up of 633 days. SSNs were categorized into pure ground-glass nodules (GGNs) (group A), part-solid GGNs with solid components of 5 mm or smaller (group B), and part-solid GGNs with solid components larger than 5 mm (group C). Three-dimensional manual segmentation for all SSNs was performed on initial and latest follow-up LD CT scans; subsequently, VDTs and MDTs were calculated and were compared among groups by using Kruskal-Wallis test, followed by the Dunn procedure with Bonferroni correction for volume-growing SSNs and mass-growing SSNs. RESULTS Volume growth was thus: 12 of 63 SSNs (19%), group A; nine of 23 SSNs (39%), group B; and eight of 11 SSNs (73%), group C. Median VDT was thus: 1832.3 days (range, 1230.7-4537.3 days), group A; 1228.5 days (range, 934.7-4617.7 days), group B; and 759.0 days (range, 376.4-941.5 days), group C. Mass growth was thus: 17 of 63 SSNs (27%), group A; 11 of 23 SSNs (48%), group B; and nine of 11 SSNs (82%), group C. Median MDT was 1556.1 days (range, 642.5-3564.5 days) for group A, 1199.9 days (range, 838.6-2578.7 days) for group B, and 627.7 days (range, 340.0-921.2 days) for group C. Median VDTs and MDTs of groups A and B were significantly longer than those of group C (P < .01). CONCLUSION Pure GGNs and part-solid GGNs with solid components of 5 mm or smaller show significantly longer VDTs and MDTs than do part-solid GGNs with solid components larger than 5 mm. Online supplemental material is available for this article.
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Affiliation(s)
- Yong Sub Song
- From the Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (Y.S.S., C.M.P., S.J.P., S.M.L., J.M.G.); Cancer Research Institute, Seoul National University, Seoul, Korea (C.M.P., S.J.P., J.M.G.); and Department of Pathology, Seoul National University College of Medicine, Seoul, Korea (Y.K.J.)
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Morimoto D, Takashima S, Sakashita N, Sato Y, Jiang B, Hakucho T, Miyake C, Takahashi Y, Tomita Y, Nakanishi K, Hosoki T, Higashiyama M. Differentiation of lung neoplasms with lepidic growth and good prognosis from those with poor prognosis using computer-aided 3D volumetric CT analysis and FDG-PET. Acta Radiol 2014; 55:563-9. [PMID: 24003260 DOI: 10.1177/0284185113502336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Many studies have reported that transverse computed tomography (CT) imaging findings correlate with prognosis of patients with small peripheral lung neoplasm with lepidic growth. However, no studies have examined this correlation with the aid of three-dimensional (3D) CT data. PURPOSE To determine the most efficacious imaging factor for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. MATERIAL AND METHODS We evaluated CT findings, nodule patterns, SUVmax on FDG-PET/CT, as well as nodule volume and ratios of solid parts to nodule volume that were semi-automatically measured on CT images of 64 pulmonary nodules of ≤ 2 cm in 60 consecutive patients (24 men and 36 women; mean age, 65 years). For logistic modeling, we used all of the significant factors observed between the neoplasms with good and with poor prognosis as independent variables to estimate the statistically significant factors for discriminating invasive adenocarcinomas with lepidic growth (lesions with poor prognosis, n=42) from the other neoplasms, including preinvasive lesions (lesions with good prognosis, n=22), resulting in a recommendation for the optimal criterion for predicting lesions with poor prognosis. RESULTS The logistic regression model identified the ratio of the solid part to the whole volume of a pulmonary nodule as the only significant factor (P=0.04) for differentiating lepidic growth type lung neoplasms with good prognosis from those with poor prognosis. A ratio of 0.238 or more showed the highest discriminatory accuracy of 84% with 91% sensitivity and 76% specificity. CONCLUSION Computer-aided analyses of pulmonary nodules proved most useful for establishing the optimal criterion for differentiation of lepidic growth type lung neoplasms with good prognosis from those with poor prognosis.
