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Guedes Pinto E, Penha D, Ravara S, Monaghan C, Hochhegger B, Marchiori E, Taborda-Barata L, Irion K. Factors influencing the outcome of volumetry tools for pulmonary nodule analysis: a systematic review and attempted meta-analysis. Insights Imaging 2023; 14:152. [PMID: 37741928 PMCID: PMC10517915 DOI: 10.1186/s13244-023-01480-z] [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: 04/18/2023] [Accepted: 07/08/2023] [Indexed: 09/25/2023] Open
Abstract
Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance. CRITICAL RELEVANCE STATEMENT: Many studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence. KEY POINTS: • Factors influencing the volumetry of pulmonary nodules have been extensively investigated. • Just 11% of studies test clinical significance (wrongly diagnosing growth). • Nodule size interacts with most other influencing factors (especially for smaller nodules). • Heterogeneity among studies makes comparison and consolidation of results challenging. • Future research should focus on clinical applicability, screening, and updated technology.
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Affiliation(s)
- Erique Guedes Pinto
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal.
| | - Diana Penha
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | - Sofia Ravara
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | | | - Edson Marchiori
- Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Bloco K - Av. Carlos Chagas Filho, 373 - 2º Andar, Sala 49 - Cidade Universitária da Universidade Federal Do Rio de Janeiro, Rio de Janeiro - RJ, 21044-020, Brasil
- Faculdade de Medicina, Universidade Federal Fluminense, Av. Marquês Do Paraná, 303 - Centro, Niterói - RJ, 24220-000, Brasil
| | - Luís Taborda-Barata
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Variability of pulmonary nodule volumetry on coronary CT angiograms. Medicine (Baltimore) 2022; 101:e30332. [PMID: 36107569 PMCID: PMC9439735 DOI: 10.1097/md.0000000000030332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate the variability of pulmonary nodule (PN) volumetry on multiphase coronary CT angiograms (CCTA). Two radiologists reviewed 5973 CCTA scans in this cross-sectional study to detect incidental solid noncalcified PNs measuring between 5 and 8 mm. Each radiologist measured the nodules' diameters and volume, in systole and diastole, using 2 commercially available software packages to analyze PNs. Bland-Altman analysis was applied between different observers, software packages, and cardiac phases. Bland-Altman subanalysis for the systolic and diastolic datasets were also performed. A total of 195 PNs were detected within the inclusion criteria and measured in systole and diastole. Bland-Altman analysis was used to test the variability of volumetry between cardiac phases ([-47.0%; 52.3%]), software packages ([-50.2%; 68.2%]), and observers ([-14.5%; 27.8%]). The inter-observer variability of the systolic and diastolic subsets was [-13.6%; 31.4%] and [-13.9%; 19.7%], respectively. Using diastolic volume measurements, the variability of PN volumetry on CCTA scans is similar to the reported variability of volumetry on low-dose CT scans. Therefore, growth estimation of PNs on CCTA scans could be feasible.
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Affiliation(s)
- Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- *Correspondence: Erique Pinto, MD, EBIR, Rua Luís DE Camões, nº 102, lt 8, 3º esq, 1300—356 Lisbon, Portugal. (e-mail: )
| | - Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio DE Janeiro, RJ, Brazil
- Universidade Federal Fluminense Faculdade de Medicina, Niteroi, RJ, Brazil
| | | | - Klaus Irion
- Imaging Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Guedes Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. The impact of cardiopulmonary hemodynamic factors in volumetry for pulmonary nodule management. BMC Med Imaging 2022; 22:49. [PMID: 35303820 PMCID: PMC8932130 DOI: 10.1186/s12880-022-00774-w] [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: 11/02/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acceptance of coronary CT angiogram (CCTA) scans in the management of stable angina has led to an exponential increase in studies performed and reported incidental findings, including pulmonary nodules (PN). Using low-dose CT scans, volumetry tools are used in growth assessment and risk stratification of PN between 5 and 8 mm in diameter. Volumetry of PN could also benefit from the increased temporal resolution of CCTA scans, potentially expediting clinical decisions when an incidental PN is first detected on a CCTA scan, and allow for better resource management and planning in a Radiology department. This study aims to investigate how cardiopulmonary hemodynamic factors impact the volumetry of PN using CCTA scans. These factors include the cardiac phase, vascular distance from the main pulmonary artery (MPA) to the nodule, difference of the MPA diameter between systole and diastole, nodule location, and cardiomegaly presence. MATERIALS AND METHODS Two readers reviewed all CCTA scans performed from 2016 to 2019 in a tertiary hospital and detected PN measuring between 5 and 8 mm in diameter. Each observer measured each nodule using two different software packages and in systole and diastole. A multiple linear regression model was applied, and inter-observer and inter-software agreement were assessed using intraclass correlation. RESULTS A total of 195 nodules from 107 patients were included in this retrospective, cross-sectional and observational study. The regression model identified the vascular distance (p < 0.001), the difference of the MPA diameter between systole and diastole (p < 0.001), and the location within the lower or posterior thirds of the field of view (p < 0.001 each) as affecting the volume measurement. The cardiac phase was not significant in the model. There was a very high inter-observer agreement but no reasonable inter-software agreement between measurements. CONCLUSIONS PN volumetry using CCTA scans seems to be sensitive to cardiopulmonary hemodynamic changes independently of the cardiac phase. These might also be relevant to non-gated scans, such as during PN follow-up. The cardiopulmonary hemodynamic changes are a new limiting factor to PN volumetry. In addition, when a patient experiences an acute or deteriorating cardiopulmonary disease during PN follow-up, these hemodynamic changes could affect the PN growth estimation.
