Dual-Layer Spectral CT as Innovative Imaging Guidance in Lung Biopsies: Could Color-Coded Z-Effective Images Allow More Diagnostic Samplings and Biomarkers Information?

Abstract

The aim of the study was to try to obtain more information on diagnostic samplings and biomarkers using dual-layer spectral CT in lung biopsies. Lung biopsies were performed by merging images obtained with CBCT with those from spectral CT to use them as functional guidance, experimenting with double sampling to determine the difference between the area with a higher Z-effective number and that with a lower Z-effective number. Ten patients with large lung lesions on spectral CT were selected and underwent percutaneous transthoracic lung mass biopsy. Technical success was calculated. The percentage of neoplastic, inflammatory, fibrotic, necrotic cells, or non-neoplastic lung parenchyma was reported. The possibility of carrying out immunohistochemical or molecular biology investigations was analyzed. All lesions were results malignant in 10/10 samples in the Zmax areas; in the Zmin areas, malignant cells were found in 7/10 samples. Technical success was achieved in 100% of cases for Zmax sampling and in 70% for Zmin sampling (p-value: 0.2105). The biomolecular profile was detected in 9/10 (90%) cases in Zmax areas, while in 4/10 (40%) cases in Zmin areas (p-value: 0.0573). The advantage of Z-effective imaging would be to identify a region of the lesion that is highly vascularized and probably richer in neoplastic cells, thus decreasing the risk of obtaining a non-diagnostic biopsy sample.

Prediction of histologic grade of hepatocellular carcinoma using dual-layer spectral-detector computed tomography (CT): comparison of two region of interest plotting methods

“…Chen et al ( 10 ) showed that in invasive colorectal adenocarcinoma, higher Zeff may be attributed to increased tumor heterogeneity, where the tumor tissue exhibited nuclear pleomorphism and abnormal elemental composition. In contrast, regions with lower Zeff imply the likelihood of less densely populated cellular structures or elements with lower atomic numbers ( 30 ). We believe that the standardized effective atomic number can better reflect the heterogeneity between HCC and may provide new markers for assessing poorly differentiated HCC.…”