title: Volumetric assessment of pulmonary nodules with ECG-gated MDCT.
abstract: OBJECTIVE
  The objective of our study was to assess physiologic lung deformation and compression originating from cardiovascular motion and their subsequent impact on determining the volume of small pulmonary nodules throughout the cardiac cycle on ECG-gated MDCT.
  
  
  METHODS
  Seventy-three small noncalcified pulmonary nodules were identified in 30 patients who underwent ECG-gated MDCT. The volume of each nodule was assessed throughout the cardiac cycle using computer-aided automatic segmentation algorithms, and the assessment was repeated three times. To ensure the validity of the subtle changes in volume that were detected, we determined the volume and signal attenuation in phantom data sets and patient nodules without temporal or spatial differentiation. Subsequently, nodules were assigned to pulmonary segments, and volume changes were correlated to cardiac phases, nodular location, and mean nodular size. Statistical multivariate tests were performed to evaluate significant patterns.
  
  
  RESULTS
  The validity of significant measurements was proven in evaluated phantom data sets with a general tendency toward overestimating nodular volume (p = 0.492). Statistical evaluation of nodular signal attenuation confirmed true deformation and compression of nodules rather than partial volume effects as the reason for volume variations (p = 0.874). Differentiating pulmonary nodules in cardiac phases, pulmonary locations, and mean nodular volumes, we found that one single effect did not determine the amount of cardiovascular motion conveyed to pulmonary parenchyma and subsequently led to nodule deformation. Multivariate testing revealed statistically significant measures identifying patterns correlating variation in nodular volume with cardiac phase (p < 0.001), nodular location (p = 0.007), and mean nodular size (p < 0.001).
  
  
  CONCLUSIONS
  Cardiovascular motion was disproportionately conveyed to various pulmonary segments and led to changes in the volume of pulmonary nodules, especially in small pulmonary nodules. A precise volumetric assessment was therefore possible only by identifying the underlying cardiac phase.
authors.affiliation: Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5056, USA. boll@uhrad.com
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Boll
authors.forename: Robert C
authors.initials: RC
authors.lastname: Gilkeson
authors.forename: Thorsten R
authors.initials: TR
authors.lastname: Fleiter
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Blackham
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Duerk
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Lewin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed