Do Dang Khanh1,, Nguyen Van Thi2, Doan Van Hoan1, Dinh Hoang Viet2, Ngo Le Lam2, Cao Van Chinh3, Ngo Xuan Thang1, Nguyen Thai Hung1
1 Đại học Y Hà Nội
2 Bệnh viện K
3 Cao đẳng Y tế Hà Nội

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Tóm tắt

Objective: This study aims to observe the value of the dual-energy computed tomography (DECT) technique in the assessment of primary lung cancer. Compare the difference in density of lung tumors on the true non-contrast (TNC) and virtual non-contrast (VNC) images. Investigate the iodine concentration value of lung tumors in differentiating malignant and benign lesions as well as adenocarcinoma and squamous carcinoma in lung cancer.

Methods: We conducted a cross-sectional descriptive study in 42 patients with solitary pulmonary nodules proved by pathology underwent doublephase enhanced CT scan at the Diagnostic Imaging Center of K Hospital, Hanoi. Process dual-energy CT data into virtual monoenergetic and virtual non-contrast images, comparing with true non-contrast images. Compare the iodine concentration of malignant and benign lesions, adenocarcinoma, and squamous cell carcinoma lung cancer. The slope rate was calculated from the spectral curve. Patients were divided into an inflammatory group, a malignant group, and a tuberculosis group. The Kruskal–Wallis test and Nemenyi test were performed to compare quantitative parameters among the three groups. Results: The study comprised 42 patients (34 males). The mean age of patients was 56 ±11. 23/42 right lung tumors (accounted for about 55%), 13/33 left lung tumors (about 40%). Pathological results showed that 73.8% (31/42) of the lesions were malignant, and 26.2% were benign. The density of lung tumors on the true non-contrast (TNC) and virtual noncontrast (VNC) images is 43,81 ± 10,90 and 43,32 ± 11,15 HU (p=0,147). The contrast-noise ratio of lung tumors has the highest value in the virtual monochrome image at 65 keV. The iodine concentration of malignant tumors was 0,37±0,15mg/ml, higher than benign lesions. The normalized iodine concentration (nIC) of lung tumors can differentiate malignant from benign lesions with an area under the curve of 0,748, with a best cut-off point of 0,27 mg/ml having a sensitivity is 74,2%, specificity of 81,8%. The normalized iodine concentration (nIC) of lung tumors can also differentiate adenocarcinoma from squamous cell carcinoma with an area under the curve of 0,835, with a best cut-off point of 0,36 mg/ml having a sensitivity is 76,5%, specificity of 100%. The mean slope rate for the inflammatory group was 2,51 ± 0,25, significantly higher than these parameters for the malignant group (p < 0.05), and the parameters for the malignant group were significantly higher than the tuberculosis group (p < 0.05). Conclusion: Virtual non-contrast images can replace the role of true non-contrast images. In virtual monoenergetic, the 65 keV sequence has the best Contrast to Noise Ratio (CNR). Quantitative analysis of iodine concentration in lung tumors can help differentiate malignant and benign lung lesions, adenocarcinoma, and squamous cell carcinoma. HU slope rate showed statistically significant differences, which is helpful in the differential diagnosis among inflammatory, malignant, and tuberculosis lesions. 