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Affiliation(s)
| | - Diana Penha
- Universidade da Beira Interior, Covilhã, Portugal.,Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust: Liverpool, Liverpool, UK
| | - Bruno Hochhegger
- Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust: Liverpool, Liverpool, UK
| | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Klaus Irion
- Imaging Department, University of Manchester, Manchester, UK
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Paks M, Leong P, Einsiedel P, Irving LB, Steinfort DP, Pascoe DM. Ultralow dose CT for follow-up of solid pulmonary nodules: A pilot single-center study using Bland-Altman analysis. Medicine (Baltimore) 2018; 97:e12019. [PMID: 30142849 PMCID: PMC6112944 DOI: 10.1097/md.0000000000012019] [Citation(s) in RCA: 6] [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: 12/17/2022] Open
Abstract
Solid pulmonary nodules are a common finding requiring serial computed tomography (CT) imaging. We sought to explore the detection and measurement accuracy of an ultralow-dose CT (ULDCT) protocol compared with our standard low-dose CT (LDCT) nodule follow-up protocol.In this pragmatic single-center pilot prospective cohort study, patients scheduled for clinically indicated CT surveillance of 1 or more known solid pulmonary nodules >2 mm underwent ULDCT immediately after routine LDCT. The Bland-Altman 95% limits of agreement for diameter and volumetry were calculated.In all, 57 patients underwent 60 imaging episodes, with 170 evaluable nodules. ULDCT detected all known solid pulmonary nodules >2 mm. Bland-Altman analyses demonstrated clinically agreement for both nodule diameter and volume, both of which fell within prespecified limits.This single-center pilot study suggests that ULDCT may be of use in surveillance of known solid pulmonary nodules >2 mm.
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Affiliation(s)
| | - Paul Leong
- Department of Respiratory Medicine, Melbourne Health
| | | | - Louis B. Irving
- Department of Respiratory Medicine, Melbourne Health
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Daniel P. Steinfort
- Department of Respiratory Medicine, Melbourne Health
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Diane M. Pascoe
- Department of Radiology
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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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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Aghighi M, Boe J, Rosenberg J, Von Eyben R, Gawande RS, Petit P, Sethi TK, Sharib J, Marina NM, DuBois SG, Daldrup-Link HE. Three-dimensional Radiologic Assessment of Chemotherapy Response in Ewing Sarcoma Can Be Used to Predict Clinical Outcome. Radiology 2016; 280:905-15. [PMID: 26982677 DOI: 10.1148/radiol.2016151301] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose To compare the agreement of three-dimensional (3D) tumor measurements for therapeutic response assessment of Ewing sarcoma according to the Children's Oncology Group (COG) criteria, one-dimensional (1D) Response Evaluation Criteria in Solid Tumors (RECIST), and two-dimensional (2D) measurements defined by the World Health Organization (WHO) with tumor volume measurements as the standard of reference and to determine which method correlates best with clinical outcomes. Materials and Methods This retrospective study was approved by the institutional review board of three institutions. Seventy-four patients (mean age ± standard deviation, 14.5 years ± 6.5) with newly diagnosed Ewing sarcoma treated at three medical centers were evaluated. Primary tumor size was assessed on pre- and posttreatment magnetic resonance images according to 1D RECIST, 2D WHO, and 3D COG measurements. Tumor responses were compared with the standard of reference (tumor volume) on the basis of RECIST, COG, and WHO therapeutic response thresholds. Agreement between the percentage reduction measurements of the methods was assessed with concordance correlation, Bland-Altman analysis, and Spearman rank correlation. Agreement between therapeutic responses was assessed with Kendall tau and unweighted κ statistics. Tumor responses were compared with patient survival by using the log-rank test, Kaplan-Meier plots, and Cox regression. Results Agreement with the reference standard was significantly better for 3D measurement than for 1D and 2D measurements on the basis of RECIST and COG therapeutic response thresholds (concordance correlation of 0.41, 0.72, and 0.84 for 1D, 2D, and 3D measurements, respectively; P < .0001). Comparison of overall survival of responders and nonresponders demonstrated P values of .4133, .0112, .0032, and .0027 for 1D, 2D, 3D, and volume measurements, respectively, indicating that higher dimensional measurements were significantly better predictors of overall survival. Conclusion The 3D tumor measurements according to COG are better predictors of therapeutic response of Ewing sarcoma than 1D RECIST or 2D WHO measurements and show a significantly higher correlation with clinical outcomes. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Maryam Aghighi
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Justin Boe
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Jarrett Rosenberg
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Rie Von Eyben
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Rakhee S Gawande
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Philippe Petit
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Tarsheen K Sethi
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Jeremy Sharib
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Neyssa M Marina
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Steven G DuBois
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
| | - Heike E Daldrup-Link
- From the Department of Radiology, Section of Pediatric Radiology (M.A., J.B., J.R., R.S.G., T.K.S., H.E.D.L.), and Department of Pediatric Hematology/Oncology (N.M.M.), Lucile Packard Children's Hospital, Stanford University, 725 Welch Rd, Stanford, CA 94305-5654; Department of Radiation and Oncology, Stanford University, Stanford, Calif (R.V.E.); Department of Pediatric and Prenatal Imaging, Hôpital de la Timone, Marseille, France (P.P.); Department of Pediatrics, University of California-San Francisco School of Medicine, San Francisco, Calif (J.S., S.G.D.); and UCSF Benioff Children's Hospital, San Francisco, Calif (J.S., S.G.D.)
