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

Autor: Larici AR; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy. Electronic address: annarita.larici@unicatt.it., Franchi P; Department of Diagnostic Radiology, G. Mazzini Hospital, Teramo, Italy., Del Ciello A; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Sica G; Department of Radiology, Azienda ULSS N.1 Dolomiti Presidio Ospedaliero, Feltre e Lamon, Italy., Coviello D; Radiology, Ospedale Valdelsa-Campostaggia, Azienda USL Toscana Sud-Est, Italy., De Waure C; Department of Experimental Medicine, University of Perugia, Italy., Cicchetti G; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Rovere G; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Storto ML; Bracco Diagnostics Inc, Global Medical and Regulatory Affairs, Monroe Twp, NJ, USA., Farchione A; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Calandriello L; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., D'Ambra G; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy., Merlino B; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Iezzi R; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Marano R; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy., Manfredi R; Department of Radiological and Hematological Sciences, Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy.
Jazyk: angličtina
Zdroj: European journal of radiology [Eur J Radiol] 2021 Nov; Vol. 144, pp. 109983. Date of Electronic Publication: 2021 Sep 29.
DOI: 10.1016/j.ejrad.2021.109983
Abstrakt: 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.
(Copyright © 2021 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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