Choi Jaeyeon, Ahn Yura, Kim Youngjae, Noh Han Na, Do Kyung-Hyun, Seo Joon Beom, Lee Sang Min
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Department of Biomedical Engineering, AMIST, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2025 Jun 3. doi: 10.1007/s00330-025-11715-w.
To investigate the effect of contrast enhancement on the diagnosis of interstitial lung abnormalities (ILA) in automatic quantitative CT measurement in patients with paired pre- and post-contrast scans.
Patients who underwent chest CT for thoracic surgery between April 2017 and December 2020 were retrospectively analyzed. ILA quantification was performed using deep learning-based automated software. Cases were categorized as ILA or non-ILA according to the Fleischner Society's definition, based on the quantification results or radiologist assessment (reference standard). Measurement variability, agreement, and diagnostic performance between the pre- and post-contrast scans were evaluated.
In 1134 included patients, post-contrast scans quantified a slightly larger volume of nonfibrotic ILA (mean difference: -0.2%), due to increased ground-glass opacity and reticulation volumes (-0.2% and -0.1%), whereas the fibrotic ILA volume remained unchanged (0.0%). ILA was diagnosed in 15 (1.3%), 22 (1.9%), and 40 (3.5%) patients by pre- and post-contrast scans and radiologists, respectively. The agreement between the pre- and post-contrast scans was substantial (κ = 0.75), but both pre-contrast (κ = 0.46) and post-contrast (κ = 0.54) scans demonstrated moderate agreement with the radiologist. The sensitivity for ILA (32.5% vs. 42.5%, p = 0.221) and specificity for non-ILA (99.8% vs. 99.5%, p = 0.248) were comparable between pre- and post-contrast scans. Radiologist's reclassification for equivocal ILA due to unilateral abnormalities increased the sensitivity for ILA (67.5% and 75.0%, respectively) in both pre- and post-contrast scans.
Applying automated quantification on post-contrast scans appears to be acceptable in terms of agreement and diagnostic performance; however, radiologists may need to improve sensitivity reclassifying equivocal ILA.
Question The effect of contrast enhancement on the automated quantification of interstitial lung abnormality (ILA) remains unknown. Findings Automated quantification measured slightly larger ground-glass opacity and reticulation volumes on post-contrast scans than on pre-contrast scans; however, contrast enhancement did not affect the sensitivity for interstitial lung abnormality. Clinical relevance Applying automated quantification on post-contrast scans appears to be acceptable in terms of agreement and diagnostic performance.
探讨对比增强对配对的对比剂注射前、后扫描患者的间质性肺异常（ILA）自动定量CT测量诊断的影响。
回顾性分析2017年4月至2020年12月期间因胸外科手术接受胸部CT检查的患者。使用基于深度学习的自动化软件进行ILA定量分析。根据Fleischner学会的定义，基于定量结果或放射科医生评估（参考标准），将病例分为ILA或非ILA。评估对比剂注射前、后扫描之间的测量变异性、一致性和诊断性能。
在纳入的1134例患者中，对比剂注射后扫描定量的非纤维化ILA体积略大（平均差异：-0.2%），这是由于磨玻璃影和网状影体积增加（分别为-0.2%和-0.1%），而纤维化ILA体积保持不变（0.0%）。对比剂注射前、后扫描及放射科医生分别诊断出15例（1.3%）、22例（1.9%）和40例（3.5%）ILA患者。对比剂注射前、后扫描之间的一致性较高（κ = 0.75），但对比剂注射前扫描（κ = 0.46）和对比剂注射后扫描（κ = 0.54）与放射科医生的一致性均为中等。对比剂注射前、后扫描对ILA的敏感性（32.5%对42.5%，p = 0.221）和对非ILA的特异性（99.8%对99.5%，p = 0.248）相当。由于单侧异常导致的ILA可疑病例，放射科医生的重新分类提高了对比剂注射前、后扫描中ILA的敏感性（分别为67.5%和75.0%）。
在一致性和诊断性能方面，对比剂注射后扫描应用自动定量分析似乎是可接受的；然而，放射科医生可能需要提高对ILA可疑病例重新分类的敏感性。
问题 对比增强对间质性肺异常（ILA）自动定量的影响尚不清楚。发现 自动定量分析显示，对比剂注射后扫描的磨玻璃影和网状影体积略大于对比剂注射前扫描；然而，对比增强并未影响间质性肺异常的敏感性。临床意义 在一致性和诊断性能方面，对比剂注射后扫描应用自动定量分析似乎是可接受的。
