Dual-energy computed tomography for evaluation of pulmonary nodules with emphasis on metastatic lesions

Abstract

Background The contrast enhancement of pulmonary nodules is a differential diagnostic criterion which can be helpful in staging investigations. Purpose To investigate the impact of dual-energy computed tomography (DECT) with regards to the evaluation of pulmonary nodules with emphasis on metastatic lesions. Material and Methods DECT scans of the thorax were performed in 70 consecutive patients. Data of the lung were acquired in the arterial and in delayed venous phase. The virtual native and overlay image data based on arterial and delayed venous phase of these lesions were compared using CT density values (HU) within the nodule tested for statistical significance. Results A total of 156 pulmonary lesions ≥5 mm were identified on 70 DECT scans. There were no significant differences between the CT-value measurements in the virtual native images based on the arterial and delayed venous phase (27.9+/–3.9 HU vs.28.1+/–4.2 HU, P = 0.89) and between the CT-value measurements in the overlay images based on the arterial und delayed venous phase (35.5+/–6.8 HU vs. 36.6+/–5.0 HU, P = 0.75). Metastases of colorectal carcinoma (51.4+/–9.4 HU vs. 32.5+/–8.9 HU, P = 0.0001), malignant melanoma (56.1+/–6.4 HU vs. 34.2+/–1.6 HU, P = 0.0045), and thyroid cancer (53.5+/–15.5 HU vs. 15.7+/–4.2 HU, P = 0.001) showed a distinct wash-out, whereas metastases of lung cancer (23.1+/–6.3 HU vs. 58.6+/–4.8 HU, P = 0.001), salivary gland cancer (41.4+/–20.3 HU vs. 65.7+/–15.7 HU, P = 0.023), and sarcoma (56.2+/–7.4 HU vs. 90.2+/–3.4 HU, P = 0.001) had an increased enhancement in the delayed venous phase. Conclusion The contrast enhancement behavior of pulmonary metastases can be evaluated with DECT and depends on the type of the primary malignant tumor.