Journal Article Ppublish
PubMed: 40235811 DOI: 10.21037/qims-24-1261
Differentiation of inflammatory pseudotumors and malignant pulmonary nodules using the time-to-peak in first-pass dual-input volume computed tomography-perfusion.
Quant Imaging Med Surg 15(4):2754-2765
Authors: Chengwei Guo, Xiaobo Zhang, Sandi Shen, Weijun Chen, Xuejing Wang, Liang Zhao, Shuqing Han
Affiliations
- Department of Radiology, No. 82 Group Hospital of Chinese People's Liberation Army, Baoding, China.
- Department of Radiology, the First Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China.
- Thoracic Surgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan, China.
- Department of Pathology, No. 82 Group Hospital of Chinese People's Liberation Army, Baoding, China.
Abstract
Background
Inflammatory pseudotumors (IPTs) are often misdiagnosed as malignant solitary pulmonary nodules (SPNs) because their imaging features overlap with those of malignant SPNs, leading to overtreatment. The purpose of this article was to investigate the value of first-pass enhanced time-to-peak (TTP) in distinguishing IPTs from malignant SPNs using dual-input volume computed tomography perfusion (DI-CTP).
Methods
This retrospective study included consecutive patients from No. 82 Group Hospital of Chinese People's Liberation Army with IPTs or malignant SPNs by surgery or biopsy from June 2016 to October 2021. Pulmonary artery flow (PF), bronchial artery flow (BF), perfusion index (PI), time-density curve, total perfusion (TLP), and first-pass TTP for all SPNs were determined by DI-CTP. The receiver operating characteristic (ROC) curve was used to analyse the values of TTP and other perfusion parameters in the differential diagnosis of IPTs and malignant SPNs.
Results
Ninety-eight patients were enrolled, including 25 with IPTs and 73 with malignant SPNs. The intraclass correlation coefficient (ICC) for inter-observer and intra-observer reliability of all parameters was perfect (all ICCs >0.90, P<0.01). Compared with IPTs, the malignant SPNs showed significantly higher PF, TLP, and TTP (all P<0.01), without significant differences in BF and PI (all P>0.05). The area under the curve of TTP was 0.987, which was higher than those of the other perfusion parameters (0.987 0.752 0.609 0.728 0.628). With a cut-off TTP of 18.10 s to distinguish IPNs from malignant SPNs, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 92.0%, 97.3%, 97.3%, 96.0%, and 96.9%, respectively. The sensitivity, specificity, and accuracy of CT plain scan combined with DI-CTP in diagnosing pulmonary nodules were 100%, 96.83%, and 98.97%, respectively.
Conclusions
Compared with other perfusion parameters, TTP may be a more valuable parameter to differentiate IPTs from malignant SPNs.
MeSH
Cone-Beam Computed Tomography, Tomography, Predictive Value Of Tests, Arteries, Lung Neoplasms, Perfusion Imaging