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

Flechsig, Paul; Choyke, Peter L.; Kratochwil, Clemens; Warth, Arne; Antoch, Gerald; Holland‐Letz, Tim; Rath, Daniel; Eichwald, Viktoria; Huber, Peter E.; Kauczor, Hans Ulrich; Haberkorn, Uwe; Giesel, Frederik L.

doi:10.5152/dir.2015.15220

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…In addition, the precontrast attenuation in the Positive group was significantly higher than that in the Negative group (Table ). The mediastinal and hilar lymph nodes have exhibited similar results on unenhanced CT in human patients and nude rats with lung cancer, and it has been suggested that these findings are due to replacement of the fatty nodal hilum with cancer cells . The precontrast attenuation in the Negative group in this study was similar to previously reported attenuation in the cranial and upper cervical lymph nodes, abdominal lymph nodes and StLNs in normal dogs .…”

Section: Discussionsupporting

confidence: 87%

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics: A retrospective cross‐sectional study

Iwasaki

Murakami

Kawabe

et al. 2017

Vet Comparative Oncology

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The accurate evaluation of sternal lymph nodes (StLNs) is critical for the staging of canine thoraco-abdominal tumours. Computed tomography (CT) provides a non-invasive means of assessing StLNs, but its diagnostic accuracy for identifying metastases is unclear. In this retrospective cross-sectional study, we assessed the diagnostic power of various CT measurements. Fifty-seven dogs that underwent concurrent CT and cytological examination of the StLNs were enrolled retrospectively. The size, shape, X-ray attenuation and uniformity of the StLNs were assessed. The dogs were divided into metastasis-negative (n = 21) and metastasis-positive (n = 36) groups. Logistic regression analysis showed that the size (StLN-to-second sternebra ratio [ratio-size]) and precontrast attenuation were significantly different between groups. Combining these parameters achieved a specificity and positive predictive value of 100% (cut-off values: 1.0, 37.5 Hounsfield units, respectively). This suggests that the combination of ratio-size and precontrast attenuation is effective for differentiating metastasis to the StLNs on CT.

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Section: Discussionsupporting

confidence: 87%

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics: A retrospective cross‐sectional study

Iwasaki

Murakami

Kawabe

et al. 2017

Vet Comparative Oncology

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“…CT density-based cutoffs for differentiating between malignant and benign LNs without mentioning a possible cutoff that might be applied to humans (16).…”

Section: Discussionmentioning

confidence: 99%

Correlation Between SUV_max and CT Radiomic Analysis Using Lymph Node Density in PET/CT-Based Lymph Node Staging

et al. 2016

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In patients with lung cancer (LC), malignant melanoma (MM), gastroenteropancreatic neuroendocrine tumors (GEP NETs), and prostate cancer (PCA), lymph node (LN) staging is often performed by 18 F-FDG PET/CT (LC and MM), 68 Ga-DOTATOC PET/CT (GEP NET), and 68 Ga-labeled prostate-specific membrane antigen PET/CT (PCA) but is sometimes not accurate because of indeterminate PET findings. To better evaluate malignant LN infiltration, additional surrogate parameters, especially in cases with indeterminate PET findings, would be helpful. The purpose of this study was to evaluate whether SUV max in the PET examination might correlate with semiautomated density measurements of LNs in the CT component of the PET/CT examination. Methods: After approval by the institutional review board, 1,022 LNs in the PET/CT examinations of 148 patients were retrospectively analyzed (LC: 327 LNs of 40 patients; MM: 224 LNs of 33 patients; GEP NET: 217 LNs of 35 patients; and PCA: 254 LNs of 40 patients). PET/CT was performed before surgery, biopsy, chemotherapy, or internal or external radiation therapy, according to the clinical schedule; patients with prior chemotherapy or radiation therapy were excluded. SUV max analyses were based on uptake 60 min after tracer injection, and volumetric CT histogram analyses were based on the unenhanced CT images of the PET/CT scan. Results: PET findings were considered positive or negative on the basis of SUV max in the LN compared with that in the blood pool; histologic confirmation was not available. Of the 1,022 LNs, 331 were PET-positive (3 times the SUV max of the blood pool), 86 were PET-indeterminate (1-3 times the SUV max of the blood pool), and 605 were PET-negative (less than the SUV max of the blood pool). PET-positive LNs had significantly higher CT densities than PET-negative LNs, irrespective of the type of cancer. Conclusion: CT density measurements of LNs in patients with LC, MM, GEP NET, and PCA correlated with 18 F-FDG uptake, 68 Ga-DOTATOC uptake, and 68 Ga-PSMA uptake, respectively, and might therefore serve as an additional surrogate parameter for differentiating between malignant and benign LNs. The use of a 7.5-Hounsfield unit CT density threshold to differentiate between malignant and benign LN infiltration and 20 Hounsfield units to exclude benign LN processes might be possible in clinical routine and would be especially helpful for PET-indeterminate LNs. Oneoft he most widespread and reliable noninvasive staging tools for cancer is PET/CT-namely, 18 F-FDG PET/CT for lung cancer (LC (1,2)) and malignant melanoma (MM (1,3)), 68 Ga-labeled prostate-specific membrane antigen (PSMA) PET/ CT for prostate cancer (PCA (4)), and 68 Ga-DOTATOC PET/ CT for gastroenteropancreatic neuroendocrine tumors (GEP NETs (5)). An exact evaluation of lymph node (LN) status before therapy is crucial to therapy planning. False-positive PET findings are not uncommon with 18 F-FDG PET/CT, because the scan can mistakenly pick up on inflammation due to infectious etiologies, such as in the lung or the h...

