Dual energy computed tomography for detection of metastatic lymph nodes in patients with hepatocellular carcinoma

Abstract

BACKGROUND Regional lymph node metastasis in patients with hepatocellular carcinoma (HCC) is not uncommon, and is often under- or misdiagnosed. Regional lymph node metastasis is associated with a negative prognosis in patients with HCC, and surgical resection of lymph node metastasis is considered feasible and efficacious in improving the survival and prognosis. It is critical to characterize lymph node preoperatively. There is currently no consensus regarding the optimal method for the assessment of regional lymph nodes in patients with HCC. AIM To evaluate the diagnostic value of single source dual energy computed tomography (CT) in regional lymph node assessment for HCC patients. METHODS Forty-three patients with pathologically confirmed HCC who underwent partial hepatectomy with lymphadenectomy were retrospectively enrolled. All patients underwent dual-energy CT preoperatively. Regional lymph nodes ( n = 156) were divided into either a metastatic (group P , n = 52) or a non-metastasis group (group N , n = 104), and further, according to pathology, divided into an active hepatitis (group P1 , n = 34; group N1 , n = 73) and a non-active hepatitis group (group P2 , n = 18; group N2 , n = 31). The maximal short axis diameter (MSAD), iodine concentration (IC), normalized IC (NIC), and the slope of the spectral curve ( λ HU ) of each group in the arterial phase (AP), portal phase (PP), and delayed phase (DP) were analyzed. RESULTS Analysis of the MSAD, IC, NIC, and λ HU showed statistical differences between groups P and N ( P < 0.05) during all three phases. To distinguish benign from metastatic lymph nodes, the diagnostic efficacy of IC, NIC, and λ HU in the PP was the best among the three phases (AP, PP, and DP), with a sensitivity up to 81.9%, 83.9%, and 81.8%, and a specificity up to 82.4%, 84.1% and 84.1%, respectively. The diagnostic value of combined analyses of MSAD with IC, NIC, or λ HU in the PP was superior to the dual energy CT parameters alone, with a sensitivity up to 84.5%, 86.9%, and 86.2%, and a specificity up to 83.0%, 93.6% and 89.8%, respectively. Between groups P1 and P2 and groups N1 and N2 , only IC, NIC, and λ HU between groups N1 ...

Development and Validation of a Novel Model to Predict Regional Lymph Node Metastasis in Patients With Hepatocellular Carcinoma

“…Considering that only 15.2% of patients received LND, a great number of patients without LND had occult LNM, indicating that the existing evaluation methods based on radiology are insufficient. Although previous studies have shown some factors that were associated with the presence of LNM, such as PET-CT imaging, dual-energy CT imaging, lncRNAs, microRNAs, and some other hematological indicators, these models were costly and required some technology to generate scores (12,13,15,(37)(38)(39)(40). In the present study, with the help of the LASSO logistic regression algorithm, we incorporated five easily accessible factors, including race, tumor size, clinical T stage (cT stage), extrahepatic bile duct invasion, and tumor grade, to develop a model for predicting LNM in HCC patients.…”

Improving radiation physics, tumor visualisation, and treatment quantification in radiotherapy with spectral or dual‐energy CT

“…For assessment of the lymph node stations, assessment of node size is not enough; it is crucial to assess texture, local perfusion, and the pattern of perfusion within the nodes. [134][135][136] By visualization and quantification of iodine, 137 spectral images help in the assessment the malignancy of lymph nodes in the abdomen, 138 HCC, 139 H&N, 140-142 gastric 143,59 , pulmonary, 168 colorectal, 144 and rectal cancer. 145,146 Within RT, PET, and MRI currently play an integral role in RT staging of many cancer types.…”

Prediction of Lymph-Node Metastasis in Cancers Using Differentially Expressed mRNA and Non-coding RNA Signatures

“…Regional lymph-node metastasis is an important predictor for tumor recurrence and survival in patients with aggressive cancers (Hermanek, 2000 ; Xu et al, 2018 ). The diagnosis of lymphatic metastasis in a certain cancer may be uncertain even after extensive clinical examinations, such as endosonography, magnetic resonance imaging, and computed tomography (Christensen et al, 2006 ; Obinu et al, 2018 ; Zeng et al, 2019 ). Cancer patients examined with ambiguous lymphatic metastasis usually suffer from uncontrolled disease progression and a short overall survival period (Biaoxue et al, 2011 ; Yang et al, 2019a ).…”