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Callister MEJ, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, Franks K, Gleeson F, Graham R, Malhotra P, Prokop M, Rodger K, Subesinghe M, Waller D, Woolhouse I. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2:ii1-ii54. [PMID: 26082159 DOI: 10.1136/thoraxjnl-2015-207168] [Citation(s) in RCA: 560] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M E J Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals, Leeds, UK
| | - D R Baldwin
- Nottingham University Hospitals, Nottingham, UK
| | - A R Akram
- Royal Infirmary of Edinburgh, Edinburgh, UK
| | - S Barnard
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle, UK
| | - P Cane
- Department of Histopathology, St Thomas' Hospital, London, UK
| | - J Draffan
- University Hospital of North Tees, Stockton on Tees, UK
| | - K Franks
- Clinical Oncology, St James's Institute of Oncology, Leeds, UK
| | - F Gleeson
- Department of Radiology, Oxford University Hospitals NHS Trust, Oxford, UK
| | | | - P Malhotra
- St Helens and Knowsley Teaching Hospitals NHS Trust, UK
| | - M Prokop
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - K Rodger
- Respiratory Medicine, St James's University Hospital, Leeds, UK
| | - M Subesinghe
- Department of Radiology, Churchill Hospital, Oxford, UK
| | - D Waller
- Department of Thoracic Surgery, Glenfield Hospital, Leicester, UK
| | - I Woolhouse
- Department of Respiratory Medicine, University Hospitals of Birmingham, Birmingham, UK
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Sayyouh M, Vummidi DR, Kazerooni EA. Evaluation and management of pulmonary nodules: state-of-the-art and future perspectives. ACTA ACUST UNITED AC 2014; 7:629-44. [PMID: 24175679 DOI: 10.1517/17530059.2013.858117] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The imaging evaluation of pulmonary nodules, often incidentally detected on imaging examinations performed for other clinical reasons, is a frequently encountered clinical circumstance. With advances in imaging modalities, both the detection and characterization of pulmonary nodules continue to evolve and improve. AREAS COVERED This article will review the imaging modalities used to detect and diagnose benign and malignant pulmonary nodules, with a focus on computed tomography (CT), which continues to be the mainstay for evaluation. The authors discuss recent advances in the lung nodule management, and an algorithm for the management of indeterminate pulmonary nodules. EXPERT OPINION There are set of criteria that define a benign nodule, the most important of which are the lack of temporal change for 2 years or more, and certain benign imaging criteria, including specific patterns of calcification or the presence of fat. Although some indeterminate pulmonary nodules are immediately actionable, generally those approaching 1 cm or larger in diameter, at which size the diagnostic accuracy of tools such as positron emission tomography (PET)/CT, single photon emission CT (SPECT) and biopsy techniques are sufficient to warrant their use. The majority of indeterminate pulmonary nodules are under 1 cm, for which serial CT examinations through at least 2 years for solid nodules and 3 years for ground-glass nodules, are used to demonstrate either benign biologic behavior or otherwise. The management of incidental pulmonary nodules involves a multidisciplinary approach in which radiology plays a pivotal role. Newer imaging and postprocessing techniques have made this a more accurate technique eliminating ambiguity and unnecessary follow-up.
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Affiliation(s)
- Mohamed Sayyouh
- University of Michigan Health System, Division of Cardiothoracic Radiology, Department of Radiology , Ann Arbor, MI , USA
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Jo HH, Hong H, Goo JM. Pulmonary nodule registration in serial CT scans using global rib matching and nodule template matching. Comput Biol Med 2013; 45:87-97. [PMID: 24480168 DOI: 10.1016/j.compbiomed.2013.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 10/26/2022]
Abstract
We propose an automatic nodule registration method between baseline and follow-up chest CT scans. Initial alignment using the center of the lung volume corrects the gross translational mismatch, and rigid registration using coronal and sagittal maximum intensity projection images effectively refines the rigid motion of the lungs. Nodule correspondences are established by finding the most similar region in terms of density as well as the geometrical constraint. The proposed nodule registration method increased the nodule hit rate (the ratio of the number of successfully matched nodules to total nodule number) from 26% to 100%.
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Affiliation(s)
- Hyun Hee Jo
- Department of Multimedia Engineering, College of Information and Media, Seoul Women's University, 126 Gongreung-dong, Nowon-gu, Seoul 139-774, Republic of Korea.
| | - Helen Hong
- Department of Multimedia Engineering, College of Information and Media, Seoul Women's University, 126 Gongreung-dong, Nowon-gu, Seoul 139-774, Republic of Korea.
