Lung, Liver and Lymph Node Metastases in Follow-Up MSCT: Comprehensive Volumetric Assessment of Lesion Size Changes

Wulff, Asmus; Bolte, Hendrik; Fischer, Susan M.; Freitag‐Wolf, Sandra; Soza, Grzegorz; Tietjen, Christian; Biederer, Jürgen; Heller, Martin; Fabel, M.

doi:10.1055/s-0032-1312860

Cited by 15 publications

(6 citation statements)

References 16 publications

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“…Nevertheless, the use of lymph node volumetry seems to be dependent on the tumor entity, since semiautomated lymph node volumetry did not have added value for the characterization of lymph nodes in patients with malignant melanomas (26). Especially for metric analysis, the role of semiautomated measurement is under current discussion, since a huge amount of data will have to be evaluated in the field of oncologic imaging (27). Regarding the assessment of SAD, long-axis diameter, and volume in patients with non-small cell lung cancer, Beyer et al showed no benefit to the use of semiautomated 3D measurements for differentiating between benign and malignant lymph node infiltration (13).…”

Section: Discussionmentioning

confidence: 99%

Quantitative Volumetric CT-Histogram Analysis in N-Staging of ¹⁸F-FDG–Equivocal Patients with Lung Cancer

et al. 2014

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Lung cancer often coexists with acute and chronic lung diseases such as chronic obstructive pulmonary disease. Therefore, mediastinal lymph nodes may be false-positive on 18 F-FDG PET because of the inflammatory disease alone. Nevertheless, 18 F-FDG PET/CT is the primary imaging modality used for staging patients with lung cancer, including nodal status. The purpose of this study was to evaluate whether volumetric CT histogram analysis can improve the characterization of lymph nodes on PET/CT staging of patients with lung cancer. Methods: Sixty histologically proven lymph nodes of 45 patients aged 43-76 y diagnosed with lung cancer were investigated. 18 F-FDG PET/CT, contrast-enhanced CT, and nonenhanced CT were performed before surgery or biopsy as part of the clinical staging procedure. Lymph nodes were analyzed on the basis of the 18 F-FDG standardized uptake value and volumetric CT histogram analysis. These findings were correlated to the gold standard of histopathology. Results: Histologic examination revealed 36 positive and 24 negative lymph nodes, which were also successfully analyzed by volumetric CT histogram. Median CT density was significantly higher for histologically positive lymph nodes (33.2 Hounsfield units [HU]; range, −29.8 to 59.1) than for histologically negative lymph nodes (10.1 HU; range, −21.0 to 87.4; P 5 0.002). The incidence of malignancy was 88% above a cutoff value of 20 HU in the ten 18 F-FDG-equivocal lymph nodes; the incidence of benign findings was 100% in the interval between −20 and 120 HU. Visualand density-based analysis on contrast-enhanced CT failed to differentiate affected from nonaffected lymph nodes. Conclusion: Three-dimensional histogram analysis is a promising and potentially valuable imaging surrogate for N-stage stratification in patients with lung cancer with unclear glucose uptake during 18 F-FDG PET imaging. In cases of equivocal 18 F-FDG PET status, this technique might potentially bridge the diagnostic gap between noninvasive techniques and invasive lymph node sampling and could help improve the yield of core biopsies. Inpat ients with lung cancer, 18 F-FDG PET/CT is considered the standard imaging methodology for noninvasive evaluation of mediastinal and hilar lymph nodes (1,2). However, in current PET/CT techniques, assessment of moving structures is limited by the time resolution of PET. In structures close to the heart and lungs, vessel pulsation and breathing may lead to a misestimation of 18 F-FDG uptake translating into equivocal findings. Accurate mediastinal N-staging is essential, because involvement of contralateral or multiregional mediastinal lymph nodes might exclude the patient from primary surgery and is often associated with a poor prognosis (3,4). Because patients with lung cancer often have comorbid diseases such as acute or chronic lung diseases (i.e., postobstructive pneumonia or chronic obstructive pulmonary disease), mediastinal lymph nodes will show positive 18 F-FDG uptake on PET/ CT due to inflammation. Consequently, transbronchial b...

