• computer-aided diagnosis
• isotropic voxel reconstruction
• lung cancer
• lung nodule classification
• radiomics

• KSVGH112-110 Kaohsiung Veterans General Hospital

In recent years, the detection rate of ground-glass nodules (GGNs) has been improved dramatically due to the popularization of low-dose computed tomography (CT) screening with high-resolution CT technique. This presents challenges for the characterization and management of the GGNs, which depends on a thorough investigation and sufficient diagnostic knowledge of the GGNs. In most diagnostic studies of the GGNs, morphological manifestations are used to differentiate benignancy and malignancy. In contrast, few studies are dedicated to the assessment of the hemodynamics, i.e., perfusion parameters of the GGNs.

To assess the dual vascular supply patterns of GGNs on different histopathology and opacities.

Forty-seven GGNs from 47 patients were prospectively included and underwent the dynamic volume CT. Histopathologic diagnoses were obtained within two weeks after the CT examination. Blood flow from the bronchial artery [bronchial flow (BF)] and pulmonary artery [pulmonary flow (PF)] as well as the perfusion index (PI) = [PF/(PF + BF)] were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types (pure or mixed GGNs) and correlated with the attenuation values of the lesions using one-way ANOVA, student’s t test and Pearson correlation analysis.

Of the 47 GGNs (mean diameter, 8.17 mm; range, 5.3-12.7 mm), 30 (64%) were carcinoma, 6 (13%) were atypical adenomatous hyperplasia and 11 (23%) were organizing pneumonia. All perfusion parameters (BF, PF and PI) demonstrated no significant difference among the three conditions (all P > 0.05). The PFs were higher than the BFs in all the three conditions (all P < 0.001). Of the 30 GGN carcinomas, 14 showed mixed GGNs and 16 pure GGNs with a higher PI in the latter (P < 0.01). Of the 17 benign GGNs, 4 showed mixed GGNs and 13 pure GGNs with no significant difference of the PI between the GGN types (P = 0.21). A negative correlation (r = -0.76, P < 0.001) was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas.

The GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.

• Ground-glass nodules
• Tomography
• X-ray computed
• Lung cancer
• Perfusion computed tomography
• Dual blood supply

Determining benign and malignant nodules before surgery is very difficult when managing patients with pulmonary nodules, which further makes it difficult to choose an appropriate treatment. This study aimed to develop a lung cancer risk prediction model for predicting the nature of the nodule in patients’ lungs and deciding whether to perform a surgical intervention.

This retrospective study included patients with pulmonary nodules who underwent lobectomy or sublobectomy at Tianjin Medical University General Hospital between 2017 and 2020. All subjects were further divided into training and validation sets. Multivariable logistic regression models with backward selection based on the Akaike information criterion were used to identify independent predictors and develop prediction models.

To build and validate the model, 503 and 260 malignant and benign nodules were used. Covariates predicting lung cancer in the current model included female sex, age, smoking history, nodule type (pure ground-glass and part-solid), nodule diameter, lobulation, margin (smooth, or spiculated), calcification, intranodular vascularity, pleural indentation, and carcinoembryonic antigen. The final model of this study showed excellent discrimination and calibration with a concordance index (C-index) of 0.914 (0.890–0.939). In an independent sample used for validation, the C-index for the current model was 0.876 (0.825–0.927) compared with 0.644 (0.559–0.728) and 0.681 (0.605–0.757) for the Mayo and Brock models. The decision curve analysis showed that the current model had higher discriminatory power for malignancy than the Mayo and the Brock models.

The current model can be used in estimating the probability of lung cancer in nodules requiring surgical intervention. It may reduce unnecessary procedures for benign nodules and prompt diagnosis and treatment of malignant nodules.

• clinical decision making
• lung cancer
• lung surgery
• prediction model
• pulmonary nodule

This is a retrospective research comparing the clinical outcomes of single-hole versus multi-hole video-assisted thoracoscopic surgical (VATS) resection for solitary pulmonary nodules (SPN) and examining the factors influencing the diagnosis of benign and malignant pulmonary nodules.

