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Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT

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Abstract

Objective

To assess diagnostic performance of dual-input CT perfusion for distinguishing malignant from benign solitary pulmonary nodules (SPNs).

Methods

Fifty-six consecutive subjects with SPNs underwent contrast-enhanced 320-row multidetector dynamic volume CT. The dual-input maximum slope CT perfusion analysis was employed to calculate the pulmonary flow (PF), bronchial flow (BF), and perfusion index \( \left( {\mathrm{PI},={{\mathrm{PF}} \left/ {{\left( {\mathrm{PF} + \mathrm{BF}} \right)}} \right.}} \right) \). Differences in perfusion parameters between malignant and benign tumours were assessed with histopathological diagnosis as the gold standard. Diagnostic value of the perfusion parameters was calculated using the receiver-operating characteristic (ROC) curve analysis.

Results

Amongst 56 SPNs, statistically significant differences in all three perfusion parameters were revealed between malignant and benign tumours. The PI demonstrated the biggest difference between malignancy and benignancy: 0.30 ± 0.07 vs. 0.51 ± 0.13 , P < 0.001. The area under the PI ROC curve was 0.92, the largest of the three perfusion parameters, producing a sensitivity of 0.95, specificity of 0.83, positive likelihood ratio (+LR) of 5.59, and negative likelihood ratio (−LR) of 0.06 in identifying malignancy.

Conclusions

The PI derived from the dual-input maximum slope CT perfusion analysis is a valuable biomarker for identifying malignancy in SPNs. PI may be potentially useful for lung cancer treatment planning and forecasting the therapeutic effect of radiotherapy treatment.

Key Points

• Modern CT equipment offers assessment of vascular parameters of solitary pulmonary nodules (SPNs)

• Dual vascular supply was investigated to differentiate malignant from benign SPNs.

• Different dual vascular supply patterns were found in malignant and benign SPNs.

• The perfusion index is a useful biomarker for differentiate malignancy from benignancy.

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Abbreviations

DI-CTP:

Dual-input maximum slope CT perfusion

SPN:

Solitary pulmonary nodule

PA:

Pulmonary artery

BA:

Bronchial artery

TDCs:

Time density curves

PF:

Pulmonary flow

BF:

Bronchial flow

\( \left( {\mathrm{PI},={{\mathrm{PF}} \left/ {{\left( {\mathrm{PF} + \mathrm{BF}} \right)}} \right.}} \right) \) :

Perfusion index

ROI:

Region of interest

ROC curve:

Receiver-operating characteristic curve

+LR:

Positive likelihood ratio

−LR:

Negative likelihood ratio

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Acknowledgements

The authors thank Dr. Kolo of Toshiba Medical Systems for outstanding technical assistance in this study.

Xiadong Yuan and Jing Zhang contributed equally to this work.

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Authors and Affiliations

  1. Department of Radiology, the 309th Hospital of Chinese People’s Liberation Army, 17 Heishanhu Road, Haidian District, Beijing, 100091, People’s Republic of China

    Xiaodong Yuan, Changbin Quan, Jianxia Cao, Guokun Ao, Yuan Tian & Hong Li

  2. Department of Radiology, Tongji Hospital of Tongji University, 389 Xincun Road, Shanghai, 200065, People’s Republic of China

    Jing Zhang

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  1. Xiaodong Yuan
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  2. Jing Zhang
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  3. Changbin Quan
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  4. Jianxia Cao
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  5. Guokun Ao
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  6. Yuan Tian
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  7. Hong Li
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Correspondence to Changbin Quan.

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Yuan, X., Zhang, J., Quan, C. et al. Differentiation of malignant and benign pulmonary nodules with first-pass dual-input perfusion CT. Eur Radiol 23, 2469–2474 (2013). https://doi.org/10.1007/s00330-013-2842-x

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  • DOI: https://doi.org/10.1007/s00330-013-2842-x

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