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ORIGINAL ARTICLE
Year : 2015  |  Volume : 11  |  Issue : 6  |  Page : 202-204

Dua-energy virtual noncontrast imaging in diagnosis of cervical metastasis lymph nodes


Department of Radiology, Tianjin Hospital, Tianjin 300211, P.R, China

Date of Web Publication26-Oct-2015

Correspondence Address:
Yeda Wan
Department of Radiology, Tianjin Hospital, No. 406, Jiefangnan Road, Hexi District, Tianjin 300211
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.168185

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 > Abstract 

Objective: The aim of this study was to evaluate the clinical value of dua-energy virtual noncontrast imaging (DVNCT) in the diagnosis of cervical metastasis lymph nodes.
Materials and Methods: From February 2014 to January 2015, 41 patients with 98 enlarged cervical lymph nodes were recruited in this study. All the enlarged lymph nodes were pathology confirmed. The patients received DVNCT and conventional noncontrast scan. The difference of average computed tomography (CT) value, signal to noise ratio, a contrast to noise ratio, image subjective assessment, and lesion detectability between virtual noncontrast imaging and conventional noncontrast scan were compared. The radiation dose of virtual noncontrast imaging and real noncontrast imaging of cervical lymph node were also compared. The diagnostic sensitivity and specificity for DVNCT was also evaluated.
Results: No statistical difference of average CT value, signal to noise ratio, a contrast to noise ratio, image subjective assessment, and radiation dosage between virtual noncontrast imaging and conventional noncontrast scan were found. However, the radiation dosage of DVNCT was significant lower than that of conventional noncontrast scan (P < 0.05). The diagnostic sensitivity and specificity for malignant metastasis lymph node were 88.6% and 70.3% by DVNCT.
Conclusion: DVNCT combined with contrast imaging can provide clear images in the diagnosis of enlarged cervical lymph nodes and reduce radiation dosage.

Keywords: Cervical metastasis lymph nodes, diagnosis, dua-energy virtual noncontrast imaging


How to cite this article:
Fu F, He A, Zhang Y, Li B, Wan Y. Dua-energy virtual noncontrast imaging in diagnosis of cervical metastasis lymph nodes. J Can Res Ther 2015;11, Suppl S2:202-4

How to cite this URL:
Fu F, He A, Zhang Y, Li B, Wan Y. Dua-energy virtual noncontrast imaging in diagnosis of cervical metastasis lymph nodes. J Can Res Ther [serial online] 2015 [cited 2020 Sep 28];11:202-4. Available from: http://www.cancerjournal.net/text.asp?2015/11/6/202/168185


 > Introduction Top


Cervical lymph node enlargement is common and frequently occurring for many diseases including malignant disease and infection.[1] The different nature of the lymph node disease determines the treatment plan and the prognosis of the patients. Moreover, the accurate pretreatment diagnosis for enlarged lymph node is essential for treatment procedure.[2] At present, the ultrasound, computed tomography, and magnetic resonance imaging are major methods for detection and diagnosis of enlarged cervical lymph nodes.[3],[4] The accurate assess of the site of cervical lymph nodes enlargement, size, shape, internal structure, and relationship with adjacent organs needs conventional noncontrast scan and enhancement computed tomography (CT) scan. However, the X-ray exposure for patients cannot be ignored especially for patients who repeated receiving CT scan. Recently, some reports indicated that the dua-energy virtual noncontrast imaging (DVNCT) is efficacy in the evaluation of cervical enlarged lymph nodes.[5] Thus, we performed this study to further assess the clinical efficacy of DVNCT in assessing the malignant metastasis lymph nodes.


 > Materials and Methods Top


From February 2014 to January 2015, 41 patients with 98 enlarged cervical lymph nodes were recruited in this study. The mean age of the patients was 48.6 ± 18.8. For the included 41 patients, 26 were male and 15 were female. Ninety-eight enlarged lymph nodes from the 41 cases were pathology confirmed [Table 1]. The patients received DVNCT and conventional noncontrast scan. The difference of average CT value, signal to noise ratio, a contrast to noise ratio, image subjective assessment, and lesion detectability between virtual noncontrast imaging and conventional noncontrast scan were compared. The radiation dose of virtual noncontrast imaging and real noncontrast imaging of cervical lymph node were also compared. The diagnostic sensitivity and specificity for DVNCT was also evaluated.
Table 1: The general characteristic of included 41 patients

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Statistical analysis

Data are expressed as the mean ± standard deviation. The Student's t-test was used for analyzing the difference between DVNCT and CNCS. The diagnosis sensitivity and specificity were calculated according to Bayes theorem. Statistical analysis was performed using SPSS version 18.0 software (SPSS Inc., USA, http://www-10.ibm.com/software/analytics/spss). Statistical significance was accepted at P < 0.05.


