Dynamic Contrast-Enhanced Perfusion Area-Detector CT: Preliminary Comparison of Diagnostic Performance for N Stage Assessment With FDG PET/CT in Non-Small Cell Lung Cancer

Yoshiharu Ohno; Yasuko Fujisawa; Naoki Sugihara; Yuji Kishida; Shinichiro Seki; Hisanobu Koyama; Takeshi Yoshikawa

doi:10.2214/AJR.17.17959

Dynamic Contrast-Enhanced Perfusion Area-Detector CT: Preliminary Comparison of Diagnostic Performance for N Stage Assessment With FDG PET/CT in Non-Small Cell Lung Cancer

AJR Am J Roentgenol. 2017 Nov;209(5):W253-W262. doi: 10.2214/AJR.17.17959. Epub 2017 Sep 20.

Authors

Yoshiharu Ohno^{1

2}, Yasuko Fujisawa³, Naoki Sugihara³, Yuji Kishida⁴, Shinichiro Seki^{1

2}, Hisanobu Koyama^{4

5}, Takeshi Yoshikawa^{1

2}

Affiliations

¹ 1 Department of Radiology, Division of Functional and Diagnostic Imaging Research, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
² 2 Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
³ 3 Toshiba Medical Systems Corporation, Otawara, Tochigi, Japan.
⁴ 4 Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
⁵ 5 Department of Radiology, Osaka Police Hospital, Osaka, Japan.

PMID: 28929810
DOI: 10.2214/AJR.17.17959

Abstract

Objective: The objective of our study was to directly compare the capability of dynamic first-pass contrast-enhanced (CE) perfusion area-detector CT (ADCT) and FDG PET/CT for differentiation of metastatic from nonmetastatic lymph nodes and assessment of N stage in patients with non-small cell lung carcinoma (NSCLC).

Subjects and methods: Seventy-seven consecutive patients, 45 men (mean age ± SD, 70.4 ± 5.9 years) and 32 women (71.2 ± 7.7 years), underwent dynamic first-pass CE-perfusion ADCT at two or three different positions for covering the entire thorax, FDG PET/CT, surgical treatment, and pathologic examination. From all ADCT data for each of the subjects, a whole-chest perfusion map was computationally generated using the dual- and single-input maximum slope and Patlak plot methods. For quantitative N stage assessment, perfusion parameters and the maximum standardized uptake value (SUV_max) for each lymph node were determined by measuring the relevant ROI. ROC curve analyses were performed for comparing the diagnostic capability of each of the methods on a per-node basis. N stages evaluated by each of the indexes were then statistically compared with the final pathologic diagnosis by means of chi-square and kappa statistics.

Results: The area under the ROC curve (A_z) values of systemic arterial perfusion (A_z = 0.89), permeability surface (A_z = 0.78), and SUV_max (A_z = 0.85) were significantly larger than the A_z values of total perfusion (A_z = 0.70, p < 0.05) and distribution volume (A_z = 0.55, p < 0.05). For each of the threshold values, agreement for systemic arterial perfusion calculated using the dual-input maximum slope model was substantial (κ = 0.70, p < 0.0001), and agreement for SUV_max was moderate (κ = 0.60, p < 0.0001).

Conclusion: Dynamic first-pass CE-perfusion ADCT is as useful as FDG PET/CT for the differentiation of metastatic from nonmetastatic lymph nodes and assessment of N stage in patients with NSCLC.

Keywords: CT; PET/CT; lymph node metastasis; non–small cell lung cancer; perfusion; perfusion CT.

Publication types

Comparative Study

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
Carcinoma, Non-Small-Cell Lung / secondary
Female
Fluorodeoxyglucose F18
Humans
Lung Neoplasms / diagnostic imaging*
Lung Neoplasms / pathology
Male
Middle Aged
Models, Theoretical
Neoplasm Staging
Observer Variation
Positron Emission Tomography Computed Tomography*
Predictive Value of Tests
Prospective Studies
ROC Curve
Radiopharmaceuticals

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18