A prospective study of dual-energy computed tomography for differentiating metastatic and non-metastatic lymph nodes of colorectal cancer

Qiu, Lin; Hu, Junjiao; Weng, Zeping; Liu, Sirun; Jiang, Guangyu; Cai, Xiang‐Ran

doi:10.21037/qims-20-3

Cited by 19 publications

(11 citation statements)

References 31 publications

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“…Thus, it may be that more contrast agents were retained in the tumor blood vessels in the low-risk group in the VP, resulting in the higher VP-NIC in the low-risk group than in the high-risk group. Nevertheless, there were no significant differences between the two groups in terms of electron density and effective atomic number, and the results support those of Qiu et al ( 32 ). However, Zhang et al ( 33 ) found that the normalized effective atomic number value of metastatic sentinel lymph nodes in breast cancer patients was significantly larger than that of non-metastatic lymph nodes.…”

Section: Discussionsupporting

confidence: 89%

Mono+ algorithm assessment of the diagnostic value of dual-energy CT for high-risk factors for colorectal cancer: a preliminary study

Chen,

Yang,

Chen

et al. 2024

Quant Imaging Med Surg

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Background Risk factors for colorectal cancer (CRC) affect the way patients are subsequently treated and their prognosis. Dual-energy computerized tomography (DECT) is an advanced imaging technique that enables the quantitative evaluation of lesions. This study aimed to evaluate the quality of DECT images based on the Mono+ algorithm in CRC, and based on this, to assess the value of DECT in the diagnosis of CRC risk factors. Methods This prospective study was performed from 2021 to 2023. A dual-phase DECT protocol was established for consecutive patients with primary CRC. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), overall image quality, lesion delineation, and image noise of the dual-phase DECT images were assessed. Next, the optimal energy-level image was selected to analyze the iodine concentration (IC), normalized iodine concentration (NIC), effective atomic number, electron density, dual-energy index (DEI), and slope of the energy spectrum curve within the tumor for the high- and low-risk CRC groups. A multifactor binary logistic regression analysis was used to construct a differential diagnostic regression model for high- and low-risk CRC, receiver operating characteristic (ROC) curves were plotted, and the area under the curve (AUC) was calculated to assess the diagnostic value of the model. Results A total of 74 patients were enrolled in this study, of whom 41 had high-risk factors and 33 had low-risk factors. The SNR and CNR were best at 40 keV virtual monoenergetic imaging (VMI) based on the Mono+ algorithm (VMI+) (SNR 8.79±1.27, P<0.001; CNR 14.89±1.77, P=0.027). The overall image quality and lesion contours were best at 60 keV VMI+ and 40 keV VMI+, respectively (P=0.001). Among all the DECT parameters, the arterial phase (AP)-IC, NIC, DEI, energy spectrum curve, and venous phase-NIC differed significantly between the two groups. The AP-IC was the optimal DECT parameter for predicting high- and low-risk CRC with AUC, sensitivity, specificity, and cut-off values of 0.96, 97.06%, 87.80%, and 2.94, respectively, and the 95% confidence interval (CI) of the AUC was 0.88–0.99. Integrating the clinical factors and DECT parameters, the AUC, sensitivity, specificity, and predictive accuracy of the model were 0.99, 100.00%, 92.68%, and 94.67%, respectively, and the 95% CI of the AUC was 0.93–1.00. Conclusions The DECT parameters based on 40 keV noise-optimized VMI+ reconstruction images depicted the CRC tumors best, and the clinical DECT model may have significant implications for the preoperative prediction of high-risk factors in CRC patients.

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Section: Discussionsupporting

confidence: 89%

Mono+ algorithm assessment of the diagnostic value of dual-energy CT for high-risk factors for colorectal cancer: a preliminary study

Chen,

Yang,

Chen

et al. 2024

Quant Imaging Med Surg

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“…ROC analysis of the different parameters of DECT in thyroid carcinomas with and without lymph node metastasis (IC mg/mL, CT value HU) HU in metastatic lymph nodes compared to nonmetastatic lymph nodes in thyroid carcinoma(34)(35)(36), it was difficult to measure the parameters of all lymph nodes for all patients, and a portion of the lymph nodes were illegible. It was relatively easy and feasible to measure the lesion of thyroid carcinoma, which may indirectly reflect the status of the lymph nodes in thyroid carcinoma.…”

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confidence: 99%

Parameters of dual-energy CT for the differential diagnosis of thyroid nodules and the indirect prediction of lymph node metastasis in thyroid carcinoma: a retrospective diagnostic study

