Department of Medical Imaging, Taipei City Hospital, Yangming Branch, No. 105, Yusheng St., Shilin Dist., Taipei City, 111024, Taiwan.
Department of Medical Imaging, National Taiwan University Hospital and National Taiwan University College of Medicine, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100225, Taiwan.
Jpn J Radiol. 2024 May;42(5):468-475. doi: 10.1007/s11604-023-01525-9. Epub 2024 Feb 5.
To ascertain the performance of dual-energy CT (DECT) with iodine quantification in differentiating malignant mediastinal and hilar lymph nodes (LNs) from benign ones, focusing on patients with lung adenocarcinoma.
In this study, patients with suspected lung cancer received a preoperative contrast-enhanced DECT scan from Jun 2018 to Dec 2020. Quantitative DECT parameters and the size were compared between metastatic and benign LNs. Their diagnostic performances were analyzed by the ROC curves and compared by using the two-sample t test.
72 patients (23 men, 49 women; mean age 62.5 ± 10.1 years) fulfilled the inclusion criteria. A total of 98 LNs (67 benign, 31 metastatic) were analyzed. The iodine concentration normalized by muscle (NIC) was significantly higher (P < 0.001) in metastatic LNs (4.79 ± 1.70) than in benign ones (3.00 ± 1.45). The optimal threshold of NIC was 3.44, which yielded AUC: 0.798, sensitivity: 83.9%, specificity: 73.1%, accuracy: 76.5%, respectively. Applying the established size parameters with 10 mm as the threshold yielded AUC: 0.600, sensitivity: 29.0%, specificity: 91.0%, accuracy: 71.4%, respectively. The diagnostic performance of NIC was significantly better (P = 0.007) than the performance obtained using the established size parameters.
For lung adenocarcinoma, the quantitative measurement of NIC derived from DECT is useful for differentiating benign and metastatic mediastinal and hilar LNs before surgical intervention.
确定碘定量双能 CT（DECT）在区分肺腺癌患者纵隔和肺门恶性与良性淋巴结（LNs）方面的性能。
本研究纳入 2018 年 6 月至 2020 年 12 月期间疑似肺癌的患者，术前进行增强 DECT 扫描。对比转移性和良性 LNs 的定量 DECT 参数和大小。采用 ROC 曲线分析其诊断性能，并采用两样本 t 检验进行比较。
72 例患者（男 23 例，女 49 例；平均年龄 62.5±10.1 岁）符合纳入标准。共分析了 98 个 LNs（67 个良性，31 个转移性）。淋巴结内碘浓度标准化（NIC）在转移性 LNs（4.79±1.70）中明显高于良性 LNs（3.00±1.45）（P<0.001）。NIC 的最佳阈值为 3.44，AUC 为 0.798，敏感性为 83.9%，特异性为 73.1%，准确性为 76.5%。应用 10mm 作为阈值的大小参数的 AUC 为 0.600，敏感性为 29.0%，特异性为 91.0%，准确性为 71.4%。NIC 的诊断性能明显优于建立的大小参数（P=0.007）。
对于肺腺癌，DECT 定量测量 NIC 有助于在手术干预前区分纵隔和肺门良恶性 LNs。
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