We collected the clinical data, surgical status, outcomes, and corresponding imaging features of 317 patients with SPN who were surgically resected by VATS and diagnosed as benign or malignant by pathology in our hospital from January 2019 to December 2021.

Among the 317 patients, 124 (39.12%) underwent single-port VATS and 193 (60.88%) underwent multiple-hole VATS. All patients were grouped according to the different surgical methods, and their postoperative indicators were statistically analyzed. The results showed that neither the single-port VATS group nor the multi-port VATS group had any serious adverse events such as death during the perioperative period. The average operation time, intraoperative blood loss, drainage tube indwelling time, and postoperative hospital stay were significantly lower in the two groups. Statistics of postoperative pathological diagnosis showed that 98 cases (30.91%) of all nodules were benign nodules and 219 cases (69.09%) were malignant nodules, and a further single-multivariate analysis showed that age, nodule maximum diameter, lobular sign, burr sign, vascular cluster sign, and pleural depression sign were independent relevant factors for the diagnosis of benign and malignant nodules.

VATS is less invasive and has fewer complications and is of great clinical value for both diagnosis and treatment of benign and malignant SPN. Age, maximum nodal diameter, lobar sign, burr sign, vascular set sign, and pleural depression sign were independent correlates affecting the diagnosis of benign and malignant SPN, which reminds that great attention should be paid to patients who are older and have risk factors on imaging, and early and timely active treatment or close follow-up should be carried out.

• Lung adenocarcinoma
• differential diagnosis
• fluorodeoxyglucose F18
• logistic models
• positron emission tomography/computed tomography (PET/CT)

To explore the association between ¹⁸F-FDG PET/CT-based SUV index and malignant risk of persistent ground-glass nodules (GGNs). We retrospectively analyzed a total of 166 patients with GGN who underwent PET/CT examination from January 2012 to October 2019. There were 113 women and 53 men, with an average age of 60.8 ± 9.1 years old. A total of 192 GGNs were resected and confirmed by pathology, including 22 in benign group and 170 in adenocarcinoma group. They were divided into three groups according to SUV index tertiles: Tertile 1 (0.14–0.54), Tertile 2 (0.55–1.17), and Tertile 3 (1.19–6.78), with 64 GGNs in each group. The clinical and imaging data of all patients were collected and analyzed. After adjusting for the potential confounding factors, we found that the malignancy risk of GGN significantly decreased as the SUV index increased (OR, 0.245; 95%CI, 0.119–0.504; P <0.001), the average probability of malignant GGN was 89.1% (95% CI, 53.1–98.3%), 80.5% (95% CI, 36.7–96.7%), and 34.3% (95%CI, 9.5–72.2%) for Tertile 1 to Tertile 3. And the increasing trend of SUV index was significantly correlated with the reduction of malignant risk (OR, 0.099; 95%CI, 0.025–0.394; P = 0.001), especially between Tertile 3 versus Tertile 1 (OR, 0.064; 95%CI, 0.012–0.356; P = 0.002). Curve fitting showed that the SUV index was linearly and negatively correlated with the malignant risk of GGN. SUV index is an independent correlation factor for malignancy risk of GGN, the higher the SUV index, the lower the probability of GGN malignancy.

