Purpose: The aim of the study was to investigate differences in non-small cell lung cancer (NSCLC) intra-thoracic staging by using contrast-enhanced computed tomography (ce-CT) at the arterial phase (AP), at the arterial plus delayed phases (AP + DEP), and at the delayed phase (DEP), and to evaluate their potential impact on disease staging. Materials and methods: Two chest radiologists with different level of expertise and a general radiologist independently reviewed the chest CT exams of 150 patients with NSCLC; CT scans were performed 40 s (AP) and 60 s (DEP) after contrast material injection. Image assessment included three reading sessions: session A (AP), session B (AP + DEP) and session C (DEP). CT descriptors for the primary tumour (T), regional nodal involvement (N), and intra-thoracic metastases (M) were evaluated in each reading session. Readers had to assign a confidence level (CL) for the assessment of each descriptor and define the TNM stage. Friedman and Cochran Q test was used to compare the assessments of the 3 reading sessions; inter-reader agreement was determined (Intraclass Correlation Coefficient – ICC). Results: The CL was significantly higher in sessions B and C than in session A for all descriptors, with the exception of pulmonary arterial invasion. Primary tumour inner necrosis and regional nodal involvement were detected in a significantly higher number of cases in sessions B and C as compared to session A (p ≤ 0.001). DEP significantly changed N stage determination (p < 0.001), particularly N3, and excluded chest wall invasion (p = 0.05) and venous invasion (p = 0.001). The agreement was good among the 3 readers (ICC = 0.761) and excellent between the 2 chest radiologists (ICC ≥ 0.940), regardless of the contrast phase. Conclusions: The 60-second DEP ce-CT for staging NSCLC significantly increased the readers’ CL, changed the N stage determination, and helped excluding chest wall invasion and venous invasion.

Larici, A., Franchi, P., Del Ciello, A., Sica, G., Coviello, D., De Waure, C., Cicchetti, G., Rovere, G., Storto, M. L., Farchione, A., Calandriello, L., D'Ambra, G., Merlino, B., Iezzi, R., Marano, R., Manfredi, R., Role of delayed phase contrast-enhanced CT in the intra-thoracic staging of non-small cell lung cancer (NSCLC): What does it add?, <<EUROPEAN JOURNAL OF RADIOLOGY>>, 2021; 144 (N/A): N/A-N/A. [doi:10.1016/j.ejrad.2021.109983] [http://hdl.handle.net/10807/206602]

Role of delayed phase contrast-enhanced CT in the intra-thoracic staging of non-small cell lung cancer (NSCLC): What does it add?

Larici, Ar.;del Ciello, A.;De Waure, C.;Cicchetti, G.;Rovere, G.;Farchione, A.;Calandriello, L.;D'Ambra, G.;Merlino, B.;Iezzi, R.;Marano, R.;Manfredi, R.
2021

Abstract

Purpose: The aim of the study was to investigate differences in non-small cell lung cancer (NSCLC) intra-thoracic staging by using contrast-enhanced computed tomography (ce-CT) at the arterial phase (AP), at the arterial plus delayed phases (AP + DEP), and at the delayed phase (DEP), and to evaluate their potential impact on disease staging. Materials and methods: Two chest radiologists with different level of expertise and a general radiologist independently reviewed the chest CT exams of 150 patients with NSCLC; CT scans were performed 40 s (AP) and 60 s (DEP) after contrast material injection. Image assessment included three reading sessions: session A (AP), session B (AP + DEP) and session C (DEP). CT descriptors for the primary tumour (T), regional nodal involvement (N), and intra-thoracic metastases (M) were evaluated in each reading session. Readers had to assign a confidence level (CL) for the assessment of each descriptor and define the TNM stage. Friedman and Cochran Q test was used to compare the assessments of the 3 reading sessions; inter-reader agreement was determined (Intraclass Correlation Coefficient – ICC). Results: The CL was significantly higher in sessions B and C than in session A for all descriptors, with the exception of pulmonary arterial invasion. Primary tumour inner necrosis and regional nodal involvement were detected in a significantly higher number of cases in sessions B and C as compared to session A (p ≤ 0.001). DEP significantly changed N stage determination (p < 0.001), particularly N3, and excluded chest wall invasion (p = 0.05) and venous invasion (p = 0.001). The agreement was good among the 3 readers (ICC = 0.761) and excellent between the 2 chest radiologists (ICC ≥ 0.940), regardless of the contrast phase. Conclusions: The 60-second DEP ce-CT for staging NSCLC significantly increased the readers’ CL, changed the N stage determination, and helped excluding chest wall invasion and venous invasion.
Inglese
Larici, A., Franchi, P., Del Ciello, A., Sica, G., Coviello, D., De Waure, C., Cicchetti, G., Rovere, G., Storto, M. L., Farchione, A., Calandriello, L., D'Ambra, G., Merlino, B., Iezzi, R., Marano, R., Manfredi, R., Role of delayed phase contrast-enhanced CT in the intra-thoracic staging of non-small cell lung cancer (NSCLC): What does it add?, <<EUROPEAN JOURNAL OF RADIOLOGY>>, 2021; 144 (N/A): N/A-N/A. [doi:10.1016/j.ejrad.2021.109983] [http://hdl.handle.net/10807/206602]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/206602
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