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Affiliation(s)
- Daisuke Morimoto
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Shodayu Takashima
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Naohiro Sakashita
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yoshinobu Sato
- Osaka University Graduate School of Medicine, Department of Radiology, Osaka, Japan
| | - Binghu Jiang
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Tomoaki Hakucho
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Chie Miyake
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Yoshiyuki Takahashi
- Osaka University Graduate School of Medicine, Division of Allied Health Sciences, Department of Diagnostic Radiological Imaging, Osaka, Japan
| | - Yasuhiko Tomita
- Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
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Scholten ET, de Hoop B, Jacobs C, van Amelsvoort-van de Vorst S, van Klaveren RJ, Oudkerk M, Vliegenthart R, de Koning HJ, van der Aalst CM, Mali WTM, Gietema HA, Prokop M, van Ginneken B, de Jong PA. Semi-automatic quantification of subsolid pulmonary nodules: comparison with manual measurements. PLoS One 2013; 8:e80249. [PMID: 24278264 PMCID: PMC3837004 DOI: 10.1371/journal.pone.0080249] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/11/2013] [Indexed: 12/27/2022] Open
Abstract
Rationale Accurate measurement of subsolid pulmonary nodules (SSN) is becoming increasingly important in the management of these nodules. SSNs were previously quantified with time-consuming manual measurements. The aim of the present study is to test the feasibility of semi-automatic SSNs measurements and to compare the results to the manual measurements. Methods In 33 lung cancer screening participants with 33 SSNs, the nodules were previously quantified by two observers manually. In the present study two observers quantified these nodules by using semi-automated nodule volumetry software. Nodules were quantified for effective diameter, volume and mass. The manual and semi-automatic measurements were compared using Bland-Altman plots and paired T tests. Observer agreement was calculated as an intraclass correlation coefficient. Data are presented as mean (SD). Results Semi-automated measurements were feasible in all 33 nodules. Nodule diameter, volume and mass were 11.2 (3.3) mm, 935 (691) ml and 379 (311) milligrams for observer 1 and 11.1 (3.7) mm, 986 (797) ml and 399 (344) milligrams for observer 2, respectively. Agreement between observers and within observer 1 for the semi-automatic measurements was good with an intraclass correlation coefficient >0.89. For observer 1 and observer 2, measured diameter was 8.8% and 10.3% larger (p<0.001), measured volume was 24.3% and 26.5% larger (p<0.001) and measured mass was 10.6% and 12.0% larger (p<0.001) with the semi-automatic program compared to the manual measurements. Conclusion Semi-automated measurement of the diameter, volume and mass of SSNs is feasible with good observer agreement. Semi-automated measurement makes quantification of mass and volume feasible in daily practice.
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Affiliation(s)
- Ernst Th. Scholten
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Radiology, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Bartjan de Hoop
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Colin Jacobs
- Image Analysis Group, Department of Radiology UMC St Radboud, Nijmegen, The Netherlands
- Fraunhofer MEVIS, Bremen, Germany
| | | | - Rob J. van Klaveren
- Departement of Pulmonology, Lievensberg Hospital, Bergen op Zoom, The Netherlands
| | - Matthijs Oudkerk
- Department of Radiology, University Medical Centre, Groningen, The Netherlands
| | | | - Harry J. de Koning
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Willem Th M. Mali
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hester A. Gietema
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mathias Prokop
- Department of Radiology, UMC St Radboud, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Image Analysis Group, Department of Radiology UMC St Radboud, Nijmegen, The Netherlands
- Fraunhofer MEVIS, Bremen, Germany
| | - Pim A. de Jong
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- * E-mail:
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Lederlin M, Revel MP, Khalil A, Ferretti G, Milleron B, Laurent F. Management strategy of pulmonary nodule in 2013. Diagn Interv Imaging 2013; 94:1081-94. [PMID: 24034970 DOI: 10.1016/j.diii.2013.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Lederlin
- Service d'imagerie médicale, Université Bordeaux Segalen, CHU Bordeaux Groupe Sud, avenue de Magellan, 33600 Pessac, France.
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Kobayashi Y, Sakao Y, Deshpande GA, Fukui T, Mizuno T, Kuroda H, Sakakura N, Usami N, Yatabe Y, Mitsudomi T. The association between baseline clinical-radiological characteristics and growth of pulmonary nodules with ground-glass opacity. Lung Cancer 2013; 83:61-6. [PMID: 24268684 DOI: 10.1016/j.lungcan.2013.10.017] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/19/2013] [Accepted: 10/21/2013] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pulmonary nodules with ground-glass opacity (GGO) are frequently encountered; there is little consensus on appropriate monitoring of them. The purpose of this study was to clarify which baseline clinical and radiological characteristics were associated with growth of these nodules. METHODS We retrospectively studied patients with pulmonary nodules that met the following criteria: (1) lesion diameter of ≤3 cm, (2) GGO proportion of ≥50%, and (3) observation without treatment in the prior 6 months. Between 1999 and 2013, 120 pulmonary lesions in 67 patients fulfilled inclusion criteria. We evaluated changes in lesion size on serial computed tomography. Two endpoints, "time to 2-mm growth" and "incidence of 2-mm growth", were analyzed using Cox proportional hazards and logistic regression models, respectively. RESULTS At the median observation period of 4.2 years, 34 lesions exhibited growth by ≥2 mm, whereas 86 remained unchanged. Smoking history and initial lesion diameter were statistically significant variables in both time-to-event and regression analyses. Hazard ratio (HR) for smoking history was 3.67 (P<0.01). Compared with those ≤1 cm, HRs for 1.1-2 cm and 2.1-3 cm lesions were 2.23 (P=0.08) and 5.08 (P=0.04), respectively. Odds ratio (OR) for smoking history was 6.51 (P<0.01); OR for lesion diameter of 1.1-3 cm (versus ≤1 cm) was 4.06 (P=0.02). CONCLUSION Smoking history and initial lesion diameter are robustly associated with GGO growth. These results suggest that large GGOs, especially in smokers, warrant close follow-up to accurately monitor lesion growth.
