Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response

Abstract

• Dual-phase DE-CT is beneficial for mediastinal lymph node assessment in NSCLC. • Arterial to venous iodine uptake ratio was higher in enlarged lymph nodes. • Change of arterial enhancement fraction correlated to therapy response.

Vasculature surrounding a nodule: A novel lung cancer biomarker

“…An invasive, ex vivo procedure is the standard approach to assess tumor angiogenesis that involves sampling the tumor to evaluate its microvascular density (MVD) and assess the metabolic burden of the supported tumor cells. Several imaging techniques have been developed to indirectly assess tumor angiogenesis by quantifying the level of perfusion or metabolic activity in the nodule (e.g., CT scan, dual energy CT scan, positron emission tomography (PET)/CT, and magnetic resonance imaging (MRI)) implementing various approaches (e.g., dynamic imaging, contrast-enhanced imaging, image texture analysis) [13, 25–31]. These techniques focus primarily on a tumor’s internal micro-vascularity.…”

Increased x-ray attenuation in malignant vs. benign mediastinal nodes in an orthotopic model of lung cancer

“…Our findings X-ray attenuation in malignant vs. benign mediastinal nodes • 37 suggest that lymph node density may also provide useful diagnostic information, potentially within time-saving semi-automatic measurements (22). It is also possible that dual energy CT may enable even better discrimination of XRA than single energy CT performed in our experiment (23), and that dual energy CT could give further information on nodal status based on the measurement of iodine uptake in contrast-enhanced dual-phase dual-energy CT (24).…”

Evaluation of lung cancer by enhanced dual-energy CT: association between three-dimensional iodine concentration and tumour differentiation

“…However, recently, a dual-energy CT (DECT) technique using two types of tube voltage has enabled quantification of the iodine-related attenuation of iodinated contrast material in the tumour after intravenous injection without the need for an additional unenhanced CT scan. [13][14][15] Furthermore, novel computer application software (syngo ® lung nodules application; Siemens Healthcare, Tokyo, Japan) attached to a DECT scanner can automatically evaluate a threedimensional segment of a tumour and calculate iodinerelated concentration (iodine volume) of the entire tumour. 16 This computer-aided segmentation can decrease measurement error by manually illustrating the region of interest (ROI) in the tumour.…”