Multimodality CT imaging contributes to improving the diagnostic accuracy of solitary pulmonary nodules: a multi-institutional and prospective study

Abstract

Background Solitary pulmonary nodules (SPNs) are one of the most common chest computed tomography (CT) abnormalities clinically. We aimed to investigate the value of non-contrast enhanced CT (NECT), contrast enhanced CT (CECT), CT perfusion imaging (CTPI), and dual- energy CT (DECT) used for differentiating benign and malignant SPNs with a multi-institutional and prospective study. Patients and methods Patients with 285 SPNs were scanned with NECT, CECT, CTPI and DECT. Differences between the benign and malignant SPNs on NECT, CECT, CTPI, and DECT used separately (NECT combined with CECT, DECT, and CTPI were methods of A, B, and C) or in combination (Method A + B, A + C, B + C, and A + B + C) were compared by receiver operating characteristic curve analysis. Results Multimodality CT imaging showed higher performances (sensitivities of 92.81% to 97.60%, specificities of 74.58% to 88.14%, and accuracies of 86.32% to 93.68%) than those of single modality CT imaging (sensitivities of 83.23% to 85.63%, specificities of 63.56% to 67.80%, and accuracies of 75.09% to 78.25%, all p < 0.05). Conclusions SPNs evaluated with multimodality CT imaging contributes to improving the diagnostic accuracy of benign and malignant SPNs. NECT helps to locate and evaluate the morphological characteristics of SPNs. CECT helps to evaluate the vascularity of SPNs. CTPI using parameter of permeability surface and DECT using parameter of normalized iodine concentration at the venous phase both are helpful for improving the diagnostic performance.

Thoracic Diseases: Technique and Applications of Dual-Energy CT

“…A multi-institutional and prospective study investigated the value of morphological criteria in non-contrast and contrast-enhanced CT, using data from perfusion CT imaging, and DECT in differentiating benign and malignant solitary pulmonary nodules. A total of 285 solitary pulmonary nodules were scanned with the different techniques and the value of normalized IC in the venous phase, with a threshold of 0.35, showed an AUC of 0.79, a sensitivity of 75.45%, and a specificity of 80.51% [50]. Ha et al investigated the use of DECT for the differential between lung metastases and benign pulmonary nodules diagnosis in patients affected by thyroid carcinoma; the authors retrospectively studied the spectral data of 153 nodules in 63 patients (55 lung metastases and 97 benign nodules).…”

Diagnostic accuracy of low-dose double-input perfusion computed tomography in the differential diagnosis of pulmonary benign and malignant ground-glass nodules

“…Therefore, tumors also can theoretically take blood from the pulmonary artery, which has been con rmed by postmortem stereoscopic microangiography and in vivo experiments [17][18]. In most previous studies on lung CT perfusion, the aorta has been considered to be the sole input artery in a single-input perfusion model [19,20]. This model re ects the dominant blood supply to lung tumors but often ignores the blood perfusion of the lesser blood supply parts.…”