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Section: Discussionmentioning

confidence: 99%

Quantitative Volumetric CT-Histogram Analysis in N-Staging of ¹⁸F-FDG–Equivocal Patients with Lung Cancer

et al. 2014

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“…The intra-observer variability of measurements (repeated measurement of the same tumor by the same observer) was not evaluated, because according to other published data in lung-nodule measurement, this was expected to be similar or even lower than the inter-observer variability [16,26]. Although the software can provide a structure based segmentation algorithm optimized for lymph nodes or for liver segmentation that has been tested for accuracy in previous publications [18,19,24], we did not include the measurement of pathological lymph nodes and/or metastasis in this study, despite the requirement from the guidelines (WHO or RECIST). The results of the present study warrant further evaluation within a prospective study design.…”

Section: Discussionmentioning

confidence: 99%

Inter-observer reproducibility of semi-automatic tumor diameter measurement and volumetric analysis in patients with lung cancer

et al. 2013

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“…The reliability of semi-automatic volumetric analysis is subject to ongoing research. Studies comparing the interobserver and/or intraobserver variability between semi-automatic and manual volume measurements have shown comparable results, namely, a superiority of semi-automatic measurements, depending on entity and used modality (14)(15)(16)(17). Also, this method depends on detection of lesions following Gd-EOB-DTPA enhancement.…”

Section: Discussionmentioning

confidence: 99%

Semi-automatic 3D-volumetry of liver metastases from neuroendocrine tumors to improve combination therapy with 177Lu-DOTATOC and 90Y-DOTATOC

Cieciera

Kratochwil

Moltz

et al. 2016

Diagn Interv Radiol

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PURPOSE Patients with neuroendocrine tumors (NET) often present with disseminated liver metastases and can be treated with a number of different nuclides or nuclide combinations in peptide receptor radionuclide therapy (PRRT) depending on tumor load and lesion diameter. For quantification of disseminated liver lesions, semi-automatic lesion detection is helpful to determine tumor burden and tumor diameter in a time efficient manner. Here, we aimed to evaluate semi-automated measurement of total metastatic burden for therapy stratification. METHODS Nineteen patients with liver metastasized NET underwent contrast-enhanced 1.5 T MRI using gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid. Liver metastases (n=1537) were segmented using Fraunhofer MEVIS Software for three-dimensional (3D) segmentation. All lesions were stratified according to longest 3D diameter >20 mm or <= 20 mm and relative contribution to tumor load was used for therapy stratification. RESULTS Mean count of lesions <= 20 mm was 67.5 and mean count of lesions > 20 mm was 13.4. However, mean contribution to total tumor volume of lesions <= 20 mm was 24%, while contribution of lesions > 20 mm was 76%. CONCLUSION Semi-automatic lesion analysis provides useful information about lesion distribution in predominantly liver metastasized NET patients prior to PRRT. As conventional manual lesion measurements are laborious, our study shows this new approach is more efficient and less operator-dependent and may prove to be useful in the decision making process selecting the best combination PRRT in each patient

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Lung, Liver and Lymph Node Metastases in Follow-Up MSCT: Comprehensive Volumetric Assessment of Lesion Size Changes

Abstract: Superior precision and inter-rater variability of volumetric over manual measurement of lesion change over time was demonstrated in a whole body setting.

Cited by 15 publications

References 16 publications

Quantitative Volumetric CT-Histogram Analysis in N-Staging of ¹⁸F-FDG–Equivocal Patients with Lung Cancer

Quantitative Volumetric CT-Histogram Analysis in N-Staging of ¹⁸F-FDG–Equivocal Patients with Lung Cancer

Inter-observer reproducibility of semi-automatic tumor diameter measurement and volumetric analysis in patients with lung cancer

Semi-automatic 3D-volumetry of liver metastases from neuroendocrine tumors to improve combination therapy with 177Lu-DOTATOC and 90Y-DOTATOC

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Lung, Liver and Lymph Node Metastases in Follow-Up MSCT: Comprehensive Volumetric Assessment of Lesion Size Changes

Abstract: Superior precision and inter-rater variability of volumetric over manual measurement of lesion change over time was demonstrated in a whole body setting.

Cited by 15 publications

References 16 publications

Quantitative Volumetric CT-Histogram Analysis in N-Staging of 18F-FDG–Equivocal Patients with Lung Cancer

Quantitative Volumetric CT-Histogram Analysis in N-Staging of 18F-FDG–Equivocal Patients with Lung Cancer

Inter-observer reproducibility of semi-automatic tumor diameter measurement and volumetric analysis in patients with lung cancer

Semi-automatic 3D-volumetry of liver metastases from neuroendocrine tumors to improve combination therapy with 177Lu-DOTATOC and 90Y-DOTATOC

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Quantitative Volumetric CT-Histogram Analysis in N-Staging of ¹⁸F-FDG–Equivocal Patients with Lung Cancer

Quantitative Volumetric CT-Histogram Analysis in N-Staging of ¹⁸F-FDG–Equivocal Patients with Lung Cancer