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      The Effects of Iodine Attenuation on Pulmonary Nodule Volumetry using Novel Dual-Layer Computed Tomography Reconstructions

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          To assess the effect of iodine attenuation on pulmonary nodule volumetry using virtual non-contrast (VNC) and mono-energetic reconstructions.


          A consecutive series of patients who underwent a contrast-enhanced chest CT scan were included. Images were acquired on a novel dual-layer spectral CT system. Conventional reconstructions as well as VNC and mono-energetic images at different keV levels were used for nodule volumetry.


          Twenty-four patients with a total of 63 nodules were included. Conventional reconstructions showed a median (interquartile range) volume and diameter of 174 (87 – 253) mm 3 and 6.9 (5.4 – 9.9) mm, respectively. VNC reconstructions resulted in a significant volume reduction of 5.5% (2.6 – 11.2%; p<0.001). Mono-energetic reconstructions showed a correlation between nodule attenuation and nodule volume (Spearman correlation 0.77, (0.49 – 0.94)). Lowering the keV resulted in increased volumes while higher keV levels resulted in decreased pulmonary nodule volumes compared to conventional CT.


          Novel dual-layer spectral CT offers the possibility to reconstruct VNC and mono-energetic images. Those reconstructions show that higher pulmonary nodule attenuation results in larger nodule volumes. This may explain the reported underestimation in nodule volume on non-contrast enhanced compared to contrast-enhanced acquisitions.

          Key Points

          Pulmonary nodule volumes were measured on virtual non-contrast and mono-energetic reconstructions

          Mono-energetic reconstructions showed that higher attenuation results in larger volumes

          This may explain the reported nodule volume underestimation on non-contrast enhanced CT

          Mostly metastatic pulmonary nodules were evaluated, results might differ for benign nodules

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          Most cited references 22

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          Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement.

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          Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer. The USPSTF reviewed the evidence on the efficacy of low-dose computed tomography, chest radiography, and sputum cytologic evaluation for lung cancer screening in asymptomatic persons who are at average or high risk for lung cancer (current or former smokers) and the benefits and harms of these screening tests and of surgical resection of early-stage non-small cell lung cancer. The USPSTF also commissioned modeling studies to provide information about the optimum age at which to begin and end screening, the optimum screening interval, and the relative benefits and harms of different screening strategies. This recommendation applies to asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation).
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              Lung nodule enhancement at CT: multicenter study.

              To test the hypothesis that absence of statistically significant lung nodule enhancement (< or =15 HU) at computed tomography (CT) is strongly predictive of benignity. Five hundred fifty lung nodules were studied. Of these, 356 met all entrance criteria and had a diagnosis. On nonenhanced, thin-section CT scans, the nodules were solid, 5-40 mm in diameter, relatively spherical, homogeneous, and without calcification or fat. All patients were examined with 3-mm-collimation CT before and after intravenous injection of contrast material. CT scans through the nodule were obtained at 1, 2, 3, and 4 minutes after the onset of injection. Peak net nodule enhancement and time-attenuation curves were analyzed. Seven centers participated. The prevalence of malignancy was 48% (171 of 356 nodules). Malignant neoplasms enhanced (median, 38.1 HU; range, 14.0-165.3 HU) significantly more than granulomas and benign neoplasms (median, 10.0 HU; range, -20.0 to 96.0 HU; P < .001). With 15 HU as the threshold, the sensitivity was 98% (167 of 171 malignant nodules), the specificity was 58% (107 of 185 benign nodules), and the accuracy was 77% (274 of 356 nodules). Absence of significant lung nodule enhancement (< or = 15 HU) at CT is strongly predictive of benignity.

                Author and article information

                +31 88 755 6687 ,
                Eur Radiol
                Eur Radiol
                European Radiology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                4 July 2017
                4 July 2017
                : 27
                : 12
                : 5244-5251
                [1 ]ISNI 0000000090126352, GRID grid.7692.a, Department of Radiology, , University Medical Center Utrecht, ; P.O. Box 85500, E01.132, 3508 GA Utrecht, The Netherlands
                [2 ]ISNI 0000 0004 0622 1269, GRID grid.415960.f, Department of Radiology, , Sint Antonius Ziekenhuis, ; P.O. Box 2500, 3430EM Nieuwegein, The Netherlands
                [3 ]ISNI 0000 0004 0398 9387, GRID grid.417284.c, Philips Healthcare, ; Best, The Netherlands
                © The Author(s) 2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funded by: University Medical Center Utrecht
                Computed Tomography
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                © European Society of Radiology 2017

                Radiology & Imaging

                iodine, computed tomography, dual–energy, multiple pulmonary nodules, volume ct


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