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Tài liệu tham khảo

1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
2. Zhang LJ, Yang GF, Wu SY, Xu J, Lu GM, Schoepf UJ. Dual-energy CT imaging of thoracic malignancies. Cancer Imaging. Published online March 6, 2013:81-91. doi:10.1102/1470-7330.2013.0009
3. A New Outlook on the Ability to Accumulate an Iodine Contrast Agent in Solid Lung Tumors Based on Virtual Monochromatic Images in Dual Energy Computed Tomography (DECT): Analysis in Two Phases of Contrast Enhancement - PMC. Accessed July 9, 2023.
4. Zhang LJ, Wang ZJ, Lu L, Chen B, Lu GM. Feasibility of gadolinium-enhanced dual-energy CT pulmonary angiography: a pilot study in rabbits. Int J Cardiovasc Imaging. 2011;27(7):1069-1080. doi:10.1007/s10554-010-9755-4
5. Lê Tấn Khiêm, Nguyễn Thị Minh Trang, Huỳnh Phượng Hải, Lê. Giá trị của chụp cắt lớp vi tính hai mức năng lượng trong đánh giá ung thư phổi. Tạp Chí Học Tp Hồ Chí Minh. 2022;Số 26:Tr. 21-27.
6. Nguyễn Mạnh Hùng, Cao Văn Chính, Bùi Văn Giang, Nguyễn Trung Kiên, Đinh Hoàng Việt, Nguyễn Trọng Bang. NGHIÊN CỨU ỨNG DỤNG KỸ THUẬT CHỤP CT HAI MỨC NĂNG LƯỢNG TRONG CHẨN ĐOÁN UNG THƯ PHỔI. Tạp Chí Học Việt Nam. 2022;520(2). doi:10.51298/vmj.v520i2.4193
7. Zhang D, Li X, Liu B. Objective characterization of GE discovery CT750 HD scanner: gemstone spectral imaging mode. Med Phys. 2011;38(3):1178-1188. doi:10.1118/1.3551999
8. Sudarski S, Apfaltrer P, Nance JW, et al. Optimization of keV-settings in abdominal and lower extremity dual-source dual-energy CT angiography determined with virtual monoenergetic imaging. Eur J Radiol. 2013;82(10):e574-581. doi:10.1016/j.ejrad.2013.04.040
9. Lv P, Lin XZ, Li J, Li W, Chen K. Differentiation of small hepatic hemangioma from small hepatocellular carcinoma: recently introduced spectral CT method. Radiology. 2011;259(3):720-729. doi:10.1148/radiol.11101425
10. Odisio EG, Truong MT, Duran C, de Groot PM, Godoy MC. Role of Dual-Energy Computed Tomography in Thoracic Oncology. Radiol Clin North Am. 2018;56(4):535-548. doi:10.1016/j.rcl.2018.03.011
11. Xiao H, Liu Y, Tan H, et al. A pilot study using low-dose Spectral CT and ASIR (Adaptive Statistical Iterative Reconstruction) algorithm to diagnose solitary pulmonary nodules. BMC Med Imaging. 2015;15(1):54. doi:10.1186/ s12880-015-0096-6
12. Zhang Z, Zou H, Yuan A, et al. A Single Enhanced Dual-Energy CT Scan May Distinguish Lung Squamous Cell Carcinoma From Adenocarcinoma During the Venous Phase. Acad Radiol. 2020;27(5):624-629. doi:10.1016/j. acra.2019.07.018
13. Sikora J, Słodkowska J, Radomyski A, et al. Immunohistochemical evaluation of tumor angiogenesis in adenocarcinoma and squamous cell carcinoma of lung. Rocz Akad Med W Bialymstoku 1995. 1997;42 Suppl 1:271-279.
14. Yuan A, Yu CJ, Kuo SH, et al. Vascular endothelial growth factor 189 mRNA isoform expression specifically correlates with tumor angiogenesis, patient survival, and postoperative relapse in non-small-cell lung cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2001;19(2):432-441. doi:10.1200/JCO.2001.19.2.432
15. Karçaaltıncaba M, Aktaş A. Dual-energy CT revisited with multidetector CT: a review of principles and clinical applications. Diagn Interv Radiol Ank Turk. 2011;17(3):181-194. doi:10.4261/1305-3825.DIR.3860-10.0
16. Deng K, Li W, Wang J jun, Wang G li, Shi H, Zhang C qi. The pilot study of dual-energy CT gemstone spectral imaging on the image quality of hand tendons. Clin Imaging. 2013;37(5):930-933. doi:10.1016/j.clinimag.2013.01.008
17. Lin J Zheng, Zhang L, Zhang C yu, Yang L, Lou H Nan, Wang Z Guo. Application of Gemstone Spectral Computed Tomography Imaging in the Characterization of Solitary Pulmonary Nodules: Preliminary Result. J Comput Assist Tomogr. 2016;40(6):907-911. doi:10.1097/RCT.0000000000000469