Preoperative assessment of parietal pleural invasion/adhesion of subpleural lung cancer: advantage of software-assisted analysis of 4-dimensional dynamic-ventilation computed tomography

• Published in: European radiology Vol. 29; no. 10; pp. 5247 - 5252
• Main Authors: Yamashiro, Tsuneo, Moriya, Hiroshi, Tsubakimoto, Maho, Nagatani, Yukihiro, Kimoto, Tatsuya, Murayama, Sadayuki
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2019; Springer Nature B.V
• Subjects: Accuracy; Adhesion; Adhesion tests; Aged; Aged, 80 and over; Chest; Color; Computed Tomography; Computer programs; Diagnostic Radiology; Diagnostic software; Diagnostic systems; Dimensional analysis; Female; Four-Dimensional Computed Tomography - methods; Humans; Image analysis; Image processing; Image reconstruction; Image resolution; Imaging; Internal Medicine; Interventional Radiology; Lung - pathology; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Invasiveness; Neuroradiology; Pleural Neoplasms - diagnostic imaging; Pleural Neoplasms - pathology; Preoperative Care - methods; Radiology; Respiration; Retrospective Studies; ROC Curve; Sensitivity; Sensitivity and Specificity; Software; Surgery; Tissue Adhesions - diagnostic imaging; Tissue Adhesions - pathology; Ultrasound; Ventilation; Computer-assisted image analysis; Lung cancer; Four-dimensional computed tomography
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-019-06131-w

Objective To evaluate the accuracy of four-dimensional (4D) dynamic-ventilation computed tomography (CT) scanning coupled with our novel image analysis software to diagnose parietal pleural invasion/adhesion of peripheral (subpleural) lung cancer. Methods Eighteen patients with subpleural lung cancer underwent both 4D dynamic-ventilation CT during free breathing and conventional (static) chest CT during preoperative assessment. The absence of parietal pleural invasion/adhesion was surgically confirmed in 13 patients, while the presence of parietal pleural invasion/adhesion was confirmed in 5 patients. Two chest radiologists, who were blinded to patient status, cooperatively evaluated the presence of pleural invasion/adhesion using two different imaging modalities: (i) conventional high-resolution CT images, reconstructed in the axial, coronal, and sagittal directions, and (ii) 4D dynamic-ventilation CT images combined with a color map created by image analysis software to visualize movement differences between the lung surface and chest wall. Parameters of diagnostic accuracy were assessed, including a receiver operating characteristic analysis. Results Software-assisted 4D dynamic-ventilation CT images achieved perfect diagnostic accuracy for pleural invasion/adhesion (sensitivity, 100%; specificity, 100%; area under the curve [AUC], 1.000) compared to conventional chest CT (sensitivity, 60%; specificity, 77%; AUC, 0.846). Conclusion Software-assisted 4D dynamic-ventilation CT can be considered as a novel imaging approach for accurate preoperative analysis of pleural invasion/adhesion of peripheral lung cancer. Key Points • 4D dynamic-ventilation CT can correctly assess parietal pleural invasion/adhesion of peripheral lung cancer. • A unique color map clearly demonstrates parietal pleural invasion/adhesion. • Our technique can be expanded to diagnose “benign” pleural adhesions for safer thoracoscopic surgery.