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Comprehensive analyses with radiological and biological markers of breast cancer on contrast-enhanced chest CT: a single center experience using dual-layer spectral detector CT

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Abstract

Objectives

To evaluate the predictive value of virtual monoenergetic images (VMIs) by assessing tumor conspicuity on dual-layer spectral detector CT (SDCT) and correlate tumor conspicuity on VMI with prognostic biomarkers in patients with breast cancer.

Methods

Sixty-four patients underwent arterial phase and 90-s delayed phase dual-layer SDCT. A retrospective tumor conspicuity analysis of 14 benign tumors and 65 breast cancers was performed using conventional images (CIs) and VMI at 40 keV (VMI40) on arterial and delayed phase scans (CIART, VMI40ART, CIDE, VMI40DE). Mean Hounsfield units (HU) of tumors were measured on VMI40ART and VMI40DE. A receiver operating characteristic (ROC) curve analysis was performed to compare diagnostic accuracy between image sets. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki67 levels were evaluated using histopathology. Correlations between VMI analyses and histological characteristics of cancers were analyzed.

Results

Cancers on VMI40 had a significantly higher conspicuity score and mean HU than benign tumors (p < 0.001). VMI40DE showed the highest conspicuity for cancers (mean, 3.79) and the greatest area under the ROC curve (0.817; 95% confidence interval 0.745–0.889). VMI40DE yielded significantly higher mean HU for cancers than VMI40ART (p < 0.001). The conspicuity score and mean HU on VMI40ART were significantly higher in cancers with ER negativity, PR negativity, and Ki67 positivity (p < 0.05).

Conclusions

VMI40DE may be useful in the diagnosis of breast cancers due to higher tumor conspicuity and better enhancement than VMI40ART. VMI40ART may be beneficial for the prediction of poor breast cancer prognoses.

Key Points

• VMI40 improved conspicuity of breast cancer than CI.

• VMI40DEyielded higher diagnostic performance of breast cancer than VMI40ART.

• VMI40ARThas an additional benefit in terms of prognosis prediction in patients with breast cancers.

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Abbreviations

AUC:

Area under the receiver operating characteristic curves

CEDM:

Contrast-enhanced digital mammography

CET:

Contrast-enhanced tomosynthesis

CI:

Conventional image

CTDIvol:

CT dose index volume

DLP:

Dose length product

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

HU:

Hounsfield units

ICC:

Intraclass correlation coefficient

keV:

Kiloelectron volt

MG:

Mammography

PR:

Progesterone receptor

ROI:

Region of interest

SDCT:

Spectral detector CT

TTP:

Time-to-peak enhancement

US:

Ultrasound

VMI:

Virtual monoenergetic image

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, South Korea

    Jin Il Moon, Bo Hwa Choi, Hye Jin Baek, Kyeong Hwa Ryu, Sung Eun Park & Ji Young Ha

  2. Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, South Korea

    Eun Jung Jung & Han Shin Lee

  3. Department of Pathology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, South Korea

    Hyo Jung An

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  1. Jin Il Moon
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Correspondence to Bo Hwa Choi.

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The scientific guarantor of this publication is Bo Hwa Choi.

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The authors declare that they have no competing interests.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

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• Retrospective

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Moon, J.I., Choi, B.H., Baek, H.J. et al. Comprehensive analyses with radiological and biological markers of breast cancer on contrast-enhanced chest CT: a single center experience using dual-layer spectral detector CT. Eur Radiol 30, 2782–2790 (2020). https://doi.org/10.1007/s00330-019-06615-9

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  • DOI: https://doi.org/10.1007/s00330-019-06615-9

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