• adenocarcinoma of lung
• fluorodeoxyglucose F18
• ground-glass nodule
• positron emission tomography computed tomography
• risk factors

• CT
• Dissociation
• Invasive mucinous adenocarcinoma
• Lung
• PET/CT

• CT
• MRI
• PET/CT
• Pulmonary nodule(s)
• artificial intelligence
• biopsy
• management guidelines
• radiomics

• PET/CT
• ground-glass opacity nodule
• high-resolution CT
• lung adenocarcinoma

• Early diagnosis
• Ground glass nodules
• Intelligent diagnosis
• Lung cancer
• Nodular signs
• Prediction models

• Humans
• Image Processing, Computer-Assisted
• Lung Neoplasms/diagnosis
• Solitary Pulmonary Nodule/diagnosis
• Tomography, X-Ray Computed

• K99 AA020514 NIAAA NIH HHS
• R00 AA020514 NIAAA NIH HHS

The aim of the present study was to examine the value of window technique in qualitative diagnosis of the ground glass opacities (GGO) in patients with non-small cell pulmonary cancer. A total of 124 clinically suspected pulmonary cancer patients were analyzed retrospectively. The lesions were affirmed by puncture biopsy, and were GGO on pulmonary window while were invisible on mediastinal window. Sixty-four multi-detector spiral computed tomography with the window width and window level of 1,500 Hounsfield units (HU) and −450 HU on pulmonary window, while the window width and window level of 400 and 40 HU on mediastinal window, was used in the study. The window adjustment technique was used to analyze the window width and window level of lesion on pulmonary window and mediastinal window, for searching invisible threshold on 3-megapixel medical displays. The diagnostic accuracy and the cut-off value were compared on receiver operating characteristic (ROC) curve. The results showed that the window width and window level on pulmonary window and mediastinal window of malignant lesions were significantly less than those of benign ones (P<0.05). The cut-off value on pulmonary window was the window width and window level of 1,300 and −220 HU, the area under the ROC was 0.830 [sensitivity was 72.5%, specificity was 84.3%; 95% confidence interval (CI), 0.712–0.945]. The cut-off value on mediastinal window was the window width and window level of 360 and 30 HU, and the area under the ROC was 0.623 (was 62.0%, specificity was 55.7%; 95% CI, 0.541–0.745). In conclusion, the window technique has high sensitivity and accuracy in qualitative diagnosis of the GGO.

• cut-off value
• ground glass opacities
• non-small cell pulmonary cancer
• receiver operating characteristic
• window level
• window technology
• window width

The aim of the present study was to analyze the value of applying dual-source 64-layer spiral computed tomography (CT) in the differential diagnosis of solitary pulmonary nodules (SPNs). Mediastinal windows from 45 cases were selected to study SPNs (maximum diameter, ≤3 cm), and the pathological nature of lesions was determined by clinical and pathological diagnosis. Conventional 64-layer spiral CT scanning, local enhancement and 3D recombination technologies were used to determine the occurrence rate, lesion diameter, degree of enhancement, lobular sign, spicule sign, pleural indentation sign, vessel convergence sign and bronchus sign. The final diagnoses indicated 34 cases of malignant SPNs (75.6%) and 11 benign cases (24.4%). When the nodule diameter in the malignant group was compared with that of the benign group, the difference was not statistically significant (P>0.05). Nodules in the malignant group showed inhomogeneous enhancement while nodules in the benign group showed homogeneous enhancement. The enhanced CT values in the malignant group were higher than those in the benign group, and the difference was statistically significant (P<0.05). The proportion of nodules with lobular sign in the malignant group was significantly higher than that in the benign group (P<0.05). The proportion of nodules with calcification, vessel convergence sign and bronchus sign in the malignant group were significantly higher than those in the benign group, and the differences were statistically significant (P<0.05). A comparison of vacuole sign, pleural indentation sign, spiculate protuberance and fat occurrence between the two groups yielded no statistically significant differences (P>0.05). The sensitivity of CT enhancement was 85.6%, specificity was 79.6%, positive predicated value was 92.3%, and the negative predicted value was 85.2%. In conclusion, SPNs diagnosed by CT enhancement manifested with enhancement degree, lobular sign, calcification, vessel convergence sign and bronchus sign with high diagnostic accuracy.

• 3D recombination
• bronchus sign
• calcification sign
• computed tomography enhancement technique
• lobular sign
• pleural indentation sign
• solitary pulmonary nodule
• spicule sign
• vessel convergence sign