DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20181302

Role of combined wash-in and wash-out threshold criteria on dynamic multislice CECT for solitary pulmonary nodule characterisation: data from Indian tertiary care hospital

Rohini Gupta Ghasi, Pragya Singh, B. B. Thukral

Abstract


Background: To prospectively assess the accuracy of combined wash-in and washout characteristics at dynamic contrast material–enhanced multi– detector row computed tomography (CT in distinguishing benign from malignant solitary pulmonary nodule (SPN).

Methods: Institutional review board approval and informed consent were obtained. The study included 30 patients (16 men, 14 women; mean age, 52 years; range, 25-80 years) with SPN. After unenhanced CT (1.25mm collimation) scan, dynamic CT was performed (series of images obtained throughout the nodule, with 0.6mm collimation, at 30, 60, 90, and 120 seconds and 4, 5, 9, 12, and 15 minutes) after intravenous injection of contrast medium (120 mL). The HU value of nodule was noted at each of the scans. Data was analyzed for dynamic enhancement characteristics. FNAC from the nodule was done in all patients. The data were correlated with the cytopathological and follow –up results. The significance of various dynamic enhancement features and different threshold criteria for wash-in and wash-out of contrast medium for differentiation between benign and malignant nodules were derived.

Results: There were 16 malignant and 14 benign nodules. When diagnostic criteria for malignancy of both wash-in of 25 HU or greater and washout of 5-34 HU were applied, sensitivity, specificity, and accuracy for malignancy were 100%, 92.8% and 96.7% respectively.

Conclusions: Evaluation of solitary pulmonary nodules by analyzing combined wash-in and washout characteristics at dynamic contrast-enhanced multi– detector row CT showed 96.7% accuracy (p<0.001) for distinguishing benign nodules from malignant nodules.


Keywords


Dynamic contrast enhanced CT, Solitary pulmonary nodule, Peak enhancement, Wash-in, washout

Full Text:

PDF

References


Heleln T. Solitary Pulmonary Nodule. Radiology 2006;239:34-49.

Groot PD, Munden RF. Lung Cancer Epidemiology, Risk factors and Prevention. Radiol Clin N Am. 2012;50:863-76.

Libby DM, Smith JP, Altorki NK, Pasmantier MW, Yankelewitz D, Henschke CI. Managing the Small Pulmonary Nodule discovered by CT. Chest. 2004;125:1522-9.

Mack MJ, Hazelrigg SR, Landreneau RJ, Acuff TE. horacoscopy in the diagnosis of indeterminate solitary pulmonary nodule. Ann Thoracic Surg. 1993;56:825-30.

Siegelman SS, Zerhouni EA, Leo FP, Khouri NF, Stitik FP. CT of the solitary pulmonary nodule. AJR. 1980;135:1-13.

Kanne JP, Jensen LE, Kirsch J, JK Amorosa. ACR Appropriateness Criterias Radiographically Detected Solitary Pulmonary Nodule. J Thorac Imaging. 2013;28:W1-W3.

Swensen SJ, Brown LR, Colby TV, Weaver AL. Pulmonary nodules: CT evaluation of enhancement using iodinated contrast material. Radiology. 1995;194:393-8.

Swensen SJ, Brown LR, Colby TV, Weaver AL, Midthun DE. Lung nodule enhancement at CT. prospective finding. Radiology. 1996;201:447-55.

Yi CA, Lee KS, Kim EA. Solitary Pulmonary Nodule: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology. 2004;233:191-9.

Zhang M, Kono M. Solitary pulmonary nodules. Evaluation of blood flow patterns with dynamic CT. Radiology. 1997;205:471-8.

Gould MK, Fletcher J, Iannettoni MD. Evaluation of patients with pulmonary nodules: when is it lungcancer?:ACCP evidence-based clinical practice guidelines (2nd Edition). Chest. 2007;132:108S-30S.

Jeong YJ, Lee KS, Jeong SY, Chung MJ, Shim SS, Kim H, et al. Solitary Pulmonary Nodule: Characterization with Combined Wash-in and Washout Features at Dynamic Multi–Detector Row CT. Radiology. 2005;237:675-83.

Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics. 2000 Jan;20(1):43-58.

Erasmus JJ, McAdams HP, Connolly JE. Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule. Radiographics. 2000;20:59-66.

Gurney JW. Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. Radiology. 1993;186:405-13.

Swensen SJ, Brown LR, Colby TV, Weaver AL. Pulmonary nodules: CT evaluation of enhancement with iodinated contrast material. Radiology. 1995;194:393-8.

Swensen SJ, Brown LR, Colby TV, Weaver AL, Midthun DE. Lung nodule enhancement at CT: prospective findings. Radiology. 1996;201:447-55.

Yi CA, Lee KS, Kim EA. Solitary pulmonary nodules: dynamic enhanced multi– detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology. 2004;233:191-9.

Swensen SJ, Morin RL, Schueler BA. Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material. A preliminary report. Radiology. 1992;182:343-7.

Swensen SJ, Viggiano RW, Midthun DE. Lung nodule enhancement at CT: multicenter study. Radiology. 2000;214:73-80.

Zhang M, Kono M. Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. Radiology. 1997;205: 471-8.

Yamashita K, Matsunobe S, Tsuda T. Solitary pulmonary nodule: preliminary study of evaluation with incremental dynamic CT. Radiology. 1995;194:399-405.

Naidich DP, Zerhouni EA, Siegelman SS. Principles and techniques of chest computed tomography. In: Naidich DP, Zerhouni EA, Siegelman SS, eds. Computed tomography of the thorax. New York, NY: Raven,; 1984:9-12.