Differentiation of benign and malignant lung lesions: Dual-Energy Computed Tomography findings.
OBJECTIVE
To determine whether parameters generated by Dual-Energy Computed Tomography (DECT) can distinguish malignant from benign lung lesions.


METHODS
A prospective review of 125 patients with 126 lung lesions (23 benign and 103 malignant) who underwent lung DECT during arterial phase. All lesions were confirmed by tissue sampling. A radiologist semi-automatically contoured lesions and placed regions of interest (ROIs) in paravertebral muscle (PVM) for normalization. Variables related to absorption in Hounsfield units (HU), effective atomic number (Zeff), iodine concentration (ρI) and spectral CT curves were assessed. Receiver operating characteristic (ROC) curves were generated to calculate sensitivity and specificity as predictors of malignancy. Multivariate logistic regression analysis was performed.


RESULTS
Reproducibility of measures normalized with PVM was poor. Bivariate analysis showed minimum Zeff and normalized mean Zeff to be statistically significant (p=0.001), with area under the curve (AUC) values: 0.66 (CI 95% 0.54-0.80) and 0.72 (CI 95%, 0.60-0.84), respectively. Logistic regression models showed no differences between raw and normalized measurements. In both models, minimum HU (OR: 0.9) and size (OR: 0.1) were predictive of benign lesions.


CONCLUSIONS
A quantitative approach to DECT using raw measurements is simpler than logistic regression models. Normalization to PVM was not clinically reliable due to its poor reproducibility. Further studies are needed to confirm our findings.
Dept Radiophysics, Foundation IVO, Valencia, Spain.
Víctor
V
González-Pérez
Dept Radiology, Foundation IVO, Valencia, Spain. Electronic address: aranae@uv.es.
Estanislao
E
Arana
Dept Radiology, Foundation IVO, Valencia, Spain.
María
M
Barrios
Dept Radiophysics, Foundation IVO, Valencia, Spain.
Albert
A
Bartrés
Dept Pathology, Foundation IVO, Valencia, Spain.
Julia
J
Cruz
GE Healthcare Diagnostic Imaging, Iberia, Spain.
Rafael
R
Montero
Dept Radiology, Foundation IVO, Valencia, Spain.
Manuel
M
González
Dept Radiology, Foundation IVO, Valencia, Spain.
Carlos
C
Deltoro
Dept Pneumology, Foundation IVO, Valencia, Spain.
Encarnación
E
Martínez-Pérez
Dept Thoracic Surgery, Foundation IVO, Valencia, Spain.
Karol
K
De Aguiar-Quevedo
Dept Thoracic Surgery, Foundation IVO, Valencia, Spain.
Miguel
M
Arrarás
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
Carcinoma; Computer-assisted; Dual-Energy Multidetector Computed Tomography; Granuloma; Image processing; Lung neoplasms; Non-small-cell lung; Small cell lung carcinoma