Abstract
The current study aim is the role of multi-slice CT perfusion in assessment of pulmonary nodules. Eighty patients with pulmonary nodules underwent non contrast CT scan of the chest and dynamic CT perfusion of the chest. Dynamic CT chest perfusion of 80 patients with pulmonary nodules revealed 24 patients had benign nodules of low biological activity, 16 patients had benign nodules of high biological activity and 40 patients had malignant nodules (16 of them had multiple nodules in both lung fields and clinical history of primary extra pulmonary malignancy, so diagnosed as metastatic nodules). Perfusion flow, extraction fraction and blood volume; these indexes showed significant differences between malignant nodules and benign nodules with low biologic activity (P>0.0001) In addition, these indexes showed a significant difference between benign nodules with high biologic activity and those with low biologic activity (P>0.0001) and the perfusion flow was of high benefit for nodules characterization than ejection fraction and blood volume by the higher significant values. CT perfusion compared the effect of therapy (chemotherapy and or radiotherapy) on metastatic pulmonary nodules before and after start of treatment by perfusion parameters (perfusion flow, extraction fraction and blood volume) & colour maps with the clinical data and follow up revealed that both results closely near and raise the efficacy of CT perfusion study in follow up and assessment of treatment response in metastatic pulmonary nodules. It can be concluded that CT perfusion is a feasible non-invasive diagnostic technique able to evaluate the nature of pulmonary nodules and treatment response in patients with metastatic pulmonary nodules.
Highlights
Pulmonary nodules are defined by Fleischner Society on chest radiographs and Computed Tomography (CT) scans as "rounded opacities, well or poorly defined, measuring up to 3 cm in diameter" & pulmonary nodules were classified into three main groups: malignant nodules, benign nodules with low biologic activity and benign nodules with high biologic activity [1, 2]
Depending on the combination of colour maps obtained by CT perfusion technique, radiological configuration and clinical data & follow up of these patients, classification of the eighty patients into three groups was done, 24 patients were diagnosed as being benign nodules with low biological activity, 16 patients were diagnosed as being benign nodules with high biological activity and 40 patients were diagnosed as being malignant nodules (32 patients of them had multiple nodules in both lung fields and clinical history of primary extra pulmonary malignancy, so diagnosed as metastatic nodules)
In our study by the combination of colour maps obtained by CT perfusion technique, radiological configuration and clinical data & follow up of these patients, classification of the forty patients into three groups was done, 24 patients were diagnosed as being benign nodules with low biological activity, 16 patients were diagnosed as being benign nodules with high biological activity and 40 patients were diagnosed as being malignant nodules (32 patients of them had multiple nodules in both lung fields and clinical history of primary extra pulmonary malignancy, so diagnosed as metastatic nodules)
Summary
Pulmonary nodules are defined by Fleischner Society on chest radiographs and CT scans as "rounded opacities, well or poorly defined, measuring up to 3 cm in diameter" & pulmonary nodules were classified into three main groups: malignant nodules, benign nodules with low biologic activity and benign nodules with high biologic activity [1, 2].The role of diagnosis is to allow treatment strategies in all patients with treatable malignant nodules and to avoid unnecessary thoracotomy in those patients with benign lesions. Attempts have been made to differentiate these two nodule types with dynamic single-detector helical and multi-detector computed. Naglaa Samy Fahmy et al.: Role of Multi-Slice Computed Tomography Perfusion in Evaluation of the Pulmonary Nodules tomography (CT), dynamic magnetic resonance (MR) imaging, and positron emission tomography (PET) or combined PET/CT with use of fluorine 18 fluorodeoxyglucose (FDG) [3, 5]. Multi-detector CT assessment of the regional CT perfusion parameters of lung cancer and/or lung parenchyma have been proposed & Dynamic first-pass area-detector perfusion CT is more specific and accurate than PET/CT for differentiating malignant from benign pulmonary nodules, by Utilizing the 320-row system, the recent dynamic volume CT mode makes it possible to include the pulmonary artery, the aorta, and the tumour studied in one gantry rotation without table movement. Contrast-enhanced dynamic volume acquisitions will simultaneously capture the pulmonary and systemic circulation input functions as well as the tumour's firstpass response function [2, 6, 7]
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