Dual-energy computed tomography for evaluation of pulmonary nodules with emphasis on metastatic lesions

• Published in: Acta radiologica (1987) Vol. 57; no. 4; p. 437
• Main Authors: Altenbernd, Jens, Wetter, Axel, Umutlu, Lale, Hahn, Steffen, Ringelstein, Adrian, Forsting, Michael, Lauenstein, Thomas
• Format: Journal Article
• Language: English
• Published: England 01.04.2016
• Subjects: Adolescent; Adult; Contrast Media; Female; Humans; Lung - diagnostic imaging; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - secondary; Male; Middle Aged; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - secondary; Prospective Studies; Radiographic Image Enhancement; Tomography, X-Ray Computed; Young Adult; pulmonary nodules; Dual energy computed tomography (DECT); enhancement; wash-in/out
• ISSN: 1600-0455
• DOI: 10.1177/0284185115582060

The contrast enhancement of pulmonary nodules is a differential diagnostic criterion which can be helpful in staging investigations. To investigate the impact of dual-energy computed tomography (DECT) with regards to the evaluation of pulmonary nodules with emphasis on metastatic lesions. DECT scans of the thorax were performed in 70 consecutive patients. Data of the lung were acquired in the arterial and in delayed venous phase. The virtual native and overlay image data based on arterial and delayed venous phase of these lesions were compared using CT density values (HU) within the nodule tested for statistical significance. A total of 156 pulmonary lesions ≥5 mm were identified on 70 DECT scans. There were no significant differences between the CT-value measurements in the virtual native images based on the arterial and delayed venous phase (27.9+/-3.9 HU vs.28.1+/-4.2 HU, P = 0.89) and between the CT-value measurements in the overlay images based on the arterial und delayed venous phase (35.5+/-6.8 HU vs. 36.6+/-5.0 HU, P = 0.75). Metastases of colorectal carcinoma (51.4+/-9.4 HU vs. 32.5+/-8.9 HU, P = 0.0001), malignant melanoma (56.1+/-6.4 HU vs. 34.2+/-1.6 HU, P = 0.0045), and thyroid cancer (53.5+/-15.5 HU vs. 15.7+/-4.2 HU, P = 0.001) showed a distinct wash-out, whereas metastases of lung cancer (23.1+/-6.3 HU vs. 58.6+/-4.8 HU, P = 0.001), salivary gland cancer (41.4+/-20.3 HU vs. 65.7+/-15.7 HU, P = 0.023), and sarcoma (56.2+/-7.4 HU vs. 90.2+/-3.4 HU, P = 0.001) had an increased enhancement in the delayed venous phase. The contrast enhancement behavior of pulmonary metastases can be evaluated with DECT and depends on the type of the primary malignant tumor.