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
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Humann-Ziehank E, Renko K, Bruegmann ML, Devi VR, Hewicker-Trautwein M, Andreae A, Ganter M. Long-term study of ovine pulmonary adenocarcinogenesis in sheep with marginal vs. sufficient nutritional selenium supply: results from computed tomography, pathology, immunohistochemistry, JSRV-PCR and lung biochemistry. J Trace Elem Med Biol 2013; 27:391-9. [PMID: 23623247 DOI: 10.1016/j.jtemb.2013.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 01/09/2013] [Accepted: 03/04/2013] [Indexed: 02/04/2023]
Abstract
The impact of selenium (Se) in carcinogenesis is still debatable due to inconsistent results of observational studies, recent suspicion of diabetic side effects and e.g. dual roles of glutathione peroxidases (GPx). Previously, our group introduced long-term studies on lung carcinogenesis using the jaagtsiekte sheep retrovirus (JSRV) induced ovine pulmonary adenocarcinoma (OPA) as an innovative animal model. The present report describes the results of sufficient (0.2 mg Se/kg dry weight (dw)) vs. marginal (<0.05 mg Se/kg dw) nutritional Se supply on cancer progression over a two-year period in 16 animals. Computed tomography (CT) evaluation of lung cancer progression, final pathological examination, evidence of pro-viral JSRV-DNA in lung, lymph nodes and broncho-alveolar lavage cells as well as biochemical analysis of Se, GPx1 and thioredoxin reductase (TrxR) activity in lung tissue were recorded. Additionally, immunohistochemical determination of GPx1 expression in unaffected and neoplastic lung cells was implemented. The feeding regime caused significant differences in Se concentration and GPx1 activity in lung tissue between groups, whereas TrxR activity remained unaffected. JSRV was evident in broncho-alveolar lavage cells, lung tissue and lung lymph nodes. Quarterly executed CT could not demonstrate differences in lung cancer proliferation intensity. Necropsy and histopathology substantiated CT findings. Immunohistochemical analysis of GPx1 in lung tissue suggested a coherency of GPx1 immunolabelling intensity in dependence of tumour size. It was concluded that the model proved to be suitable for long-term studies of lung cancer proliferation including the impact of modifiable nutritional factors. Proliferation of OPA was unaffected by marginal vs. sufficient nutritional Se supply.
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Affiliation(s)
- Esther Humann-Ziehank
- Klinik für kleine Klauentiere und Forensische Medizin und Ambulatorische Klinik, Stiftung Tierärztliche Hochschule Hannover, Bischofsholer Damm 15, D-30173 Hannover, Germany.
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Computer-aided diagnosis systems for lung cancer: challenges and methodologies. Int J Biomed Imaging 2013; 2013:942353. [PMID: 23431282 PMCID: PMC3570946 DOI: 10.1155/2013/942353] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 11/20/2012] [Indexed: 11/24/2022] Open
Abstract
This paper overviews one of the most important, interesting, and challenging problems in oncology, the problem of lung cancer diagnosis. Developing an effective computer-aided diagnosis (CAD) system for lung cancer is of great clinical importance and can increase the patient's chance of survival. For this reason, CAD systems for lung cancer have been investigated in a huge number of research studies. A typical CAD system for lung cancer diagnosis is composed of four main processing steps: segmentation of the lung fields, detection of nodules inside the lung fields, segmentation of the detected nodules, and diagnosis of the nodules as benign or malignant. This paper overviews the current state-of-the-art techniques that have been developed to implement each of these CAD processing steps. For each technique, various aspects of technical issues, implemented methodologies, training and testing databases, and validation methods, as well as achieved performances, are described. In addition, the paper addresses several challenges that researchers face in each implementation step and outlines the strengths and drawbacks of the existing approaches for lung cancer CAD systems.
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Imaging the heart-lung relationships during a chest computed tomography examination: is electrocardiographic gating the only option? J Thorac Imaging 2010; 25:239-46. [PMID: 20711040 DOI: 10.1097/rti.0b013e3181e0f8c9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Before the advent of fast-scanning multidetector-row computed tomography (CT) technology, thoracic CT studies were exclusively used for the morphologic assessment of thoracic organs, as the concurrent examination of the heart was hampered by image degradation from cardiac motion artifacts. The introduction of fast rotation speed and dedicated cardiac reconstruction algorithms has opened new possibilities for chest imaging, starting with the possibility to integrate cardiac morphologic and functional information into a diagnostic CT scan of the chest. Initiated with 16-slice multidetector-row CT, this concept of integrating morphology and function has been further simplified with 64-slice CT scanners, thus allowing radiologists to provide vital information in the management of patients with a wide variety of acute or chronic respiratory disorders. Because this CT technology offers the possibility of generating high-resolution and motion-free images of the coronary arteries, evaluation of the coronary arteries during CT examinations of the chest should further widen the clinical applications of CT for respiratory patients, keeping in mind that cigarette smoking is a shared risk factor for both impaired lung function and cardiovascular events. The recent advent of high temporal resolution and high pitch modes with dual-source CT simplifies the concept of integrated cardiothoracic imaging, introducing non-electrocardiographic-gated coronary artery imaging. The purpose of this article is to review the successive approaches of these redefined borders of thoracic imaging.