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Affiliation(s)
- Yoshihisa Kobayashi
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Yukinori Sakao
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
| | - Gautam A Deshpande
- St. Luke's Life Science Institute, St. Luke's International Hospital, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; Department of Internal Medicine, University of Hawaii, 1356 Lusitana Street #711, Honolulu, HI 96813, USA
| | - Takayuki Fukui
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Tetsuya Mizuno
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Noriaki Sakakura
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Noriyasu Usami
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan
| | - Yasushi Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan
| | - Tetsuya Mitsudomi
- Department of Thoracic Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama 589-8511, Japan
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Gavrielides MA, Li Q, Zeng R, Myers KJ, Sahiner B, Petrick N. Minimum detectable change in lung nodule volume in a phantom CT study. Acad Radiol 2013; 20:1364-70. [PMID: 24119348 DOI: 10.1016/j.acra.2013.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 08/28/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES The change in volume of lung nodules is being examined as a measure of response to treatment. The aim of this study was to determine the minimum detectable change in nodule volume with the use of computed tomography. MATERIALS AND METHODS Four different layouts of synthetic nodules with different shapes but with the same size (5, 8, 9, or 10 mm) for each layout were placed within an anthropomorphic phantom and scanned with a 16-detector-row computed tomography scanner using multiple imaging parameters. Nodule volume estimates were determined using a previously developed matched-filter estimator. Analysis of volume change was then conducted as a detection problem. For each nodule size, the pooled distribution of volume estimates was shifted by a percentage c to simulate a changing nodule, while accounting for standard deviation. The value of c resulting in a prespecified area under the receiver operating characteristic curve (AUC) was deemed the minimum detectable change for that AUC value. RESULTS Both nodule size at baseline and choice of slice collimation protocol had an effect on the value of minimum detectable growth. For AUC = 0.95, the minimum detectable nodule growth in volume when using the thin-slice collimation protocol (16 × 0.75 mm) was 17%, 19%, and 15% for nodule sizes of 5, 8, and 9 mm, respectively. CONCLUSIONS Our results indicate that an approximate bound for detectable nodule growth in subcentimeter nodules may be relatively small, on the order of 20% or less in volume for a thin-slice CT acquisition protocol.
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Affiliation(s)
- Marios A Gavrielides
- Division of Imaging and Applied Mathematics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Bldg. 62, Rm.4114, Silver Spring, MD 20993.
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Koike W, Iwano S, Matsuo K, Kitano M, Kawakami K, Naganawa S. Doubling time calculations for lung cancer by three‐dimensional computer‐aided volumetry: Effects of inter‐observer differences and nodule characteristics. J Med Imaging Radiat Oncol 2013; 58:82-8. [DOI: 10.1111/1754-9485.12128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 09/18/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Wataru Koike
- Department of Radiology Nagoya University Graduate School of Medicine Nagoya Japan
- Department of Radiology Gifu Prefectural Tajimi Hospital Tajimi Japan
| | - Shingo Iwano
- Department of Radiology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Keiji Matsuo
- Department of Radiology Ichinomiya Municipal Hospital Ichinomiya Japan
| | - Mariko Kitano
- Department of Radiology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Kenichi Kawakami
- Department of Radiology Nagoya University Graduate School of Medicine Nagoya Japan
| | - Shinji Naganawa
- Department of Radiology Nagoya University Graduate School of Medicine Nagoya Japan
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Abstract
In this review, we focus on the radiologic, clinical, and pathologic aspects primarily of solitary subsolid pulmonary nodules. Particular emphasis will be placed on the pathologic classification and correlative computed tomography (CT) features of adenocarcinoma of the lung. The capabilities of fluorodeoxyglucose positron emission tomography-CT and histologic sampling techniques, including CT-guided biopsy, endoscopic-guided biopsy, and surgical resection, are discussed. Finally, recently proposed management guidelines by the Fleischner Society and the American College of Chest Physicians are reviewed.
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Affiliation(s)
- Roy A Raad
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, New York, NY 10016, USA.
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