Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan.
Nagoya University Graduate School of Medicine, Department of Radiology, 65 Tsurumai-cho, Showa-ku, Nagoya 4668550, Japan.
Eur J Radiol. 2017 Oct;95:186-191. doi: 10.1016/j.ejrad.2017.08.010. Epub 2017 Aug 14.
To compare dual-phase dual-energy CT (DE-CT) with FDG-PET/CT for predicting histopathological locoregional invasiveness of non-small cell lung cancers (NSCLCs).
We selected 63 consecutive patients with NSCLC lesions (37 males, 26 females; age range, 44-85 years; mean age, 69 years) who were evaluated preoperatively by both DE-CT and PET/CT at our institution. Postoperative microscopic invasiveness (lymphatic permeation, vascular invasion, and/or pleural involvement) was reviewed, and we defined locoregionally invasive tumors as those that had at least one positive finding of microscopic invasiveness. DE-CT scanning in the arterial and delayed phases was performed after injection of iodinated contrast media using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation of primary tumors in the arterial and delayed phases was quantified automatically using "syngo Dual Energy Lung Nodules" application software, and the ratio of arterial phase to delayed phase enhancement (A/D ratio) was calculated. The A/D ratio and SUVmax on PET/CT were evaluated with respect to postoperative invasiveness by univariate logistic regression analysis.
The A/D ratio was significantly correlated with lymphatic permeation, vascular invasion, and pleural involvement (p=0.011, p=0.021, and p=0.010, respectively). In contrast, the SUVmax was significantly correlated with pleural involvement (p=0.020) but not with lymphatic permeation or vascular invasion (p=0.088 and p=0.100, respectively). In the subgroup of patients with lesion diameters ≤2cm, the A/D ratio was significantly correlated with locoregional invasiveness (p=0.040), while the SUVmax was not (p=0.121).
For the prediction of microscopic invasiveness of NSCLCs, the diagnostic performance of dual-phase DE-CT may be comparable to that of FDG-PET/CT.
比较双能 CT（DE-CT）与 FDG-PET/CT 预测非小细胞肺癌（NSCLC）的组织病理学局部侵犯程度。
我们选择了在我院接受 DE-CT 和 PET/CT 检查的 63 例连续 NSCLC 患者（男 37 例，女 26 例；年龄 44-85 岁，平均 69 岁）。术后显微镜下侵犯程度（淋巴管浸润、血管侵犯和/或胸膜侵犯）进行了回顾，并将至少有一项显微镜下侵犯阳性发现的肿瘤定义为局部侵犯性肿瘤。DE-CT 扫描在注射碘造影剂后分别采用 140kVp 和 80kVp 管电压进行动脉期和延迟期扫描。使用“syngo Dual Energy Lung Nodules”应用软件自动量化原发性肿瘤在动脉期和延迟期的三维碘衰减，计算动脉期与延迟期增强比值（A/D 比值）。采用单变量逻辑回归分析评估 DE-CT 的 A/D 比值和 PET/CT 的 SUVmax 与术后侵犯程度的相关性。
A/D 比值与淋巴管浸润、血管侵犯和胸膜侵犯显著相关（p=0.011、p=0.021 和 p=0.010）。相反，SUVmax 与胸膜侵犯显著相关（p=0.020），但与淋巴管浸润或血管侵犯无关（p=0.088 和 p=0.100）。在病变直径≤2cm 的患者亚组中，A/D 比值与局部侵犯程度显著相关（p=0.040），而 SUVmax 则无显著相关性（p=0.121）。
在预测 NSCLC 的显微镜下侵犯程度方面，双能 CT 的诊断性能可能与 FDG-PET/CT 相当。
