Skip to main content

Advertisement

SpringerLink
Log in

Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To investigate the potential contribution of iodine uptake calculation from dual-phase dual-energy CT (DE-CT) for lymph node staging and therapy response monitoring in lung cancer patients.

Methods

Retrospective analysis of 27 patients with non-small cell lung carcinoma (NSCLC), who underwent dual-phase DE-CT before and after chemotherapy, was performed. Iodine uptake (mg/mL) and total iodine uptake (mg) were calculated using prototype software in the early (arterial) and late (venous) post-contrast circulatory phase in 110 mediastinal lymph nodes. The arterial enhancement fraction (AEF) was calculated and compared with lymph node size and response to chemotherapy.

Results

A significant difference of AEF was observed between enlarged (90.4 %; 32.3–238.5 %) and non-enlarged (72.7 %; −37.5-237.5 %) lymph nodes (p = 0.044) before treatment onset. A significantly different change of AEF in responding (decrease of 26.3 %; p = 0.022) and non-responding (increase of 43.0 %; p = 0.031) lymph nodes was demonstrated. A higher value of AEF before treatment was observed in lymph nodes with subsequent favourable response (88.6 % vs. 77.7 %; p = 0.122), but this difference did not reach statistical significance.

Conclusions

The dual-phase DE-CT examination with quantification of ratio of early and late post-contrast iodine uptake is a feasible and promising method for the functional evaluation of mediastinal lymph nodes including therapy response assessment.

Key Points

• Dual-phase DE-CT is beneficial for mediastinal lymph node assessment in NSCLC.

• Arterial to venous iodine uptake ratio was higher in enlarged lymph nodes.

• Change of arterial enhancement fraction correlated to therapy response.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Raz J, Zell JA, Ou SH, Gandara DR, Anton-Culver H, Jablons M (2007) Natural history of stage I non-small cell lung cancer: implications for early detection. Chest 132:193–199

    Article  PubMed  Google Scholar 

  2. Savas P, Hughes B, Solomon B (2013) Targeted therapy in lung cancer: IPASS and beyond, keeping abreast of the explosion of targeted therapies for lung cancer. J Thorac Dis 5:S579–S592

    PubMed Central  PubMed  Google Scholar 

  3. Van Persijn van Meerten EL, Gelderblom H, Bloem JL (2010) RECIST revised: implications for radiologist. A review article on the modified RECIST guidelines. Eur Radiol 20:1456–1467

    Article  PubMed Central  PubMed  Google Scholar 

  4. Nathan PD, Vinayan A, Stott D, Juttla J, Goh V (2010) CT response assessment combining reduction in both size and arterial phase density correlates with time to progression in metastatic renal cancer patients treated with targeted therapies. Cancer Biol Ther 9:15–19

    Article  PubMed  Google Scholar 

  5. Walker CM, Chung JH, Abbott GF et al (2012) Mediastinal lymph node staging: from noninvasive to surgical. AJR Am J Roentgenol 199:W54–W56

    Article  PubMed  Google Scholar 

  6. De Wever W, Ceyssens S, Mortelmans L et al (2007) Additional value of PET-CT in staging of lung cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. Eur Radiol 17:23–32

    Article  PubMed  Google Scholar 

  7. Pandit N, Gonen M, Krug L, Larson SM (2003) Prognostic value of [18F]FDG-PET imaging in small cell lung cancer. Eur J Nucl Med Mol Imaging 30:78–84

    Article  PubMed  Google Scholar 

  8. García-Figueiras R, Goh VJ, Padhani AR et al (2013) CT perfusion in oncologic imaging: a useful tool? AJR Am J Roentgenol 200:8–19

    Article  PubMed  Google Scholar 

  9. Tacelli N, Santangelo T, Scherpereel A et al (2013) Perfusion CT allows prediction of therapy response in non-small cell lung cancer treated with conventional and antiangiogenic chemotherapy. Eur Radiol 23:2127–2136

    Article  PubMed  Google Scholar 

  10. Godoy MC, Naidich DP, Marchioni D et al (2009) Basic principles and postprocessing techniques of dual-energy CT: illustrated by selected congenital abnormalities of the thorax. J Thorac Imaging 24:152–159

    Article  PubMed  Google Scholar 

  11. Toepker M, Moritz T, Krauss B et al (2012) Virtual non-contrast in second-generation, dual-energy computed tomography: reliability of attenuation values. Eur J Radiol 81:e398–e405

    Article  PubMed  Google Scholar 

  12. Zhang LJ, Wu S, Wang M et al (2012) Quantitative dual energy CT measurements in rabbit VX2 liver tumors: comparison to perfusion CT measurements and histopathological findings. Eur J Radiol 81:1766–1775

    Article  PubMed  Google Scholar 

  13. Joo I, Lee JM, Kim KW, Klotz E, Han JK, Choi BI (2011) Liver metastases on quantitative color mapping of the arterial enhancement fraction from multiphasic CT scans: evaluation of the hemodynamic features and correlation with the chemotherapy response. Eur J Radiol 80:e278–e283

    Article  PubMed  Google Scholar 

  14. Tawfik AM, Razek AA, Kerl JM, Nour-Eldin NE, Bauer R, Vogl TJ (2014) Comparison of dual-energy CT-derived iodine content and iodine overlay of normal, inflammatory and metastatic squamous cell carcinoma cervical lymph nodes. Eur Radiol 24:574–580