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Pulmonary Nodules: Contrast-Enhanced Volumetric Variation at Different CT Scan Delays. AJR Am J Roentgenol 2010; 195:149-54. [DOI: 10.2214/ajr.09.3212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rinaldi MF, Bartalena T, Braccaioli L, Sverzellati N, Mattioli S, Rimondi E, Rossi G, Zompatori M, Battista G, Canini R. Three-dimensional analysis of pulmonary nodules: variability of semiautomated volume measurements between different versions of the same software. Radiol Med 2010; 115:403-12. [PMID: 20082224 DOI: 10.1007/s11547-010-0511-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 05/05/2009] [Indexed: 12/21/2022]
Abstract
PURPOSE This study was done to evaluate the variability of semiautomated volume measurements of solid pulmonary nodules between two different versions of the same volumetric software. MATERIALS AND METHODS The volumes of 100 solid intraparenchymal nodules (mean volume 88.10 mm(3); range 7.36-595.25 mm(3)) studied with the same multidetector computed tomography (MDCT) protocol were determined using two different versions of the same volumetric software (LungCARE 2006G and LungCARE 2007S). The 2006G version is based on a single-segmentation algorithm, whereas the newer version features two algorithms: SmallSizeNodule and AllSizeNodule. The results obtained with the 2006G version were compared with those of the 2007S version with the SmallSizeNodule algorithm, as recommended by the user manual. In addition, we compared the volumetric measurements obtained by the two different algorithms of the 2007S version. RESULTS The 2006G version and the 2007S version with the SmallSizeNodule algorithm agreed in only two of 100 cases and showed a mean variability of 1.66% (range 0%-8.78%). A more significant volumetric discrepancy was observed between the two different algorithms of the 2007S version, with the AllSizeNodule algorithm providing on average larger volumes (mean variability 71.08%; range 6.02%-218.80%) than SmallSizeNodule. Volume discrepancies were more pronounced in the subgroups of smaller nodules in all comparisons. CONCLUSIONS There is variability also in the results provided by different versions of the same volumetric software, and this may affect the calculation of the nodule-doubling time. Computer-aided assessment of the growth of lung nodules should always be performed using the same version of volumetric software and the same segmentation algorithm.
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Affiliation(s)
- M F Rinaldi
- Radiologia III, Policlinico S. Orsola-Malpighi, Bologna, Italy
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MARTEN K, DULLIN C, MACHANN W, SCHMID JS, DAS M, HERMANN KP, ENGELKE C. Comparison of flat-panel-detector-based CT and multidetector-row CT in automated volumetry of pulmonary nodules using an anthropomorphic chest phantom. Br J Radiol 2009; 82:716-23. [DOI: 10.1259/bjr/40733553] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Edey AJ, Hansell DM. Incidentally detected small pulmonary nodules on CT. Clin Radiol 2009; 64:872-84. [PMID: 19664477 DOI: 10.1016/j.crad.2009.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/25/2009] [Accepted: 03/31/2009] [Indexed: 12/21/2022]
Abstract
The widespread use of multidetector computed tomography for imaging of the chest has lead to a significant increase in the number of incidentally detected pulmonary nodules. The significance of these nodules is often uncertain and further investigations may be required. This article will review the spectrum of imaging appearances of small pulmonary nodules, and highlight the few features that allow confident characterization of a nodule as benign or malignant; current guidelines for the management of incidentally detected nodules will also be discussed.
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Affiliation(s)
- A J Edey
- Department of Radiology, Royal Brompton Hospital, London, UK
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17
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In vivo repeatability of automated volume calculations of small pulmonary nodules with CT. AJR Am J Roentgenol 2009; 192:1657-61. [PMID: 19457831 DOI: 10.2214/ajr.08.1825] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objectives of our study were to evaluate the in vivo reproducibility of automated volume calculations of small lung nodules with both low-dose and standard-dose CT and to assess whether repeatability within each technique varies according to the diameter, site, or morphology of the nodule or to percentage of emphysema. SUBJECTS AND METHODS Sixty-six subjects with 83 solid pulmonary nodules between 5 and 10 mm in diameter were enrolled in this prospective study. Four consecutive MDCT data sets, two low dose and two standard dose, were obtained for each nodule on separate breath-holds during the same session. The volume of each nodule was calculated by automated software. Repeatability was evaluated by Bland-Altman's approach and the coefficient of repeatability. Associations of the percentage of volume variation between two measurements with nodule diameter, emphysema percentage, nodule site, and nodule morphology were assessed by Spearman's correlation coefficient and the Kruskal-Wallis test. A p value of < 0.05 was considered statistically significant. RESULTS The range of variation of the volumes of pulmonary nodules between two subsequent measurements was -38% +/- 60% for low-dose CT and -27% +/- 40% for standard-dose CT. No significant statistical association was found between variation in volume measurements and nodule site, nodule diameter, nodule morphology, or emphysema percentage by semiautomated calculation of lung density. CONCLUSION Automated volume calculations of small pulmonary nodules can significantly differ between two subsequent breath-holds with both low-dose and standard-dose CT techniques; in clinical practice we recommend that a volume variation of greater than 30% for nodules between 5 and 10 mm should be confirmed by follow-up CT to be sure that a nodule is actually growing.
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Honda O, Kawai M, Gyobu T, Kawata Y, Johkoh T, Sekiguchi J, Tomiyama N, Yoshida S, Sumikawa H, Inoue A, Yanagawa M, Daimon T, Nakamura H. Reproducibility of temporal volume change in CT of lung cancer: comparison of computer software and manual assessment. Br J Radiol 2009; 82:742-7. [PMID: 19332515 DOI: 10.1259/bjr/67746844] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to investigate the reproducibility of volumetric software evaluation and manual evaluation of tumour growth. Three observers manually evaluated whether tumour volume was increasing, if it was unchanged, or if it had decreased in size in 2 serial CT examinations of 45 solid lung cancers. The tumour volumes were calculated 3 times using volumetric software and were evaluated using the same classifications as for manual evaluation. Both data sets were divided into three groups: growth or reduction with consistency among all three evaluations (group A), growth or reduction with consistency between only two evaluations (group B), and others (group C). The volume variation and relative volume variation were calculated from the median volumes measured by volumetric software. Although all 45 tumours were categorised in group A by volumetric software, only 21 tumours were categorised in group A by manual assessment. The relative volume variation of the manual assessment was 88.5 +/- 76.5%, 20.8 +/- 28.3% and 12.9 +/- 12.8% in group A, B and C, respectively. Significant differences were found between groups A and B (p<0.01) and between groups A and C (p<0.001). Inconsistency is often seen in manual assessment; in contrast, evaluation using volumetric software has good reproducibility, even when the relative change in tumour volume is small.
