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Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping

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Abstract

Objectives

To determine whether quantitative analysis of iodine-enhanced images generated from dual-energy CT (DECT) have added value in distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma (MIA) showing ground-glass nodule (GGN).

Methods

Thirty-four patients with 39 GGNs were enrolled in this prospective study and underwent DECT followed by complete tumour resection. Various quantitative imaging parameters were assessed, including virtual non-contrast (VNC) imaging and iodine-enhanced imaging.

Results

Of all 39 GGNs, four were adenocarcinoma in situ (AIS) (10 %), nine were MIA (23 %), and 26 were invasive adenocarcinoma (67 %). When assessing only VNC imaging, multivariate analysis revealed that mass, uniformity, and size-zone variability were independent predictors of invasive adenocarcinoma (odds ratio [OR] = 19.92, P = 0.02; OR = 0.70, P = 0.01; OR = 16.16, P = 0.04, respectively). After assessing iodine-enhanced imaging with VNC imaging, both mass on the VNC imaging and uniformity on the iodine-enhanced imaging were independent predictors of invasive adenocarcinoma (OR = 5.51, P = 0.04 and OR = 0.67, P < 0.01). The power of diagnosing invasive adenocarcinoma was improved after adding the iodine-enhanced imaging parameters versus VNC imaging alone, from 0.888 to 0.959, respectively (P = 0.029).

Conclusion

Quantitative analysis using iodine-enhanced imaging metrics versus VNC imaging metrics alone generated from DECT have added value in distinguishing invasive adenocarcinoma from AIS or MIA.

Key Points

• Quantitative analysis using DECT was used to distinguish invasive adenocarcinoma.

• Tumour mass and uniformity were independent predictors of invasive adenocarcinoma.

• Diagnostic performance was improved after adding iodine parameters to VNC parameters.

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Abbreviations

AIS:

Adenocarcinoma in situ

ATS:

American Thoracic Society

AUC:

Area under the receiver operating characteristic curve

CT:

Computed tomography

DECT:

Dual-energy CT

ERS:

European Respiratory Society

GGN:

Ground-glass opacity nodule

HU:

Hounsfield unit

IASLC:

International Association for the Study of Lung Cancer

MIA:

Minimally invasive adenocarcinoma

OR:

Odds ratio

ROC:

Receiver operating characteristic

ROI:

Region of interest

VNC:

Virtual non-contrast

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Acknowledgments

The scientific guarantor of this publication is Ho Yun Lee. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding through grants from the Korean Foundation for Cancer Research (KFCR-CB-2011-02-02). Dr. Seonwoo Kim at the Biostatistics Unit of Samsung Biomedical Research Institute kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained (IRB 2011 09-083). Written informed consent was obtained from all patients in this study. Methodology: prospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 135-710, Korea

    Ji Ye Son, Ho Yun Lee, Jae-Hun Kim & Kyung Soo Lee

  2. Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    Joungho Han & Ji Yun Jeong

  3. Division of Respiratory and Critical Medicine of the Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    O. Jung Kwon

  4. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 135-710, Korea

    Young Mog Shim

  5. Department of Pathology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, 702-210, Korea

    Ji Yun Jeong

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  1. Ji Ye Son
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Correspondence to Ho Yun Lee or Young Mog Shim.

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Son, J.Y., Lee, H.Y., Kim, JH. et al. Quantitative CT analysis of pulmonary ground-glass opacity nodules for distinguishing invasive adenocarcinoma from non-invasive or minimally invasive adenocarcinoma: the added value of using iodine mapping. Eur Radiol 26, 43–54 (2016). https://doi.org/10.1007/s00330-015-3816-y

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  • DOI: https://doi.org/10.1007/s00330-015-3816-y

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