 > Results Top


Computed tomography value, signal noise ratio, contrast to noise ratio, and image quality score comparison

The CT value of DVNCT were 51.3 ± 22.0 and 55.8 ± 24.1 Hu for the arterial phase and venous phase which showed no statistical difference to conventional noncontrast scan 50.4 ± 11.6 (P > 0.05). The signal noise ratio, contrast to noise ratio, and image quality score were also not statistical different between DVNCT and conventional noncontrast scan [Table 2] and [Figure 1].
Table 2: The CT value, signal noise ratio, contrast to noise ratio and image quality score comparison

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Figure 1: Computed tomography scan for cervical lymph nodes ((a) conventional noncontrast scan; (b) arterial phase virtual noncontrasted scan; (c) parenchymal phase virtual noncontrasted scan)

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Radiation dosage comparison

We also compared the radiation dosage for DVNCT and conventional noncontrast scan. The CT dose index volume (CTDIvol), dose length product (DLP), and effective dose (ED) were 62.3 ± 8.1 mGy, 1921.6 ± 289.8 mGy·cm, and 10.88 ± 2.1 mSv for the DVNCT. The CTDIvol, DLP, and ED were 88.6 ± 7.9 mGy, 2441.3 ± 223.6 mGy·cm, and 14.6 ± 1.9 mSv for the conventional noncontrast scan. The CTDIvol, DLP, and ED were significant lower in DVNCT compared to CNCS with statistical difference (P < 0.05) [Table 3].
Table 3: The radiation dosage comparison

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Diagnostic value malignant metastatic lymph nodes

The diagnostic sensitivity and specificity were 88.6% and 70.3% for malignant metastasis enlarged lymph nodes by DVNCT.


 > Discussion Top


The occurrence of cervical lymph node metastasis is common in malignant head and neck carcinoma patients and other cancers such as lung cancer and esophageal cancer.[6] The presence of metastasis cervical lymph nodes can affect the treatment procedure and prognosis of the primary disease.[7] Thus, the detection of cervical lymph nodes nature is very important for a treatment plan.[8] At present, the ultrasound, CT, and magnetic resonance imaging are major methods for detection and diagnosis of enlarged cervical lymph nodes. The accurate assess of the site of cervical lymph nodes enlargement, size, shape, internal structure, and relationship with adjacent organs needs conventional noncontrast scan and enhancement CT scan.[9] However, the radiation dosage of the conventional noncontrast scan and enhancement CT scan were relative high. A recent study showed that the DVNCT can provide well imaging quality and low radiation exposure for patients with enlarged cervical lymph nodes.[10]

In our study, we evaluate the diagnostic specificity, sensitivity average CT value, signal to noise ratio, a contrast to noise ratio, image subjective assessment, and radiation dosage of DVNCT in asses of cervical metastasis lymph nodes. We found that the average CT value, signal to noise ratio, a contrast to noise ratio, and image quality were not inferior in DVNCT compared to conventional noncontrast scan. However, the radiation dosage in DVNCT was much lower than that of the conventional noncontrast scan. Moreover, the diagnostic sensitivity and specificity were relative high for detection of malignant metastasis lymph nodes. Hence, the DVNCT combined with contrast imaging can provide clear images in the diagnosis of enlarged cervical lymph nodes and reduce radiation dosage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 > References Top

1.
Kyung MS, Kim HB, Seoung JY, Choi IY, Joo YS, Lee MY, et al. Tumor size and lymph node status determined by imaging are reliable factors for predicting advanced cervical cancer prognosis. Oncol Lett 2015;9:2218-24.  Back to cited text no. 1
    
2.
Allameh T, Hashemi V, Mohammadizadeh F, Behnamfar F. Sentinel lymph node mapping in early stage of endometrial and cervical cancers. J Res Med Sci 2015;20:169-73.  Back to cited text no. 2
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3.
Sun J, Li B, Li CJ, Li Y, Su F, Gao QH, et al. Computed tomography versus magnetic resonance imaging for diagnosing cervical lymph node metastasis of head and neck cancer: A systematic review and meta-analysis. Onco Targets Ther 2015;8:1291-313.  Back to cited text no. 3
    
4.
Wang L, Ge M, Xu D, Chen L, Qian C, Shi K, et al. Ultrasonography-guided percutaneous radiofrequency ablation for cervical lymph node metastasis from thyroid carcinoma. J Cancer Res Ther 2014;10 Suppl: C144-9.  Back to cited text no. 4
    
5.
Chae EJ, Song JW, Seo JB, Krauss B, Jang YM, Song KS. Clinical utility of dual-energy CT in the evaluation of solitary pulmonary nodules: Initial experience. Radiology 2008;249:671-81.  Back to cited text no. 5
    
6.
Chen J, Wu S, Zheng X, Pan J, Zhu K, Chen Y, et al. Cervical lymph node metastasis classified as regional nodal staging in thoracic esophageal squamous cell carcinoma after radical esophagectomy and three-field lymph node dissection. BMC Surg 2014;14:110.  Back to cited text no. 6
    
7.
Yoon HI, Cha J, Keum KC, Lee HY, Nam EJ, Kim SW, et al. Treatment outcomes of extended-field radiation therapy and the effect of concurrent chemotherapy on uterine cervical cancer with para-aortic lymph node metastasis. Radiat Oncol 2015;10:18.  Back to cited text no. 7
    
8.
Liang ZP, Xu SE, Jiang L, Zhao C, Sun XQ, Qin G. Scalp junctional nevus with malignant transformation (melanoma) metastatic to parotid lymph node region, cervical lymph nodes and the back: A case report and review of literature. Int J Clin Exp Pathol 2015;8:954-9.  Back to cited text no. 8
    
9.
Li X, Yin Y, Sheng X, Han X, Sun L, Lu C, et al. Distribution pattern of lymph node metastases and its implication inindividualized radiotherapeutic clinical target volume delineation of regional lymph nodes in patients with stage IA to IIA cervical cancer. Radiat Oncol 2015;10:40.  Back to cited text no. 9
    
10.
Vogl TJ, Schulz B, Bauer RW, Stöver T, Sader R, Tawfik AM. Dual-energy CT applications in head and neck imaging. AJR Am J Roentgenol 2012;199 5 Suppl: S34-9.  Back to cited text no. 10
    


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  [Table 1], [Table 2], [Table 3]



 

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