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Affiliation(s)
- O Honda
- Department of radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City, Osaka, 565-0871, Japan.
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JONES YM, IRION KL, HOLEMANS JA. A review of the imaging and clinical management of solitary pulmonary nodules. IMAGING 2008. [DOI: 10.1259/imaging/31140292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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20
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Jeong YJ, Lee KS, Kwon OJ. Diagnosis and management of solitary pulmonary nodules. Expert Rev Respir Med 2008; 2:767-77. [PMID: 20477238 DOI: 10.1586/17476348.2.6.767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The advent of computed tomography (CT) screening with or without the help of computer-aided detection systems has increased the detection rate of solitary pulmonary nodules (SPNs), including that of early peripheral lung cancer. Helical dynamic (HD)CT, providing the information on morphologic and hemodynamic characteristics with high specificity and reasonably high accuracy, can be used for the initial assessment of SPNs. (18)F-fluorodeoxyglucose PET/CT is more sensitive at detecting malignancy than HDCT. Therefore, PET/CT may be selectively performed to characterize SPNs when HDCT gives an inconclusive diagnosis. Serial volume measurements are currently the most reliable methods for the tissue characterization of subcentimeter nodules. When malignant nodule is highly suspected for subcentimeter nodules, video-assisted thoracoscopic surgery nodule removal after nodule localization using the pulmonary nodule-marker system may be performed for diagnosis and treatment.
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Affiliation(s)
- Yeon Joo Jeong
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan 602-739, Korea
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22
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Hein PA, Romano VC, Rogalla P, Klessen C, Lembcke A, Bornemann L, Dicken V, Hamm B, Bauknecht HC. Variability of semiautomated lung nodule volumetry on ultralow-dose CT: comparison with nodule volumetry on standard-dose CT. J Digit Imaging 2008; 23:8-17. [PMID: 18773240 DOI: 10.1007/s10278-008-9157-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2008] [Revised: 06/23/2008] [Accepted: 07/28/2008] [Indexed: 11/28/2022] Open
Abstract
The study investigates the effect of a substantial dose reduction on the variability of lung nodule volume measurements by assessing and comparing nodule volumes using a dedicated semiautomated segmentation software on ultralow-dose computed tomography (ULD-CT) and standard-dose computed tomography (SD-CT) data. In 20 patients, thin-slice chest CT datasets (1 mm slice thickness; 20% reconstruction overlap) were acquired at ultralow-dose (120 kV, 5 mAs) and at standard-dose (120 kV, 75 mAs), respectively, and analyzed using the segmentation software OncoTREAT (MeVis, Bremen, Germany; version 1.3). Interobserver variability of volume measurements of 202 solid pulmonary nodules (mean diameter 11 mm, range 3.2-44.5 mm) was calculated for SD-CT and ULD-CT. With respect to interobserver variability, the 95% confidence interval for the relative differences in nodule volume in the intrascan analysis was measured with -9.7% to 8.3% (mean difference -0.7%) for SD-CT and with -12.6% to 12.4% (mean difference -0.2%) for ULD-CT. In the interscan analysis, the 95% confidence intervals for the differences in nodule volume ranged with -25.1% to -23.4% and 26.2% to 28.9% (mean difference 1.4% to 2.1%) dependent on the combination of readers and scans. Intrascan interobserver variability of volume measurements was comparable for ULD-CT and SD-CT data. The calculated variability of volume measurements in the interscan analysis was similar to the data reported in the literature for CT data acquired with equal radiation dose. Thus, the evaluated segmentation software provides nodule volumetry that appears to be independent of the dose level with which the CT source dataset is acquired.
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Affiliation(s)
- Patrick A Hein
- Department of Radiology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Das M, Mühlenbruch G, Katoh M, Bakai A, Salganicoff M, Stanzel S, Mahnken AH, Günther RW, Wildberger JE. Automated volumetry of solid pulmonary nodules in a phantom: accuracy across different CT scanner technologies. Invest Radiol 2007; 42:297-302. [PMID: 17414525 DOI: 10.1097/01.rli.0000258683.20123.c4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The accuracy of automated volumetry for pulmonary nodules in a phantom using different CT scanner technologies from single-slice spiral CT (SSCT) to 64-slice multidetector-row CT (MDCT) was compared. MATERIALS AND METHODS A lung phantom with 5 different categories of pulmonary nodules was scanned using a single-slice spiral CT, a 4-slice MDCT, a 16-slice MDCT and a 64-slice MDCT. Each category comprised of 7-9 nodules each (total n = 40) with different known volumes. Standard dose and low dose protocols were performed using thin and thick collimation. Image data were reconstructed at the thinnest slice thickness. Data sets were analyzed with a dedicated volumetry software. Volumes of all nodules were calculated and compared. RESULTS Mean absolute percentage error (APE) for all nodules was 8.65% (+/-7.29%) for the SSCT, 10.26% (+/-8.25%) for the 4-slice MDCT, 8.19% (+/-7.57%) for the 16-slice MDCT and 7.89% (+/-7.39%) for the 64-slice MDCT. There was statistically significant influence of the scanner type, protocol, anatomic location, and nodule volume on APE, but overall, APEs were comparable. CONCLUSION Computer-aided volumetry showed accurate measurements in all tested scanner types. This finding has important implications for nodule assessment and follow-up.
