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Differentiating pulmonary metastasis from benign lung nodules in thyroid cancer patients using dual-energy CT parameters

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Abstract

Objectives

To explore the importance of quantitative characteristics of dual-energy CT (DECT) between pulmonary metastasis and benign lung nodules in thyroid cancer.

Methods

In this retrospective study, we identified 63 patients from our institution’s database with pathologically proven thyroid cancer who underwent DECT to assess pulmonary metastasis. Among these patients, 22 had 55 pulmonary metastases, and 41 had 97 benign nodules. If nodules showed increased iodine uptake on I-131 single-photon emission computed tomography-computed tomography or increased size in follow-up CT, they were considered metastatic. We compared the clinical findings and DECT parameters of both groups and performed a receiver operating characteristic analysis to evaluate the optimal cutoff values of the DECT parameters.

Results

Patients with metastases were significantly older than patients with benign nodules (p = 0.048). The DECT parameters of the metastatic nodules were significantly higher than those of the benign nodules (iodine concentration [IC], 5.61 ± 2.02 mg/mL vs. 1.61 ± 0.98 mg/mL; normalized IC [NIC], 0.60 ± 0.20 vs. 0.16 ± 0.11; NIC using pulmonary artery [NICPA], 0.60 ± 0.44 vs. 0.15 ± 0.11; slope of the spectral attenuation curves [λHU], 5.18 ± 2.54 vs. 2.12 ± 1.39; and Z-effective value [Zeff], 10.0 ± 0.94 vs. 8.79 ± 0.75; all p < 0.001). In the subgroup analysis according to nodule size, all DECT parameters of the metastatic nodules in all subgroups were significantly higher than those of the benign nodules (all p < 0.05). The cutoff values for IC, NIC, λHU, NICPA, and Zeff for diagnosing metastases were 3.10, 0.29, 3.57, 0.28, and 9.34, respectively (all p < 0.001).

Conclusions

DECT parameters can help to differentiate metastatic and benign lung nodules in thyroid cancer.

Key Points

• DECT parameters can help to differentiate metastatic and benign lung nodules in patients with thyroid cancer.

• DECT parameters showed a significant difference between benign lung nodules and lung metastases, even for nodules with diameters ≥ 3 mm and < 5 mm.

• Among the DECT parameters, the highest diagnostic accuracy for differentiating pulmonary metastases from benign lung nodules was achieved with the NIC and IC, followed by the NIC PA and λHU, and their cutoff values were 0.29, 3.10, 0.28, and 3.57, respectively.

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Abbreviations

DECT:

Dual-energy CT

IC:

Iodine concentration

LN:

Lymph node

NIC:

Normalized iodine concentration

Tg:

Thyroglobulin

TSH:

Thyroid-stimulating hormone

VMI:

Virtual monochromatic image

Z eff :

Z-effective value

λHU:

Slope of the spectral attenuation curve

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Funding

This research was funded by the National Research Foundation of Korea (NRF) (NRF-2018R1D1A1B07049989), Korea University Ansan Hospital research grant (O1903581), and Korea University grant (K2008271).

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Authors and Affiliations

  1. Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea

    Taeho Ha, Young Hen Lee, Hyung Suk Seo & Cherry Kim

  2. Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, Box 800170, Charlottesville, VA, USA

    Wooil Kim

  3. Medical Science Research Center, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea

    Jaehyung Cha

  4. Department of Endocrinology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea

    So Young Park & Nan Hee Kim

  5. Department of Radiology, Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea

    Sung Ho Hwang & Yu-Whan Oh

  6. Department of Radiology, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea

    Hwan Seok Yong & Eun-Young Kang

Authors
  1. Taeho Ha
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  12. Cherry Kim
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Corresponding author

Correspondence to Cherry Kim.

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Guarantor

The scientific guarantor of this publication is Cherry Kim.

Conflict of interest

The authors declare no competing interests.

Statistics and biometry

Jaehyung Cha, one of the authors, has contributed to the statistical analysis.

Informed consent

Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective.

• case–control study.

• performed at one institution.

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Ha, T., Kim, W., Cha, J. et al. Differentiating pulmonary metastasis from benign lung nodules in thyroid cancer patients using dual-energy CT parameters. Eur Radiol 32, 1902–1911 (2022). https://doi.org/10.1007/s00330-021-08278-x

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  • DOI: https://doi.org/10.1007/s00330-021-08278-x

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