Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT

Yuan, Xiaoyang; Zhang, Jing; Quan, Changbin; Jianxia, Cao; Ao, Guokun; Tian, Yuan; Li, Hong

doi:10.1007/s00330-013-2842-x

Cited by 50 publications

(41 citation statements)

References 16 publications

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“…16 Consistent with the results of the recent study by Yuan et al, 22 our findings show that, in NSCLC, the bronchial contribution is higher than the pulmonary contribution. In addition, we have now demonstrated that there are also differences depending on the NSCLC subtype: LCC shows higher bronchial and pulmonary BV and BF compared with AC and SCC.…”

Section: Discussionsupporting

confidence: 83%

“…20 Cutoff values have been defined for several CTP parameters to differentiate benign from malignant pulmonary nodules, with lower perfusion index (PI) and higher BF and BV obtained in malignancy. 21,22 Similar accuracy of CTP and fluoro-2-deoxy-D-glucose-PET/CT was confirmed in the meta-analysis by Cronin et al 23 Several studies have addressed differences of CTP parameters among histological lung cancer subtypes, assessing them with a single-input CTP analysis of either the pulmonary or the bronchial arterial system. [24][25][26][27] Computed tomography perfusion in lung cancer remains a technical challenge, particularly due to breathing motion over time.…”

Section: Results: According To Biopsy 37 Patients Had Nsclc (22 Adenmentioning

confidence: 82%

“…28 Furthermore, a true separation of pulmonary and bronchial BF using a CTP analysis is technically not possible at this time because blood from both vascular inputs is mixed within lesions at a microscopic level, precluding both spatial and temporal separation. Despite these difficulties, Yuan et al 22 recently demonstrated that a dual-input maximum slope CTP analysis is valuable in NSCLC. However, many centers do not fulfill the hardware and software requirements for such a dual-input analysis and rely on either single-input pulmonary or bronchial CTP assessment.…”

Section: Results: According To Biopsy 37 Patients Had Nsclc (22 Adenmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

Nguyen-Kim¹,

Frauenfelder²,

Strobel³

et al. 2015

Investigative Radiology

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OBJECTIVES: The aim of this study was to investigate the dual blood supply of non-small cell lung cancer (NSCLC) and its association with tumor subtype, size, and stage, using computed tomography perfusion (CTP). MATERIALS AND METHODS: A total of 54 patients (median age, 65 years; range, 42-79 years; 15 women, 39 men) with suspected lung cancer underwent a CTP scan of the lung tumor. Pulmonary and bronchial vasculature regions of interest were used to calculate independently CTP parameters (blood flow [BF], blood volume [BV], and mean transit time [MTT]) of the tumor tissue. The mean and maximum pulmonary and bronchial perfusion indexes (PImean and PImax) were calculated. The tumoral volume and the largest tumoral diameter were assessed. Differences in CTP parameters and indexes among NSCLC subtypes, tumor stages and tumor dimensions were analyzed using non-parametric tests. RESULTS: According to biopsy, 37 patients had NSCLC (22 adenocarcinomas [ACs], 8 squamous cell carcinomas [SCCs], 7 large-cell carcinomas [LCC]). The mean bronchial BF/pulmonary BF, bronchial BV/pulmonary BV, and bronchial MTT/pulmonary MTT was 41.2 ± 30.0/36.9 ± 24.2 mL/100 mL/min, 11.4 ± 9.7/10.4 ± 9.4 mL/100 mL, and 11.4 ± 4.3/14.9 ± 4.4 seconds, respectively. In general, higher bronchial BF than pulmonary BF was observed in NSCLC (P = 0.014). Using a tumoral volume cutoff of 3.5 cm, a significant difference in pulmonary PImax was found (P = 0.028). There was a significantly higher mean pulmonary BF in LCCs and SCCs compared with ACs (P = 0.018 and P = 0.044, respectively), whereas the mean bronchial BF was only significantly higher in LCCs compared with ACs (P = 0.024). Correspondingly, the PImax was significantly higher in LCCs and SCCs than in ACs (P = 0.001 for both). Differences between bronchial and pulmonary PImean and PImax among T stages and Union Internationale Contre le Cancer stages were not statistically significant (P values ranging from 0.691 to 0.753). CONCLUSIONS: The known dual blood supply of NSCLC, which depends on tumor size and histological subtype, is reflected in CTP parameters, with parameters depending both on tumor size and histological subtype. This has to be accounted for when analyzing NSCLC with CTP.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0.

