Whole tumour perfusion of peripheral lung carcinoma: evaluation with first-pass CT perfusion imaging at 64-detector row CT

Li, Y.; Yang, Zhi‐gang; Chen, T.-w.; Deng, Yu-Ping; Yu, Jianqun; Li, Z.-l.

doi:10.1016/j.crad.2007.12.012

Cited by 30 publications

(15 citation statements)

References 24 publications

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“…These results were confirmed by Yi et al and Li et al [7,[11][12][13]. As noted, there is a tradition of reporting malignant and inflammatory lesions together and then distinguishing these lesions from (other) benign lesions in a dichotomised setting.…”

Section: Malignant Vs Benign Tumourssupporting

confidence: 78%

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Dynamic contrast-enhanced CT in suspected lung cancer: quantitative results

Harders

Madsen²,

Nellemann³

et al. 2013

BJR

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Objectives: To examine whether dynamic contrastenhanced CT (DCE-CT) could be used to characterise and safely distinguish between malignant and benign lung tumours in patients with suspected lung cancer. Methods: Using a quantitative approach to DCE-CT, two separate sets of regions of interest (ROIs) in tissues were placed in each tumour: large ROIs over the entire tumour and small ROIs over the maximally perfused parts of the tumour. Using mathematical modelling techniques and dedicated perfusion software, this yielded a plethora of results. Results: First, because of their non-normal distribution, DCE-CT measurements must be analysed using log scale data transformation. Second, there were highly significant differences between large ROI and small ROI measurements (p,0.001). Thus, the ROI method used in a given study should always be specified in advance. Third, neither quantitative parameters (blood flow and blood volume) nor semi-quantitative parameters (peak enhancement) could be used to distinguish between malignant and benign tumours. This was irrespective of the method of quantification used for large ROIs (0.13,p,0.76) and small ROIs (0.084,p,0.31). Fourth, although there were no indications of systematic reproducibility bias, the 95% limits of agreement were so broad that the risk of disagreement between the measurements could affect the clinical use of the measurements. This lack of reproducibility should be addressed. Conclusion and advances in knowledge:A quantitative approach to DCE-CT is not a clinically usable method for characterising lung tumours.In the Western world, lung cancer remains the leading cause of cancer-related death in both males and females. The disease has a poor prognosis with an overall 5-year mortality rate of approximately 84% [1]. In patients with suspected lung cancer, the first imaging examination is that of a chest radiograph followed by a contrastenhanced CT of the thorax and upper abdomen. Depending on the local arrangements, this is followed by other examinations such as dynamic contrast-enhanced CT (DCE-CT).DCE-CT is a tool which, in theory, can quantify the perfusion of tissues by calculating the delivery of a contrast agent, and therefore blood, to these tissues [2][3][4]. This is expected to be clinically useful, and, accordingly, studies investigating the use of DCE-CT in oncology are increasingly reported in the literature [5][6][7].The fundamental principle of DCE-CT is based on the temporal changes in tissue density after an intravenous administration of iodinated contrast media. By obtaining, in quick succession, a series of images of a particular tissue of interest, it is possible to record the temporal changes in tissue attenuation occurring after intravenous injection of the contrast. The quantification of perfusion recorded by CT is performed using mathematical modelling techniques.In quantitative analysis, the operator places a region of interest (ROI) in the tumour, and a dedicated perfusion software is then used to calculate a numeric perfusion value for ...

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Section: Malignant Vs Benign Tumourssupporting

confidence: 78%

“…DCE-CT reproducibility was studied by Li et al [11,12] for early stage lung cancer. In these reports, intraclass correlation coefficients were applied with excellent results.…”

Section: Reproducibilitymentioning

confidence: 99%

Dynamic contrast-enhanced CT in suspected lung cancer: quantitative results

Harders

Madsen²,

Nellemann³

et al. 2013

BJR

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“…Firstly, a small-fractionated contrast medium administration is necessary to fit the theoretical basis of the Patlak algorithm used to analyse perfusion CT data. Secondly, the rotating movement of the scanner allows a real-time volumetric perfusional evaluation rather than that reported on a single arbitrary section or a small proportion of the lesions, as still reported in recent studies performed with 64-or even 16-section multidetector CT [21]. Finally, radiation exposure with respect to the scan parameters is a risk; although radiation exposure for CT-p is small compared with the RT doses that many patients with lung cancer are likely to receive, it is important to establish protocols with the minimum dose possible for quality measurements.…”

Section: Discussionmentioning

confidence: 99%

Whole-tumour CT-perfusion of unresectable lung cancer for the monitoring of anti-angiogenetic chemotherapy effects

Fraioli

Anzidei

Serra

et al. 2013

BJR

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Objective: To determine whether CT-perfusion (CT-p) can be used to evaluate the effects of chemotherapy and anti-angiogenic treatment in patients with non-small-cell lung carcinoma (NSCLC) and whether CT-p and standard therapeutic response assessment (RECIST) data obtained before and after therapy correlate. Methods: 55 patients with unresectable NSCLC underwent CT-p before the beginning of therapy and 50 of them repeated CT-p 90 days after it. Therapeutic protocol included platinum-based doublets plus bevacizumab for non-squamous carcinoma and platinum-based doublets for squamous carcinoma. RECIST measurements and calculations of blood flow (BF), blood volume (BV), time to peak (TTP) and permeability surface (PS) were performed, and baseline and post-treatment measurements were tested for statistically significant differences. Baseline and follow-up perfusion parameters were also compared based on histopathological subclassification (2004 World Health Organization Classification of Tumours) and therapy response assessed by RECIST. Results: Tumour histology was consistent with large cell carcinoma in 14/50 (28%) cases, adenocarcinoma in 22/50 (44%) cases and squamous cell carcinoma in the remaining 14/50 (28%) cases. BF and PS differences for all tumours between baseline and post-therapy measurements were significant (p50.001); no significant changes were found for BV (p50.3) and TTP (p50.1). The highest increase of BV was demonstrated in adenocarcinoma (5.2634.1%), whereas the highest increase of TTP was shown in large cell carcinoma (6.9622.4%), and the highest decrease of PS was shown in squamous cell carcinoma (221.5618.5%). A significant difference between the three histological subtypes was demonstrated only for BV (p,0.007). On the basis of RECIST criteria, 8 (16%) patients were classified as partial response (PR), 2 (4%) as progressive disease (PD) and the remaining 40 (80%) as stable disease (SD). Among PR, a decrease of both BF (1869.6%) and BV (12.669.2%) were observed; TTP increased in 3 (37.5%) cases, and PS decreased in 6 (75%) cases. SD patients showed an increase of BF, BV, TTP and PS in 6

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“…However, there is no consensus on an effective standardized protocol [5,[17][18][19][20]. This is partly due to the dependence of the CTp protocols on the target organ, analytical method employed, the configuration of the CT scanner employed and the clinical objective in question [5,[17][18][19][20]. In addition, the risk of exposure to excessive ionizing radiation particularly in patients in whom multiple perfusion studies are necessitated for assessment of treatment response remains a major concern in its clinical use [16].…”

Section: Introductionmentioning

confidence: 98%