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Affiliation(s)
- Marco Das
- Department of Diagnostic Radiology, RWTH Aachen University, Aachen, Germany.
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Petkovska I, Brown MS, Goldin JG, Kim HJ, McNitt-Gray MF, Abtin FG, Ghurabi RJ, Aberle DR. The effect of lung volume on nodule size on CT. Acad Radiol 2007; 14:476-85. [PMID: 17368218 PMCID: PMC2752296 DOI: 10.1016/j.acra.2007.01.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 01/10/2007] [Accepted: 01/10/2007] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES We sought to determine how measures of nodule diameter and volume on computed tomography (CT) vary with changes in inspiratory level. MATERIALS AND METHODS CT scans were performed with inspiration suspended at total lung capacity (TLC) and then at residual volume (RV) in 41 subjects, in whom 75 indeterminate lung nodules were detected. A fully automated contouring program was used to segment the lungs; followed by segmentation of all nodules and the corresponding lobe using semiautomated contouring in both TLC and RV scans. The percent changes in lung and lobar volumes between TLC and RV were correlated with percent changes in nodule diameters and volumes. RESULTS Both nodule diameter and volume varied nonuniformly from TLC to RV-some nodules decreased in size, while others increased. There was a 16.8% mean change in absolute volume across all nodules. Stratified by size, the mean value of the absolute percent volume changes for nodules > or =5 mm and <5 mm were not significantly different (P = .26). Stratified by maximum attenuation, the mean value of the absolute percent volume changes between the TLC and RV series for noncalcified (17.7%, SD = 13.1) and completely calcified nodules (8.6% SD = 5.7) were significantly different (P < .05). CONCLUSION Significant differences in nodule size were measured between TLC and RV scans. This has important implications for standardizing acquisition protocols in any setting where size and, more important, size change are being used for purposes of lung cancer staging, nodule characterization, or treatment response assessment.
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Affiliation(s)
- Iva Petkovska
- Thoracic Imaging Research Group, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 650, Box 957319, Los Angeles, CA 90095-7319, USA.
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Petrou M, Quint LE, Nan B, Baker LH. Pulmonary nodule volumetric measurement variability as a function of CT slice thickness and nodule morphology. AJR Am J Roentgenol 2007; 188:306-12. [PMID: 17242235 DOI: 10.2214/ajr.05.1063] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to assess differences in volumetric measurements of pulmonary nodules obtained using different CT slice thicknesses; correlate these differences with nodule size, shape, and margination; and compare measurements generated by two different software packages. MATERIALS AND METHODS Seventy-five individual nodules identified on 29 lowdose, unenhanced, MDCT chest examinations were selected for volumetric analysis. Each image data set was reconstructed in three ways (slice thickness/reconstruction interval): 1.25 mm/0.625 mm, 2.5 mm/2 mm, and 5 mm/2.5 mm. Volumetric measurements were made on all 75 nodules at 1.25- and 2.5-mm slice thicknesses and on 57 of 75 nodules at the 5-mm thickness using Volume Analysis software. For 69 of 75 nodules, measurements were obtained on 1.25- and 2.5-mm-thick sections using a different commercially available software system, LN500 R2 software. Volume variability between different slice thicknesses was correlated with nodule diameter, shape, and margination using multiple linear regression. Percent differences between measurements obtained with the two software systems were calculated. Significance of relative volume differences between slice thicknesses and software packages was assessed using a one-sample Student's t-test. RESULTS Although statistically significant differences in volumes between different section thicknesses were seen only for the tiny nodule size group, many individual nodules showed substantial volume variation. Significant differences were seen in nodule volume variability for smaller nodules (3-10 mm) compared with larger nodules (> or = 11 mm) (p < 0.0001), as well as spiculated compared with smooth nodules, within a single size group (p < 0.05). No effect of nodule shape (round vs elongated) was noted. Statistically significant differences in measurements obtained with the two software systems were seen only with 2.5-mm-thick sections (p = 0.001). CONCLUSION CT slice thickness variation resulted in significant differences in volume measurements for tiny nodules. A spiculated margin was shown to have a significant effect on nodule volume variability within a single size group. Use of different software packages resulted in significant volume measurement differences at the 2.5-mm CT slice thickness.
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Affiliation(s)
- Myria Petrou
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA.
