Value of spectral computed tomography-derived quantitative parameters based on full volume analysis in the diagnosis of benign/malignant and pathological subtypes of solitary pulmonary nodules

Abstract

Background: Conventional dynamic computed tomography (CT) has a low specificity for the distinction between benign and malignant solitary pulmonary nodules (SPNs), and spectral CT has been proposed as a potential alternative. We aimed to investigate the role of quantitative parameters based on full-volume spectral CT in the differential diagnosis of SPNs.Methods: This retrospective study included spectral CT images of 100 patients with pathologically confirmed SPNs (78 and 22 in the malignant and benign groups, respectively). All cases were confirmed by postoperative pathology, percutaneous biopsy, and bronchoscopic biopsy. Multiple quantitative parameters derived from spectral CT were extracted from whole-tumor volume and standardized. Differences in quantitative parameters between groups were statistically analyzed. Diagnostic efficiency was evaluated by generating a receiver operating characteristic (ROC) curve. Between-group differences were evaluated using an independent sample t-test or Mann-Whitney U test. Interobserver repeatability was assessed using intraclass correlation coefficients (ICCs) and Bland-Altman plots.Results: Spectral CT-derived quantitative parameters, except attenuation difference between the SPN in the 70 keV and arterial enhancement [Δ S-A(70 keV) ], were significantly higher for malignant SPNs than for benign nodules (P<0.05). In the subgroup analysis, most parameters could distinguish between the benign and adenocarcinoma groups, and between the benign and squamous cell carcinoma groups (P<0.05). Only 1 parameter could differentiate the adenocarcinoma and squamous cell carcinoma groups (P=0.020). ROC curve analysis indicated that normalized arterial enhancement fraction in the 70 keV (NEF 70 keV ), normalized iodine concentration (NIC), and Δ70 keV had high diagnostic efficacy for differentiating SPNs between the benign and malignant SPNs [area under the curve (AUC): 0.867, 0.866, and 0.848, respectively] and between the benign and adenocarcinoma groups (AUC: 0.873, 0.872, and 0.874, respectively). The multiparameters derived from spectral CT exhibited satisfactory interobserver repeatability (ICC: 0.856-0.996).Conclusions: Our study suggests that quantitative parameters derived from whole-volume spectral CT may be useful to improve discrimination of SPNs.

Value of dual-layer spectral detector CT in predicting lymph node metastasis of non-small cell lung cancer

“…The following values were recorded in our study: The CT values of the lesions at virtual non-contrast (VNC) and enhancement (40 and 70 keV), which were recorded as CT SPN-VNC , CT SPN-40keV , and CT SPN-70keV , respectively; and the CT values of the aorta at VNC (CT aorta-VNC ) and enhancement at 70 keV (CT aorta ), which were recorded and used as references. The following formulas were used to calculate the lesion to aorta virtual plain scan ratio (SAR VNC ), the lesion to aorta enhancement ratios (SAR 40keV and SAR 70keV ), the differences between the lesion enhancement and virtual plain scan CT value (Δ 40keV and Δ 70keV ), the contrast enhancement ratios (CER 40keV and CER 70keV ), the standardized reinforcement scores (NEF 40keV and NEF 70keV ), and λ ( 23 , 24 ):…”