Intraobserver and interobserver agreement of volume perfusion CT (VPCT) measurements in patients with lung lesions.
ABSTRACT To evaluate intraobserver and interobserver agreement of manually encompassed lung lesions for perfusion measurements using volume-perfusion computed tomography (VPCT).
Institutional review board approval and informed consent were obtained. HIPAA guidelines were followed. A 65-s dynamic study was acquired with scan parameters 80 kV, 60 mAs (80 mAs for patients ≥ 70 kg), 128 × 0.6mm collimation. Blood flow (BF), blood volume (BV) and K(trans) parameters were determined by syngo volume perfusion CT body with 88 lesions analyzed retrospectively.
Within-subject coefficients of variation for intraobserver agreement (range 6.59-12.82%) were superior to those for interobserver agreement (range 21.75-38.30%). Size-dependent analysis revealed lower agreements for lesions <4 cm as compared to larger lesions. Additionally, agreements of the upper, middle and lower lung zones were different.
Intraobserver agreement was substantial for VPCT lung cancer perfusion measurements encouraging the use for tumor characterization and therapy response monitoring. Interobserver agreement is limited and unexperienced readers should be trained before using this new method.
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ABSTRACT: To determine the diagnostic benefit of volume perfusion computed tomography (VPCT) at end of treatment for response assessment in lymphoma patients. Seventy-five patients with different lymphoma subtypes were included: 50/75 patients had residual masses at end of treatment, 26/50 patients underwent VPCT at baseline and at end of treatment, and 24/50 patients only had end-of-treatment VPCTs. We evaluated the size of the main lymphoma mass, its blood flow (BF), blood volume (BV) and k-trans, calculated ratios (baseline and end of treatment) as well as sensitivity/specificity/negative (NPV)/positive predictive values (PPV). For VPCT at end of treatment, a cutoff threshold between responders and non-responders was calculated. For patients undergoing VPCT at baseline and end of treatment, reduction in size, BF, BV and k-trans was significant (P < 0.001). Identification of non-response was reached at: <53 % reduction in size (sensitivity/specificity/accuracy/PPV/NPV of 88.89 %/62.5 %/80.77 %/84.21 %/71.43 %), <15 % reduction of BF (sensitivity/specificity/accuracy/PPV/NPV of 100 %/37.5 %/80.77 %/0.26 %/100 %), or <45 % reduction of k-trans (sensitivity/specificity/accuracy/PPV/NPV of 88.89 %/75 %/84.62 %/88.89 %/75 %). In the subgroup undergoing VPCT at end of treatment, BF >18.51 ml/100 ml indicated non-responsiveness (sensitivity 92.86 %, specificity 72.73 %, accuracy 84 %, PPV 81.25 %, NPV 88.89 %). VPCT seems adequate for assessment of lymphoma response at end of treatment. The degree of residual lymphoma perfusion at end of treatment helps to identify patients likely to remain in remission 1 year after completion of therapy. • Volume perfusion computed tomography (VPCT) offers measurements for assessing tumour response. • Perfusion parameter changes measured by VPCT correlate with antitumour therapy response. • In lymphoma, baseline and end-of-treatment perfusion parameter ratios can predict response. • Perfusion measurements after treatment identify patients likely to remain in remission.European Radiology 12/2013; · 4.34 Impact Factor
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ABSTRACT: Tumor response assessment has been a foundation for advances in cancer therapy. Recent discoveries of effective targeted therapy for specific genomic abnormalities in lung cancer and their clinical application have brought revolutionary advances in lung cancer therapy and transformed the oncologist's approach to patients with lung cancer. Because imaging is a major method of response assessment in lung cancer both in clinical trials and practice, radiologists must understand the genomic alterations in lung cancer and the rapidly evolving therapeutic approaches to effectively communicate with oncology colleagues and maintain the key role in lung cancer care. This article describes the origin and importance of tumor response assessment, presents the recent genomic discoveries in lung cancer and therapies directed against these genomic changes, and describes how these discoveries affect the radiology community. The authors then summarize the conventional Response Evaluation Criteria in Solid Tumors and World Health Organization guidelines, which continue to be the major determinants of trial endpoints, and describe their limitations particularly in an era of genomic-based therapy. More advanced imaging techniques for lung cancer response assessment are presented, including computed tomography tumor volume and perfusion, dynamic contrast material-enhanced and diffusion-weighted magnetic resonance imaging, and positron emission tomography with fluorine 18 fluorodeoxyglucose and novel tracers. State-of-art knowledge of lung cancer biology, treatment, and imaging will help the radiology community to remain effective contributors to the personalized care of lung cancer patients. © RSNA, 2014.Radiology 04/2014; 271(1):6-27. · 6.21 Impact Factor
Article: Functional imaging in lung cancer.[Show abstract] [Hide abstract]
ABSTRACT: Lung cancer represents an increasingly frequent cancer diagnosis worldwide. An increasing awareness on smoking cessation as an important mean to reduce lung cancer incidence and mortality, an increasing number of therapy options and a steady focus on early diagnosis and adequate staging have resulted in a modestly improved survival. For early diagnosis and precise staging, imaging, especially positron emission tomography combined with CT (PET/CT), plays an important role. Other functional imaging modalities such as dynamic contrast-enhanced CT (DCE-CT) and diffusion-weighted MR imaging (DW-MRI) have demonstrated promising results within this field. The purpose of this review is to provide the reader with a brief and balanced introduction to these three functional imaging modalities and their current or potential application in the care of patients with lung cancer.Clinical Physiology and Functional Imaging 12/2013; · 1.33 Impact Factor