Dual-Phase Dual-Energy CT in Patients Treated with Erlotinib for Advanced Non-Small Cell Lung Cancer: Possible Benefits of Iodine Quantification in Response Assessment

Baxa, Jan; Matoušková, Táňa; Krákorová, Gabriela; Schmidt, Bernhard; Flohr, Thomas; Sedlmair, Martin; Bejcek, Jiri; Ferda, Jiří

doi:10.1007/s00330-015-4092-6

Cited by 64 publications

(35 citation statements)

References 30 publications

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“…In earlier reports, DE-CT-derived parameters were used for the differentiation of PM from different primary tumors [12,13] and for the evaluation of therapy response in LC [17]. However, to our knowledge, no previous studies have examined the differentiation between LC and PM.…”

Section: Discussionmentioning

confidence: 99%

Improved differentiation between primary lung cancer and pulmonary metastasis by combining dual-energy CT–derived biomarkers with conventional CT attenuation

et al. 2020

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Objectives To assess the clinical utility of dual-energy CT (DE-CT)-derived iodine concentration (IC) and effective Z (Z eff) in addition to conventional CT attenuation (HU) for the discrimination between primary lung cancer (LC) and pulmonary metastases (PM) from different primary malignancies. Methods DE-CT scans of 79 patients with LC (3 histopathologic subgroups) and 89 patients with PM (5 histopathologic subgroups) were evaluated. Quantitative IC, Z eff , and conventional HU values were extracted and normalized to the thoracic aorta. Differences between groups were assessed by pairwise Welch's t test. Correlation and linear regression analyses were used to examine the relationship of imaging parameters in LC and PM. Diagnostic accuracy was measured by the area under receiver operator characteristic curve (AUC) and validated based on resampling methods. Results Significant differences between subgroups of LC and PMs were noted for all imaging parameters, with the highest number of significant pairs for IC. In univariate analysis, only IC was a significant diagnostic feature for discriminating LC from PM (p = 0.03). All quantitative imaging parameters correlated significantly (p < 0.0001, respectively), with the highest correlation between IC and Z eff (r = 0.91), followed by IC and HU (r = 0.76) and Z eff and HU (r = 0.73). Diagnostic models combining IC or Z eff with HU (IC+HU: AUC = 0.73; Z eff +HU: AUC = 0.69; IC+Z eff +HU: AUC = 0.73) were not significantly different and outperformed individual parameters (IC: AUC = 0.57; Z eff : AUC = 0.57; HU: AUC = 0.55) in diagnostic accuracy (p < 0.05, respectively). Conclusion DE-CT-derived IC or Z eff and conventional HU represent complementary imaging parameters, which, if used in combination, may improve the differentiation between LC and PM. Key Points • Individual quantitative imaging parameters derived from DE-CT (iodine concentration, effective Z) and conventional CT (HU) provide complementary diagnostic information for the differentiation of primary lung cancer and pulmonary metastases. • A combination of conventional HU and DE-CT parameters enhances the diagnostic utility of individual parameters.

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Section: Discussionmentioning

confidence: 99%

Improved differentiation between primary lung cancer and pulmonary metastasis by combining dual-energy CT–derived biomarkers with conventional CT attenuation

et al. 2020

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“…Iodine map is helpful not only to distinguish a particularly hyperdense, cystic lesion or hematoma from enhancing lesion, but also to clearly delineate the extent of bowel ischemia (141825); in addition, malignant tumors may be more accurately differentiated from benign tumors based on the degree of iodine enhancement (19). Treatment response may be assessed quantitatively by measuring the iodine concentration in enhancing tumors in oncologic patients (14182831). …”

Section: Dual-energy Applicationsmentioning

confidence: 99%

Dual-Energy CT: New Horizon in Medical Imaging

2017

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Dual-energy CT has remained underutilized over the past decade probably due to a cumbersome workflow issue and current technical limitations. Clinical radiologists should be made aware of the potential clinical benefits of dual-energy CT over single-energy CT. To accomplish this aim, the basic principle, current acquisition methods with advantages and disadvantages, and various material-specific imaging methods as clinical applications of dual-energy CT should be addressed in detail. Current dual-energy CT acquisition methods include dual tubes with or without beam filtration, rapid voltage switching, dual-layer detector, split filter technique, and sequential scanning. Dual-energy material-specific imaging methods include virtual monoenergetic or monochromatic imaging, effective atomic number map, virtual non-contrast or unenhanced imaging, virtual non-calcium imaging, iodine map, inhaled xenon map, uric acid imaging, automatic bone removal, and lung vessels analysis. In this review, we focus on dual-energy CT imaging including related issues of radiation exposure to patients, scanning and post-processing options, and potential clinical benefits mainly to improve the understanding of clinical radiologists and thus, expand the clinical use of dual-energy CT; in addition, we briefly describe the current technical limitations of dual-energy CT and the current developments of photon-counting detector.

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“…Quantification of the iodine concentration in tumors may represent a more objective approach to tumor volume delineation, tumor vasculature characterization, and tumor burden assessment. The change in iodine concentration appeared to be a promising tool for predicting the tumor response to treatment for a variety of cancers . Iodine concentration mapping has also been proposed for determining the perfused blood volume, as a surrogate to pulmonary function, to guide treatment plan optimization and reduce pulmonary toxicities .…”

Section: Introductionmentioning

confidence: 99%

Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual‐layer dual‐energy computed tomography system

et al. 2018

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Dual-Phase Dual-Energy CT in Patients Treated with Erlotinib for Advanced Non-Small Cell Lung Cancer: Possible Benefits of Iodine Quantification in Response Assessment

Cited by 64 publications

References 30 publications

Improved differentiation between primary lung cancer and pulmonary metastasis by combining dual-energy CT–derived biomarkers with conventional CT attenuation

Improved differentiation between primary lung cancer and pulmonary metastasis by combining dual-energy CT–derived biomarkers with conventional CT attenuation

Dual-Energy CT: New Horizon in Medical Imaging

Accuracy of electron density, effective atomic number, and iodine concentration determination with a dual‐layer dual‐energy computed tomography system

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