Dual-energy CT-based iodine quantification for differentiating pulmonary artery sarcoma from pulmonary thromboembolism: a pilot study
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The purpose of this study was to determine whether dual-energy computed tomography (DECT) angiography could differentiate pulmonary thromboembolism (PTE) from pulmonary artery sarcoma (PAS).
We prospectively enrolled 19 patients that had a filling defect in the main pulmonary artery on DECT. Six patients who had PAS and underwent DECT were retrospectively enrolled for comparison. Pathological results or follow-up CT after anticoagulation therapy were used to make the final diagnosis. Two investigators measured the following parameters at the filling defect in the main pulmonary artery: CT attenuation density [Hounsfield units (HU)], iodine-related HU (IHU) and iodine concentration (IC, mg/ml).
From a total of 25 patients (M:F = 10:15; mean age, 65 years old), 19 were categorised into the PTE group and six were categorised into the PAS group. The mean HU values were not significantly different between the PTE and PAS groups (45.5 ± 15.9 vs 47.1 ± 9.2 HU; P = 0.776). However, the mean IHU and IC values of the lesions were significantly different between the PTE and PAS groups (10.6 ± 7.2 vs 27.9 ± 9.1 HU; P = 0.004, and 0.61 ± 0.39 vs 1.49 ± 0.57; P = 0.001).
DECT angiography using a quantitative analytic methodology can be used to differentiate PTE and PAS.
• DECT can be useful for differentiation of PAS and PTE.
• With quantitative analysis, DECT offers tissue characterisation by detecting lesion parameter increases.
• The patients without predisposing factors for PTE can be candidates for DECT.
KeywordsDual-energy computed tomography (DECT) Pulmonary thromboembolism (PTE) Pulmonary artery sarcoma (PAS) Quantitative analysis Differential diagnosis
The scientific guarantor of this publication is Jin Hur, MD, PhD. 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 by a faculty research grant from Yonsei University College of Medicine (6-2012-0105). No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all patients for prospective study. For retrospective study, written informed consent was waived by the Institutional Review Board. Methodology: prospective and retrospective, diagnostic or prognostic study, performed at one institution.