Abstract
Background The number of incidental findings of pulmonary nodules using imaging methods to diagnose other thoracic or extrathoracic conditions has increased, suggesting the need for in-depth radiological image analyses to identify nodule type and avoid unnecessary invasive procedures. Objectives The present study evaluated solid indeterminate nodules with a radiological stability suggesting benignity (SINRSBs) through a texture analysis of computed tomography (CT) images. Methods A total of 100 chest CT scans were evaluated, including 50 cases of SINRSBs and 50 cases of malignant nodules. SINRSB CT scans were performed using the same noncontrast enhanced CT protocol and equipment; the malignant nodule data were acquired from several databases. The kurtosis (KUR) and skewness (SKW) values of these tests were determined for the whole volume of each nodule, and the histograms were classified into two basic patterns: peaks or plateaus. Results The mean (MEN) KUR values of the SINRSBs and malignant nodules were 3.37 ± 3.88 and 5.88 ± 5.11, respectively. The receiver operating characteristic (ROC) curve showed that the sensitivity and specificity for distinguishing SINRSBs from malignant nodules were 65% and 66% for KUR values >6, respectively, with an area under the curve (AUC) of 0.709 (p < 0.0001). The MEN SKW values of the SINRSBs and malignant nodules were 1.73 ± 0.94 and 2.07 ± 1.01, respectively. The ROC curve showed that the sensitivity and specificity for distinguishing malignant nodules from SINRSBs were 65% and 66% for SKW values >3.1, respectively, with an AUC of 0.709 (p < 0.0001). An analysis of the peak and plateau histograms revealed sensitivity, specificity, and accuracy values of 84%, 74%, and 79%, respectively. Conclusions KUR, SKW, and histogram shape can help to noninvasively diagnose SINRSBs but should not be used alone or without considering clinical data.
Highlights
Smoking is the most preventable cause of death globally, followed by cancer and cardiovascular disease
Increased access to computed tomography (CT) and newly recommended low-dose CT screening has facilitated the detection of new cases and helped reduce mortality [2]
CT scans were obtained at our institution (University Hospital Pedro Ernesto of the State University of Rio de Janeiro, Rio de Janeiro, Brazil) using a helical acquisition apparatus (HiSpeed LX; General Electric Medical Systems, Milwaukee, WI, USA). e acquisitions were performed along the axial plane with the patients in the dorsal decubitus position using the following parameters: 120 kV, 100–200 mA with automatic exposure control, a slice thickness of 1 mm, and a pitch of 2 mm from the jugular notch to the xiphoid process at full inspiration. e gantry was inclined by 43 cm
Summary
Solid Indeterminate Nodules with a Radiological Stability Suggesting Benignity: A Texture Analysis of Computed Tomography Images Based on the Kurtosis and Skewness of the Nodule Volume Density Histogram. E present study evaluated solid indeterminate nodules with a radiological stability suggesting benignity (SINRSBs) through a texture analysis of computed tomography (CT) images. E mean (MEN) KUR values of the SINRSBs and malignant nodules were 3.37 ± 3.88 and 5.88 ± 5.11, respectively. E receiver operating characteristic (ROC) curve showed that the sensitivity and speci city for distinguishing SINRSBs from malignant nodules were 65% and 66% for KUR values >6, respectively, with an area under the curve (AUC) of 0.709 ( < 0.0001). An analysis of the peak and plateau histograms revealed sensitivity, speci city, and accuracy values of 84%, 74%, and 79%, respectively. KUR, SKW, and histogram shape can help to noninvasively diagnose SINRSBs but should not be used alone or without considering clinical data
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