Differentiating malignant from benign gastric mucosal lesions with quantitative analysis in dual energy spectral computed tomography

Abstract

To investigate the value of quantitative analysis in dual energy spectral computed tomography (DESCT) for differentiating malignant gastric mucosal lesions from benign gastric mucosal lesions (including gastric inflammation [GI] and normal gastric mucosa [NGM]). This study was approved by the ethics committee, and all patients provided written informed consent. A total of 161 consecutive patients (63 with gastric cancer [GC], 48 with GI, and 50 with NGM) who underwent dual-phase contrast enhanced DESCT scans in the arterial phase (AP) and portal venous phase (PVP) were included in this study. Iodine concentration (IC) in lesions was derived from the iodine-based material-decomposition images and normalized to that in the aorta to obtain normalized IC (nIC). The ratios of IC and nIC between the AP and PVP were calculated. Diagnostic confidence for GC and GI was evaluated with reviewing the features including gastric wall thickness, focal, and eccentric on the conventional polychromatic images. All statistical analyses were performed by using statistical software SPSS 17.0 (SPSS, Chicago, IL). IC and nIC in GC differed significantly from those in GI and NGM, except for nICAP in comparing GC with GI. Mean nIC values of GC (0.18 ± 0.06 in AP and 0.62 ± 0.16 in PVP) were significantly higher than that of NGM (0.12 ± 0.03 in AP and 0.37 ± 0.08 in PVP) (all P < 0.05). There was also significant difference for IC values in GC, GI, and NGM (24.19 ± 8.27, 19.07 ± 5.82, and 13.61 ± 2.52 mg/mL, respectively, in AP and 28.00 ± 7.01, 24.66 ± 6.55, and 16.94 ± 3.06 mg/mL, respectively, in PVP). Based on Receiver Operating Characteristic Curve analysis, nIC and IC in PVP had high sensitivities of 88.89% and 90.48%, respectively, in differentiating GC from NGM, while the sensitivities were 71.43% and 88.89% during AP. Ratios IC and nIC ratios did not provide adequate diagnostic accuracy with their area under curves less than 0.65. With the conventional features, the diagnostic accuracies for GC and GI were 75.0% and 98.0%, respectively. Quantitative analysis of DESCT imaging parameters for gastric mucosa, such as nIC and IC, is useful for differentiating malignant from benign gastric mucosal lesions.

Preoperative computed tomography‐guided disease‐free survival prediction in gastric cancer: a multicenter radiomics study

“…Second, we investigated the associations of radiomic features extracted from different MDCT image phases and proved that portal venous phase images might be more appropriate and stable for radiomic feature extraction in gastric cancer (Text S9, Figure S10, Table S3, Table S4), which was partially consistent with previous studies. [29][30][31] Our results also showed that most of the selected features from different MDCT image phases showed close correlations, and morphological features may be more stable for different MDCT image phases. Third, clearer than previous studies, we specified ICC calculation models, making consistency tests by ICC more reasonable.…”

Detection of gastric cancer and its histological type based on iodine concentration in spectral CT

“…The growth and progression of solid tumors depend upon the formation of new blood vessels, which is different from normal tissues or benign lesions. Several studies have reported that CT imaging is useful for distinguishing small hepatocellular carcinoma from other hepatic lesions [ 23 , 24 ], small intrahepatic mass-forming cholangiocarcinoma from small liver abscess [ 25 ], malignant from benign pulmonary nodules [ 26 ], and gastric cancer from benign gastric mucosal lesions [ 11 ]. Indeed, the quantitative IC measurement is significantly higher in cancerous lesions compared to benign lesions, and its accuracy is greater than that of conventional CT.…”

“…Besides, the reason why PP is less effective than AP in distinguishing histological types may be due to the influence of blood flow. In addition, nICPP has been reported to exert a high sensitivity in differentiating malignant gastric mucosal lesions from normal gastric mucosa [ 11 ]. Furthermore, studies on the diagnostic efficacy of tumor differentiation degree are inconsistent [ 35 , 36 ], which may be due to the different biological behaviors of tumors and degrees of differentiation.…”

“…This IC value has been found to be strongly correlated with the actual IC in the phantom [ 10 ]. Preliminary studies have reported the use of IC value in differentiating benign from malignant lesions, evaluating tumor, node, and metastasis (TNM) staging and determining the efficacy of anticancer therapy [ 11 – 16 ]. However, to the best of our knowledge, only a few studies have employed IC value in discriminating the histological types of gastric adenocarcinoma [ 12 , 17 ], and the results are inconsistent with respect to arterial phase (AP) and portal venous phase (PP).…”

Differentiation of atypical pancreatic neuroendocrine tumors from pancreatic ductal adenocarcinomas: Using whole‐tumor CT texture analysis as quantitative biomarkers

“…7 Contrast-enhanced CT is currently widely used for evaluating abdominal lesions because of its broad availability and convenience. [8][9][10] Jung Hoon 11 and Sun Kyung et al 12 have evaluated the imaging characteristics of atypical hypovascular PNET and PDAC, respectively. They found duct dilatation in CT may be a helpful predictor for PDAC.…”