• Record: found
  • Abstract: found
  • Article: not found

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

Read this article at

      There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.



      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

      Related collections

      Most cited references 22

      • Record: found
      • Abstract: found
      • Article: not found

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

       V Moyer,   (2014)
      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).
        • Record: found
        • Abstract: found
        • Article: not found

        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.
          • Record: found
          • Abstract: not found
          • Article: not found

          British Thoracic Society guidelines for the investigation and management of pulmonary nodules.


            Author and article information

            [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
            +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
            28677062 5674131 4938 10.1007/s00330-017-4938-1
            © 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
            Custom metadata
            © European Society of Radiology 2017


            Comment on this article