title: Differentiation between malignant and benign solitary pulmonary nodules: use of volume first-pass perfusion and combined with routine computed tomography.
abstract: OBJECTIVE
  To evaluate the capability of first-pass volume perfusion computed tomography (PCT) for differentiation of solitary pulmonary nodules (SPNs) and to compare that of combination of PCT and routine CT with CT alone for the differentiation.
  
  
  METHODS
  Our institutional review board approved this study and informed consent was obtained. With nine excluded, 65 consecutive patients having a SPN with histopathologic proof or follow-up underwent a 30s PCT using the deconvolution model were evaluated. Kruskal-Wallis tests and receiver operating characteristics (ROC) analysis were underwent. Four radiologists assessed nodules independently and retrospectively. Diagnostic capability was compared for CT alone and PCT plus CT. ROC analysis, McNemar test, and weighted kappa statistics were performed.
  
  
  RESULTS
  Significant differences were found in parameters between malignant and benign nodules (p<0.0001 for blood flow, blood volume, and permeability surface area product), SPNs were more likely to be malignant by using threshold values of more than 55 ml/100 g/min, 2.5 ml/100 g, and 10 ml/100 g/min, respectively. PCT plus CT was significantly better in overall sensitivity (93%, p=0.004) and accuracy (94%, p=0.003) compared to CT alone, not specificity (96%). Area under the curve for ROC analyses of PCT plus CT was significantly larger than that of CT alone (p=0.018). Mean weighted kappa for PCT plus CT was 0.715, that for CT alone was 0.447.
  
  
  CONCLUSIONS
  Volume first-pass PCT can distinguish SPNs. Using PCT plus routine CT may be more sensitive and accurate for differentiating malignant from benign nodules than CT alone and allows more confidence and constancy.
authors.affiliation: Department of Radiology, Third Affiliated Hospital of Suzhou University, 185, Juqian Road, Changzhou, Zip Code: 213003, PR China. shanfeiqz@gmail.com
authors.forename: Fei
authors.initials: F
authors.lastname: Shan
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Xing
authors.forename: Jianguo
authors.initials: J
authors.lastname: Qiu
authors.forename: Shan
authors.initials: S
authors.lastname: Yang
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Yaping
authors.initials: Y
authors.lastname: Jiang
authors.forename: Gang
authors.initials: G
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*