    Article  PubMed  Google Scholar 

  15. Kim YN, Lee HY, Lee KS et al (2012) Dual energy CT in patients treated with anti-angiogenic agents for non-small cell lung cancer: new method of monitoring tumor response? Korean J Radiol 13:702–710

    Article  PubMed Central  PubMed  Google Scholar 

  16. Yoo SY, Kim Y, Cho HH et al (2013) Dual-energy CT in the assessment of mediastinal lymph nodes: comparative study of virtual non-contrast and true non-contrast images. Korean J Radiol 14:532–539

    Article  PubMed Central  PubMed  Google Scholar 

  17. Uhrig M, Sedlmair M, Schlemmer HP, Hassel JC, Ganten M (2013) Monitoring targeted therapy using dual-energy CT: semi-automatic RECIST plus supplementary functional information by quantifying iodine uptake of melanoma metastases. Cancer Imaging 13:306–313

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Iwano S, Koike W, Matsuo K et al (2012) Correlation between dynamic CT findings and pathological prognostic factors of small lung adenocarcinoma. Cancer Imaging 12:187–193

    Article  PubMed Central  PubMed  Google Scholar 

  19. Platt JF, Francis IR, Ellis JH, Reige KA (1997) Liver metastases: early detection based on abnormal contrast material enhancement at dual-phase helical CT. Radiology 205:49–53

    CAS  PubMed  Google Scholar 

  20. Kim KW, Lee JM, Klotz E et al (2009) Quantitative CT colour mapping of the arterial enhancement fraction of the liver to detect hepatocellular carcinoma. Radiology 250:425–434

    Article  PubMed  Google Scholar 

  21. Aki R, Amoh Y, Bouvet M, Katsuoka K, Hoffman RM (2014) Color-coded fluorescence imaging of lymph-node metastatis, angiogenesis, and its drug-induced inhibition. J Cell Biochem 115:457–463

    Article  CAS  PubMed  Google Scholar 

  22. Naresh KN, Nerurkar AY, Borges AM (2001) Angiogenesis is redundant for tumour growth in lymph node metastasis. Histopathology 38:466–470

    Article  CAS  PubMed  Google Scholar 

  23. Miles KA, Griffiths MR, Keith CJ (2006) Blood flow-metabolic relationships are dependent on tumour size in non-small cell lung cancer: a study using quantitative contrast-enhanced computer tomography and positron emission tomography. Eur J Nucl Med Mol Imaging 33:22–28

    Article  CAS  PubMed  Google Scholar 

  24. Sauter AW, Winterstein S, Spira D et al (2012) Multifunctional profiling of non-small cell lung cancer using 18F-FDG PET/CT and volume perfusion CT. J Nucl Med 53:521–529

    Article  CAS  PubMed  Google Scholar 

  25. Yi CA, Lee KS, Kim BT et al (2007) Efficacy of helical dynamic CT versus integrated PET/CT for detection of mediastinal nodal metastasis in non-small cell lung cancer. AJR Am J Roentgenol 188:318–325

    Article  PubMed  Google Scholar 

  26. Kim SH, Lee KN, Kang EJ, Kim DW, Hong SH (2012) Hounsfield units upon PET/CT are useful in evaluating metastatic regional lymph nodes in patients with oesophageal squamous cell carcinoma. Br J Radiol 85:606–612

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Schmid-Bindert G, Henzler T, Chu TQ et al (2012) Functional imaging of lung cancer using dual energy CT: how does iodine related attenuation correlate with standardized uptake value of 18FDG-PET-CT? Eur Radiol 22:93–103

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Univ. Prof. Jiri Ferda. The authors of this manuscript declare relationships with the following companies: Thomas Flohr, Bernhard Schmidt and Martin Sedlmair are employees of Siemens Healthcare, Forchheim, Germany. This study has received funding by the Charles University Research Fund (project number P36) and by the Ministry of Health, Czech Republic – the project of conceptual development of research organization (Faculty Hospital in Pilsen – FNPl, 00669806). One of the authors has significant statistical expertise. Institutional review board approval was not required because this was a retrospective anonymous analysis and all examinations were performed within a standard examination algorithm in our institution. Written informed consent was obtained from all subjects (patients) in this study. No subjects have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Imaging Methods, Charles University Teaching Hospital Plzen, alej Svobody 80, 306 40, Plzen, Czech Republic

    Jan Baxa, Alena Vondráková, Táňa Matoušková & Jiří Ferda

  2. Department of Pulmonary Diseases, Charles University Teaching Hospital Plzen, Plzen, Czech Republic

    Olga Růžičková

  3. CT Physics and Applications Development, Siemens Healthcare, Forchheim, Germany

    Bernhard Schmidt, Thomas Flohr & Martin Sedlmair

Authors
  1. Jan Baxa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alena Vondráková
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Táňa Matoušková
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olga Růžičková
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernhard Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Flohr
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martin Sedlmair
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jiří Ferda
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jan Baxa.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baxa, J., Vondráková, A., Matoušková, T. et al. Dual-phase dual-energy CT in patients with lung cancer: assessment of the additional value of iodine quantification in lymph node therapy response. Eur Radiol 24, 1981–1988 (2014). https://doi.org/10.1007/s00330-014-3223-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3223-9

Keywords

Search

Navigation