Taeho Ha1, Wooil Kim2, Jaehyung Cha3, Young Hen Lee1, Hyung Suk Seo1, So Young Park4, Nan Hee Kim4, Sung Ho Hwang5, Hwan Seok Yong6, Yu-Whan Oh5, Eun-Young Kang6, Cherry Kim7. 1. Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea. 2. Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, Box 800170, Charlottesville, VA, USA. 3. Medical Science Research Center, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea. 4. Department of Endocrinology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea. 5. Department of Radiology, Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea. 6. Department of Radiology, Guro Hospital, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea. 7. Department of Radiology, Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi, 15355, South Korea. cherrykim0505@gmail.com.
Abstract
OBJECTIVES: To explore the importance of quantitative characteristics of dual-energy CT (DECT) between pulmonary metastasis and benign lung nodules in thyroid cancer. METHODS: In this retrospective study, we identified 63 patients from our institution's database with pathologically proven thyroid cancer who underwent DECT to assess pulmonary metastasis. Among these patients, 22 had 55 pulmonary metastases, and 41 had 97 benign nodules. If nodules showed increased iodine uptake on I-131 single-photon emission computed tomography-computed tomography or increased size in follow-up CT, they were considered metastatic. We compared the clinical findings and DECT parameters of both groups and performed a receiver operating characteristic analysis to evaluate the optimal cutoff values of the DECT parameters. RESULTS: Patients with metastases were significantly older than patients with benign nodules (p = 0.048). The DECT parameters of the metastatic nodules were significantly higher than those of the benign nodules (iodine concentration [IC], 5.61 ± 2.02 mg/mL vs. 1.61 ± 0.98 mg/mL; normalized IC [NIC], 0.60 ± 0.20 vs. 0.16 ± 0.11; NIC using pulmonary artery [NICPA], 0.60 ± 0.44 vs. 0.15 ± 0.11; slope of the spectral attenuation curves [λHU], 5.18 ± 2.54 vs. 2.12 ± 1.39; and Z-effective value [Zeff], 10.0 ± 0.94 vs. 8.79 ± 0.75; all p < 0.001). In the subgroup analysis according to nodule size, all DECT parameters of the metastatic nodules in all subgroups were significantly higher than those of the benign nodules (all p < 0.05). The cutoff values for IC, NIC, λHU, NICPA, and Zeff for diagnosing metastases were 3.10, 0.29, 3.57, 0.28, and 9.34, respectively (all p < 0.001). CONCLUSIONS: DECT parameters can help to differentiate metastatic and benign lung nodules in thyroid cancer. KEY POINTS: • DECT parameters can help to differentiate metastatic and benign lung nodules in patients with thyroid cancer. • DECT parameters showed a significant difference between benign lung nodules and lung metastases, even for nodules with diameters ≥ 3 mm and < 5 mm. • Among the DECT parameters, the highest diagnostic accuracy for differentiating pulmonary metastases from benign lung nodules was achieved with the NIC and IC, followed by the NICPA and λHU, and their cutoff values were 0.29, 3.10, 0.28, and 3.57, respectively.
OBJECTIVES: To explore the importance of quantitative characteristics of dual-energy CT (DECT) between pulmonary metastasis and benign lung nodules in thyroid cancer. METHODS: In this retrospective study, we identified 63 patients from our institution's database with pathologically proven thyroid cancer who underwent DECT to assess pulmonary metastasis. Among these patients, 22 had 55 pulmonary metastases, and 41 had 97 benign nodules. If nodules showed increased iodine uptake on I-131 single-photon emission computed tomography-computed tomography or increased size in follow-up CT, they were considered metastatic. We compared the clinical findings and DECT parameters of both groups and performed a receiver operating characteristic analysis to evaluate the optimal cutoff values of the DECT parameters. RESULTS: Patients with metastases were significantly older than patients with benign nodules (p = 0.048). The DECT parameters of the metastatic nodules were significantly higher than those of the benign nodules (iodine concentration [IC], 5.61 ± 2.02 mg/mL vs. 1.61 ± 0.98 mg/mL; normalized IC [NIC], 0.60 ± 0.20 vs. 0.16 ± 0.11; NIC using pulmonary artery [NICPA], 0.60 ± 0.44 vs. 0.15 ± 0.11; slope of the spectral attenuation curves [λHU], 5.18 ± 2.54 vs. 2.12 ± 1.39; and Z-effective value [Zeff], 10.0 ± 0.94 vs. 8.79 ± 0.75; all p < 0.001). In the subgroup analysis according to nodule size, all DECT parameters of the metastatic nodules in all subgroups were significantly higher than those of the benign nodules (all p < 0.05). The cutoff values for IC, NIC, λHU, NICPA, and Zeff for diagnosing metastases were 3.10, 0.29, 3.57, 0.28, and 9.34, respectively (all p < 0.001). CONCLUSIONS: DECT parameters can help to differentiate metastatic and benign lung nodules in thyroid cancer. KEY POINTS: • DECT parameters can help to differentiate metastatic and benign lung nodules in patients with thyroid cancer. • DECT parameters showed a significant difference between benign lung nodules and lung metastases, even for nodules with diameters ≥ 3 mm and < 5 mm. • Among the DECT parameters, the highest diagnostic accuracy for differentiating pulmonary metastases from benign lung nodules was achieved with the NIC and IC, followed by the NICPA and λHU, and their cutoff values were 0.29, 3.10, 0.28, and 3.57, respectively.
Authors: Mijin Kim; Won Gu Kim; Suyeon Park; Hyemi Kwon; Min Ji Jeon; Jong Jin Lee; Jin-Sook Ryu; Tae Yong Kim; Young Kee Shong; Won Bae Kim Journal: Thyroid Date: 2016-11-15 Impact factor: 6.568
Authors: Tihana Ibrahimpasic; Ronald Ghossein; Diane L Carlson; Natalya Chernichenko; Iain Nixon; Frank L Palmer; Nancy Y Lee; Ashok R Shaha; Snehal G Patel; R Michael Tuttle; Alfons J M Balm; Jatin P Shah; Ian Ganly Journal: Thyroid Date: 2013-07-17 Impact factor: 6.568
Authors: Margo Shoup; Alexander Stojadinovic; Aviram Nissan; Ronald A Ghossein; Sam Freedman; Murray F Brennan; Jatin P Shah; Ashok R Shaha Journal: J Am Coll Surg Date: 2003-08 Impact factor: 6.113
Authors: Anne Laure Giraudet; Daniel Vanel; Sophie Leboulleux; Anne Aupérin; Clarisse Dromain; Linda Chami; Noël Ny Tovo; Jean Lumbroso; Nathalie Lassau; Guillaume Bonniaud; Dana Hartl; Jean-Paul Travagli; Eric Baudin; Martin Schlumberger Journal: J Clin Endocrinol Metab Date: 2007-08-28 Impact factor: 5.958
Authors: Cherry Kim; Wooil Kim; Sung Joon Park; Young Hen Lee; Sung Ho Hwang; Hwan Seok Yong; Yu Whan Oh; Eun Young Kang; Ki Yeol Lee Journal: Korean J Radiol Date: 2020-07 Impact factor: 3.500