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Das M, Ley-Zaporozhan J, Gietema HA, Czech A, Mühlenbruch G, Mahnken AH, Katoh M, Bakai A, Salganicoff M, Diederich S, Prokop M, Kauczor HU, Günther RW, Wildberger JE. Accuracy of automated volumetry of pulmonary nodules across different multislice CT scanners. Eur Radiol 2007; 17:1979-84. [PMID: 17206420 DOI: 10.1007/s00330-006-0562-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 12/04/2006] [Accepted: 12/05/2006] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to compare the accuracy of an automated volumetry software for phantom pulmonary nodules across various 16-slice multislice spiral CT (MSCT) scanners from different vendors. A lung phantom containing five different nodule categories (intraparenchymal, around a vessel, vessel attached, pleural, and attached to the pleura), with each category comprised of 7-9 nodules (total, n = 40) of varying sizes (diameter 3-10 mm; volume 6.62 mm(3)-525 mm(3)), was scanned with four different 16-slice MSCT scanners (Siemens, GE, Philips, Toshiba). Routine and low-dose chest protocols with thin and thick collimations were applied. The data from all scanners were used for further analysis using a dedicated prototype volumetry software. Absolute percentage volume errors (APE) were calculated and compared. The mean APE for all nodules was 8.4% (+/-7.7%) for data acquired with the 16-slice Siemens scanner, 14.3% (+/-11.1%) for the GE scanner, 9.7% (+/-9.6%) for the Philips scanner and 7.5% (+/-7.2%) for the Toshiba scanner, respectively. The lowest APEs were found within the diameter size range of 5-10 mm and volumes >66 mm(3). Nodule volumetry is accurate with a reasonable volume error in data from different scanner vendors. This may have an important impact for intraindividual follow-up studies.
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Affiliation(s)
- Marco Das
- Department of Diagnostic Radiology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany.
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Picozzi G, Diciotti S, Falchini M, Foresti S, Gallesi F, Cavigli E, Livi L, Villari N, Mascalchi M. Operator-Dependent Reproducibility of Size Measurements of Small Phantoms and Lung Nodules Examined With Low-Dose Thin-Section Computed Tomography. Invest Radiol 2006; 41:831-9. [PMID: 17035874 DOI: 10.1097/01.rli.0000242837.11436.6e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We sought to assess the reproducibility of size measurements of small lung nodules examined with low-dose thin-section computed tomography (LDTSCT). MATERIALS AND METHODS Three radiologists measured volume with a semiautomatic tool and diameters manually of 20 (equivalent diameter range, 5.3-11 mm) phantom nodules and 37 (mean diameter range, 5-8.5 mm) lung nodules in subjects undergoing LDTSCT. RESULTS In phantoms, the worst 95% limits of agreement (95% LA) for volume were -3.0% and 3.0% within operator and -3.1% and 2.8% between operators. The coefficient of repeatability (CR) for diameter ranged between 0.51 and 0.67 mm within operator and the 95% LA were from -0.71 to 0.71 mm between operators. In nodules, the worst intraoperator 95% LA for volume were -14.4% and 17.6% within operator and -13.1% and 14.2% between operators. The CR for diameter ranged between 0.48 and 0.73 mm within operator and the 95% LA were from -1.16 to 1.16 mm between operators. CONCLUSION Operator-dependent variability of size measurements of small nodules examined with LDTSCT is not negligible and should be considered in lung cancer-screening studies.
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Affiliation(s)
- Giulia Picozzi
- Radiodiagnostic, Department of Clinical Physiopathology, University of Florence, Florence, Italy
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Goodman LR, Gulsun M, Washington L, Nagy PG, Piacsek KL. Inherent variability of CT lung nodule measurements in vivo using semiautomated volumetric measurements. AJR Am J Roentgenol 2006; 186:989-94. [PMID: 16554568 DOI: 10.2214/ajr.04.1821] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate repeatability and reproducibility of lung nodule volume measurements using volumetric nodule-sizing software. MATERIALS AND METHODS Fifty nodules, less than 20 mm in diameter, in 29 patients were scanned with 1.25-mm collimation using MDCT (time 1 = T1). During the same session, two additional scans, using identical technique, were obtained through each nodule (T2, T3). Three observers working independently then obtained volumetric measurements using a semiautomated volumetric nodule-sizing software package. Qualitative nodule characterization was also performed. The Bland-Altman method for assessing measurement agreement was used to calculate the 95% limits for agreement for nodule volumes at T1, T2, and T3. RESULTS Automated nodule segmentation was successful in 438 (97%) of 450 measurements. Forty-three nodules were available for final evaluation. Twenty-six nodules had well-defined edges, and 17 had irregular or spiculated margins. Seventeen were freestanding, 16 were juxtapleural, and 10 were juxtavascular in location. Average nodule volume was 345.5 mm(3) (range, 49.3-1,434 mm(3)). The mean interobserver variability (repeatability) was 0.018% (SD = 0.73%), and the SD of the mean for the three contemporaneous scans (reproducibility) was 13.1% (confidence limits, +/- 25.6%). SD and confidence limits narrowed as volumes increased. CONCLUSION Volumetric measurements show minimal interobserver variability (0.018%) but an interscan SEM of 13.1% (confidence limits, +/- 25.6%). Repeatability and reproducibility of volumetric measurements are better than those of linear measurements reported in the literature.
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Affiliation(s)
- Lawrence R Goodman
- Department of Radiology, Medical College of Wisconsin, 9200 W Wisconsin Ave., Milwaukee, WI 53226-3596, USA
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Abstract
The influence of MSCT on nodule detection and characterization will be discussed. The objective is to improve understanding of the clinical issues involved in nodule detection, characterization, and management in light of technological advances. Topics to be covered are noninvasive characterization techniques, such as morphologic and density inspection on CT, nodule enhancement techniques, CT-PET, temporal nodule size assessment, and computer aided diagnosis for both detection and characterization.
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Affiliation(s)
- Jane P Ko
- Thoracic Imaging Section, Department of Radiology, New York University Medical Center, New York 10016, USA.
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