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Section: Discussionsupporting

confidence: 83%

Section: Results: According To Biopsy 37 Patients Had Nsclc (22 Adenmentioning

confidence: 82%

Section: Results: According To Biopsy 37 Patients Had Nsclc (22 Adenmentioning

confidence: 99%

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Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

Nguyen-Kim¹,

Frauenfelder²,

Strobel³

et al. 2015

Investigative Radiology

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“…Using global mean or median values can also work for diagnosis purposes, where CTp has been used to discriminate between benign and malignant in different types of lung lesions, including pulmonary solitary nodules. For instance, the overall mean of pulmonary index, pulmonary and bronchial blood flow (BF), is computed on multiple slices in [29] and on three tumour sections chosen according to the axial, coronal, and sagittal planes, in [30]. The overall median of all the CTp parameters for the whole tumour is computed in [14], where the median was preferred over the mean operator to avoid outliers.…”

Section: Introductionmentioning

confidence: 99%

Multislice Analysis of Blood Flow Values in CT Perfusion Studies of Lung Cancer

Malavasi

Barone

Gavelli

et al. 2017

BioMed Research International

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Objectives. Tumour heterogeneity represents a key issue in CT perfusion (CTp), where all studies are usually based on global mean or median values of perfusion maps, often computed on whole tumour. We sought to determine whether, and to what extent, such global values can be representative of tumour heterogeneity, with respect to single slices, and could be used for therapy assessment. Materials and Methods. Twelve patients with one primary non-small cell lung cancer lesion were enrolled in this study, for a total amount of 26 CTp examinations and 118 slices. Mean and median blood flow (BF) values, calculated voxel-based, were computed on each slice and the whole tumour. To measure functional heterogeneity, entropy was calculated on BF values as well. Results. Most of the slices were not represented by the global BF values computed on the whole tumour. In addition, there are a number of lesions having equivalent global BF values, but they are composed of slices having very different heterogeneity distributions, that is, entropy values. Conclusions. Global mean/median BF values of the single slices separately should be considered for clinical assessment, only if interpreted through entropy computed on BF values. The numerical equivalence between global BF values of different lesions may correspond to different clinical status, thus inducing possible errors in choice of therapy when considering global values only.

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“…The absolut BF, BV, MTT and TTP were commonly evaluated for tumor identify. In mostly past researches [9,10,15,16] , many different types of parotid tumor were usually contained as benign group to compared to malignant lesiones. So far, few studies evaluated the distinction of various histological types of benign tumors by comparing perfusion parmaters.…”

Section: Pei (Hu)mentioning

confidence: 99%

Pleomorphic Adenoma Versus Warthin Tumor of the Parotid Gland: Diagnostic Value of CT Perfusion Imaging and Its Pathologic Explanation

Fang

Tian

et al. 2016

Journal of Tumor

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Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT

Cited by 50 publications

References 16 publications

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

Assessment of Bronchial and Pulmonary Blood Supply in Non-Small Cell Lung Cancer Subtypes Using Computed Tomography Perfusion

Multislice Analysis of Blood Flow Values in CT Perfusion Studies of Lung Cancer

Pleomorphic Adenoma Versus Warthin Tumor of the Parotid Gland: Diagnostic Value of CT Perfusion Imaging and Its Pathologic Explanation

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