Usability of the lateral decubitus position on four-dimensional ultra-low-dose computed tomography for the detection of localized pleural adhesion in the pulmonary apical region

Author:

Sato Shigetaka1ORCID,Nagatani Yukihiro1ORCID,Hashimoto Masayuki2,Nitta Norihisa1,Hanaoka Jun2,Ushio Noritoshi1,Tsukagoshi Shinsuke3,Uranishi Ayumi3,Kimoto Tatsuya4,Oshio Yasuhiko2,Mayumi Masayuki1,Sonoda Akinaga1,Otani Hideji1,Yamashiro Tsuneo5ORCID,Moriya Hiroshi6,Murata Kiyoshi1,Watanabe Yoshiyuki1,

Affiliation:

1. Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan

2. Department of Respiratory Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan

3. CT System Division, Canon Medical Systems, Otawara, Tochigi, Japan

4. Center for Medical Research and Development, Canon Medical Systems, Otawara, Tochigi, Japan

5. Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Nishihara, Okinawa, Japan

6. Department of Radiology, Ohara General Hospital, Fukushima, Fukushima, Japan

Abstract

Background Localized pleural adhesion (LPA) evaluation in the apical region is difficult even with four-dimensional ultra-low-dose computed tomography (4D-ULDCT) in the supine position due to smaller pleural movements. Purpose To assess usability of 4D-ULDCT in the lateral decubitus (LD) position for LPA detection in the apical region. Material and Methods Forty-seven patients underwent 4D-ULDCT of a single respiration cycle with 16-cm coverage of body axis in supine and LD positions with the affected lung uppermost. Intraoperative thoracoscopic findings confirmed LPA presence. A pleural point and a corresponding point on costal outer edge were placed in identical axial planes at end-inspiration. Pleuro-chest wall distance between two points (PCD) was calculated at each respiratory phase. In the affected lung, average change in amount of PCD (PCDACA) was compared between patients with and without LPA in total and two sub-groups (non-COPD and COPD, non-emphysematous and emphysematous patients) in supine and non-dependent (ND) LD positions. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal thresholds in PCDACA for differentiating patients with LPA from those without. Results In COPD/emphysematous patients and total population, PCDACA with LPA was smaller than in those without in the supine and NDLD positions for overall, lateral, and dorsal regions. For the lateral region in COPD patients, area under ROC curve (AUC) increased from supine (0.64) to NDLD position (0.81). For the dorsal region in emphysematous patients, AUC increased from supine (0.76) to NDLD position (0.96). Conclusion 4D-ULDCT in LD position may be useful for LPA detection in apical regions for COPD and/or emphysematous patients.

Publisher

SAGE Publications

Subject

Radiology Nuclear Medicine and imaging,General Medicine,Radiological and Ultrasound Technology

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