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Comparative Study
. 2017 Jul;96(28):e7479.
doi: 10.1097/MD.0000000000007479.

Correlation of iodine uptake and perfusion parameters between dual-energy CT imaging and first-pass dual-input perfusion CT in lung cancer

Xiaoliang Chen  1 , Yanyan Xu, Jianghui Duan, Chuandong Li, Hongliang Sun, Wu Wang
Affiliations
Comparative Study

Correlation of iodine uptake and perfusion parameters between dual-energy CT imaging and first-pass dual-input perfusion CT in lung cancer

Xiaoliang Chen et al. Medicine (Baltimore). 2017 Jul.

Abstract

To investigate the potential relationship between perfusion parameters from first-pass dual-input perfusion computed tomography (DI-PCT) and iodine uptake levels estimated from dual-energy CT (DE-CT).The pre-experimental part of this study included a dynamic DE-CT protocol in 15 patients to evaluate peak arterial enhancement of lung cancer based on time-attenuation curves, and the scan time of DE-CT was determined. In the prospective part of the study, 28 lung cancer patients underwent whole-volume perfusion CT and single-source DE-CT using 320-row CT. Pulmonary flow (PF, mL/min/100 mL), aortic flow (AF, mL/min/100 mL), and a perfusion index (PI = PF/[PF + AF]) were automatically generated by in-house commercial software using the dual-input maximum slope method for DI-PCT. For the dual-energy CT data, iodine uptake was estimated by the difference (λ) and the slope (λHU). λ was defined as the difference of CT values between 40 and 70 KeV monochromatic images in lung lesions. λHU was calculated by the following equation: λHU = |λ/(70 - 40)|. The DI-PCT and DE-CT parameters were analyzed by Pearson/Spearman correlation analysis, respectively.All subjects were pathologically proved as lung cancer patients (including 16 squamous cell carcinoma, 8 adenocarcinoma, and 4 small cell lung cancer) by surgery or CT-guided biopsy. Interobserver reproducibility in DI-PCT (PF, AF, PI) and DE-CT (λ, λHU) were relatively good to excellent (intraclass correlation coefficient [ICC]Inter = 0.8726-0.9255, ICCInter = 0.8179-0.8842; ICCInter = 0.8881-0.9177, ICCInter = 0.9820-0.9970, ICCInter = 0.9780-0.9971, respectively). Correlation coefficient between λ and AF, and PF were as follows: 0.589 (P < .01) and 0.383 (P < .05). Correlation coefficient between λHU and AF, and PF were as follows: 0.564 (P < .01) and 0.388 (P < .05).Both the single-source DE-CT and dual-input CT perfusion analysis method can be applied to assess blood supply of lung cancer patients. Preliminary results demonstrated that the iodine uptake relevant parameters derived from DE-CT significantly correlated with perfusion parameters derived from DI-PCT.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
The time-attenuation curves (TDCs) of 1 patient's DE-CT scan shows curves of the lesion (blue), the aortic (red), and the pulmonary artery (green). DI-PCT and DE-CT scan protocols were marked in the diagram. DI-PCT scan was initiated with a delay of 2 seconds after the start of CA injection, and the optimal DE-CT acquisition was set 4.5 seconds after DI-PCT scan. CA = contrast agent.
Figure 2
Figure 2
Time-density curves (TDCs) of PF (blue curve), AF (red curve), and left atrium (orange curve) and lung tumor (green, right axis). The vertical orange dotted line indicates the left atrial peak time, which is centered between the PF and AF peaks, representing the boundary between the pulmonary and systemic circulation. During the DI-PCT, 2 peak enhancements were demonstrated from the TDCs of pulmonary circulation and systemic circulation, respectively. The latter one with greater slope demonstrated predominance in this case.
Figure 3
Figure 3
A 63-year-old male patient showed a right upper lobe adenocarcinoma. (A) Iodine map of the lesion showed iodine distribution of the lesion: solid portion with significant iodine uptake. (B) Coronal reconstruction showed the nodule located in the right upper chest. (C) Curves of CT numbers of the aorta (red line), pulmonary artery (dark blue), nodule (light blue), and lymph node (yellow). (D) DE-CT showed the perfusion of the lesion.
Figure 4
Figure 4
Correlation scatter diagram of AF-λ indicated significant positive correlation, with the correlation coefficient being 0.589 (P < .01).
Figure 5
Figure 5
Correlation scatter diagram of PF-λ indicated significant positive correlation, and the correlation coefficient being 0.383 (P < .05).
Figure 6
Figure 6
Correlation scatter diagram of AF-slope (λHU) indicated significant positive correlation, with the correlation coefficient being 0.564 (P < .01).
Figure 7
Figure 7
Correlation scatter diagram of PF-slope (λHU) indicated significant positive correlation, with the correlation coefficient being 0.388 (P < .05).
See this image and copyright information in PMC

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