Li¹,

Huang²,

Liu³

et al. 2022

Gland Surg

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Background: To further investigate the differential diagnosis of thyroid nodules using dual-energy computed tomography (DECT) and explore the relationship between DECT parameters and lymph node metastasis in thyroid carcinoma for clinical practice, especially difficult diagnosis by routine imaging examination.Methods: A total of 150 patients with thyroid nodules who underwent preoperative DECT and Thyroid Imaging Report and Data System (TIRADS) classification were enrolled in this study, including 96 patients with malignant tumors and 54 with benign tumors. The DECT parameters were got form regions of interest (ROI) by an experienced radiologist team and thyroid nodules and lymph node status of all patients were identified by cytology and histopathology. Statistical analyses were performed using Student's t-test, Chisquared test, and receiver operating characteristic (ROC) curves.Results: In the differential diagnosis of benign and malignant thyroid nodules, the optimal iodine concentration (IC) and normalized iodine concentration (NIC) cut-off values were IC a (2.835 mg/mL), NIC 1a (0.690), and their corresponding area under the curve (AUC) were 0.940, 0.954 respectively; meantime, the optimal computed tomography (CT) value and slope of the spectral Hounsfield unit curve (λ HU ) cut-off values were 70 keVa (125.05 HU) and λ HU2a (1.405), and their corresponding AUC were 0.955, 0.941 respectively. For lymph node status (with or without lymph node metastasis), the optimal IC and NIC thresholds were IC a (1.715 mg/mL) and NIC 2a (0.155), and their corresponding AUC were 0.717, 0.720 respectively; meanwhile, the optimal CT value and λ HU thresholds were 70 keVv (89.635 HU) and λ HU2v(1.185), and their corresponding AUC were 0.729, 0.641 respectively.Conclusions: Base on our study, we think DECT is useful in differentiating malignant from benign thyroid nodules, which has potential value in the indirect prediction of lymph node metastasis in thyroid carcinoma.

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“…The mean age of patients in the 16 included studies varied from 34.0±7.8 to 59.5±8.7 years, while the percentage of males ranged from around 0.0% to 70.9%. Moreover, 7 of the 16 studies included patients with thyroid cancer ( 16 , 23 , 24 , 29 , 30 , 33 , 36 ), 4 studies included patients with colorectal cancer ( 25 , 28 , 35 , 37 ), and the remaining 5 studies included patients with esophageal cancer, liver cancer, breast cancer, squamous cell carcinoma of the oropharynx, or lung cancer ( 26 , 27 , 31 , 32 , 34 ). Table 1 details the patient characteristics of the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…After a reading of the titles and abstracts of these 257 original studies, 202 papers were excluded. Then, full texts were read in detail, and a rescreening was performed based on the inclusion and exclusion criteria, resulting in a final sample of 16 eligible studies for inclusion in this meta-analysis (16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The flowchart outlining the screening process is shown in Figure 1.…”

Section: Literature Searchmentioning

confidence: 99%

“…This meta-analysis included 16 original investigations, totaling 2,577 lymph nodes from 984 individuals. The papers included were published between 2015 and 2022, with 11 studies having been published in the last 5 years (16,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). The mean age of patients in the 16 included studies varied from 34.0±7.8 to 59.5±8.7 years, while the percentage of males ranged from around 0.0% to 70.9%.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Diagnostic accuracy of contrast-enhanced dual-energy computed tomography for detecting metastatic lymph nodes in patients with malignant tumors: a systematic review and meta-analysis

Kong¹,

Chen²,

Gao³

et al. 2023

Quant Imaging Med Surg

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Background: This meta-analysis evaluated the diagnostic accuracy of contrast-enhanced dual-energy computed tomography (DECT) for detecting metastatic lymph nodes in patients with cancer.Methods: PubMed, Embase and Cochrane Library databases were searched for literature published from database inception until September 2022. Only studies that investigated the diagnostic accuracy of DECT for metastatic lymph nodes in patients with malignant tumors and surgically removed metastatic lymph nodes for pathological confirmation were included. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. The threshold effect was determined by calculating Spearman correlation coefficients and summary receiver operating characteristic (SROC) curve patterns. Deeks test was used to assess publication bias.Results: All of the included studies were observational studies. A total of 16 articles involving 984 patients were included (2,577 lymph nodes) in this review. A total of 15 variables were included in the meta-analysis, including 6 individual parameters and 9 combined parameters. Normalized iodine concentration (NIC) in the arterial phase combined with the slope in the arterial phase showed better identification of metastatic lymph nodes. The spearman correlation coefficient was -0.371 (P=0.468), and the SROC curve did not show a "shoulder-arm" shape, suggesting that there was no threshold effect and that heterogeneity was present.The combined sensitivity was 94% [95% confidence interval (CI): 86-98%], the specificity was 74% (95% CI: 52-88%), and the area under the curve was 0.94. The Deeks test suggested no significant publication bias in the included studies (P=0.06).Conclusions: NIC in arterial phase combined with the slope in the arterial phase has some diagnostic value in differentiating between metastatic and benign lymph nodes, but this should be further evaluated in additional studies with rigorous design and high homogeneity.

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A prospective study of dual-energy computed tomography for differentiating metastatic and non-metastatic lymph nodes of colorectal cancer

Cited by 19 publications

References 31 publications

Mono+ algorithm assessment of the diagnostic value of dual-energy CT for high-risk factors for colorectal cancer: a preliminary study

Mono+ algorithm assessment of the diagnostic value of dual-energy CT for high-risk factors for colorectal cancer: a preliminary study

Parameters of dual-energy CT for the differential diagnosis of thyroid nodules and the indirect prediction of lymph node metastasis in thyroid carcinoma: a retrospective diagnostic study

Diagnostic accuracy of contrast-enhanced dual-energy computed tomography for detecting metastatic lymph nodes in patients with malignant tumors: a systematic review and meta-analysis

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