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“…Shao et al investigated a lymph node/aorta density ratio in patients with non-small cell lung cancer undergoing preoperative 18 F-FDG-PET/CT, pointing out a correlation between lymph node metastases and lymph node density 40 . Flechsig et al proved a correlation between lymph node density in standard-dose CT and malignancy in lymph node metastases of a lung cancer rat model by extracting and scanning lymph nodes before the histopathologic examination 41 . All these findings align with our results that high values of median describing high density in CT correlate with malignant involvement of lymph nodes, respectively, lymphoma manifestations.…”

Section: Discussionmentioning

confidence: 99%

CT radiomics to predict Deauville score 4 positive and negative Hodgkin lymphoma manifestations

Jensen

Rogasch

Kim

et al. 2022

Sci Rep

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Abstract18F-FDG-PET/CT is standard to assess response in Hodgkin lymphoma by quantifying metabolic activity with the Deauville score. PET/CT, however, is time-consuming, cost-extensive, linked to high radiation and has a low availability. As an alternative, we investigated radiomics from non-contrast-enhanced computed tomography (NECT) scans. 75 PET/CT examinations of 43 patients on two different scanners were included. Target lesions were classified as Deauville score 4 positive (DS4+) or negative (DS4−) based on their SUVpeak and then segmented in NECT images. From these segmentations, 107 features were extracted with PyRadiomics. All further statistical analyses were then performed scanner-wise: differences between DS4+ and DS4− manifestations were assessed with the Mann–Whitney-U-test and single feature performances with the ROC-analysis. To further verify the reliability of the results, the number of features was reduced using different techniques. The feature median showed a high sensitivity for DS4+ manifestations on both scanners (scanner A: 0.91, scanner B: 0.85). It furthermore was the only feature that remained in both datasets after applying different feature reduction techniques. The feature median from NECT concordantly has a high sensitivity for DS4+ Hodgkin manifestations on two different scanners and thus could provide a surrogate for increased metabolic activity in PET/CT.

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

Cited by 7 publications

References 25 publications

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics: A retrospective cross‐sectional study

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics: A retrospective cross‐sectional study

Correlation Between SUV_max and CT Radiomic Analysis Using Lymph Node Density in PET/CT-Based Lymph Node Staging

CT radiomics to predict Deauville score 4 positive and negative Hodgkin lymphoma manifestations

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

Cited by 7 publications

References 25 publications

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics: A retrospective cross‐sectional study

Metastatic diagnosis of canine sternal lymph nodes using computed tomography characteristics: A retrospective cross‐sectional study

Correlation Between SUVmax and CT Radiomic Analysis Using Lymph Node Density in PET/CT-Based Lymph Node Staging

CT radiomics to predict Deauville score 4 positive and negative Hodgkin lymphoma manifestations

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Correlation Between SUV_max and CT Radiomic Analysis Using Lymph Node Density in PET/CT-Based Lymph Node Staging