Iodine-related attenuation in contrast-enhanced dual-energy computed tomography in small-sized solid-type lung cancers is associated with the postoperative prognosis

Shingo Iwano,Rintaro Ito,Shinichiro Kamiya,Shota Nakamura,Shinji Naganawa

doi:10.1186/s40644-020-00368-1

Shingo Iwano, Rintaro Ito + Show 3 more

Open Access

https://doi.org/10.1186/s40644-020-00368-1

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Journal: Cancer Imaging	Publication Date: Jan 7, 2021
Citations: 6	License type: open-access

Affiliation: Nagoya University

Abstract

BackgroundTo investigate the correlation between iodine-related attenuation in contrast-enhanced dual-energy computed tomography (DE-CT) and the postoperative prognosis of surgically resected solid-type small-sized lung cancers.MethodsWe retrospectively reviewed the DE-CT findings and postoperative course of solid-type lung cancers ≤3 cm in diameter. After injection of iodinated contrast media, arterial phases were scanned using 140-kVp and 80-kVp tube voltages. Three-dimensional iodine-related attenuation (3D-IRA) of primary tumors at the arterial phase was computed using the “lung nodule” application software. The corrected 3D-IRA normalized to the patient’s body weight and contrast medium concentration was then calculated.ResultsA total of 120 resected solid-type lung cancers ≤3 cm in diameter were selected for analysis (82 males and 38 females; mean age, 67 years). During the observation period (median, 47 months), 32 patients showed postoperative recurrence. Recurrent tumors had significantly lower 3D-IRA and corrected 3D-IRA at early phase compared to non-recurrent tumors (p = 0.046 and p = 0.027, respectively). The area under the receiver operating characteristic curve for postoperative recurrence was 0.624 for the corrected 3D-IRA at early phase (p = 0.025), and the cutoff value was 5.88. Kaplan–Meier curves for disease-free survival indicated that patients showing tumors with 3D-IRA > 5.88 had a significantly better prognosis than those with tumors showing 3D-IRA < 5.88 (p = 0.017).ConclusionsThe 3D-IRA of small-sized solid-type lung cancers on contrast-enhanced DE-CT was significantly associated with postoperative prognosis, and low 3D-IRA tumors showed a higher TNM stage and a significantly poorer prognosis.

Highlights

The prognosis of primary lung cancer is affected by many clinical, imaging, and histopathological findings
There is a need for imaging techniques that can predict the postoperative prognosis of small-sized solid lung cancers
We reviewed preoperative data from contrast CT with dual-energy scanning as well as postoperative pathological TNM staging and disease-free survival of resected of lung cancers ≤3 cm, and validated the hypothesis that the Three-dimensional iodine-related attenuation (3D-iodinerelated attenuation (IRA)) of small-sized solid lung cancers could be a predictive factor for the prognosis

Summary

Introduction

The prognosis of primary lung cancer is affected by many clinical, imaging, and histopathological findings. Small-sized lung cancers with a diameter equal to or less than 3 cm have a good postoperative prognosis [1, 2]. Several recent studies have shown that solid nodules have a worse prognosis than part-solid nodules with groundglass opacity, even if the solid sizes of tumors are the same [6,7,8,9,10]. Preoperative diagnostic imaging is essential for determining the best therapeutic strategy, including the type of surgical procedure. There is a need for imaging techniques that can predict the postoperative prognosis of small-sized solid lung cancers. To investigate the correlation between iodine-related attenuation in contrast-enhanced dual-energy computed tomography (DE-CT) and the postoperative prognosis of surgically resected solid-type small-sized lung cancers

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Discussion

Conclusion