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Thoracic Imaging |
1 From the Dept of Diagnostic Radiology (S.J.S., T.E.H.) and Div of Pulmonary and Critical Care Medicine and Internal Medicine (D.E.M.), Mayo Clinic and Mayo Foundation, 200 First St SW, Rochester, MN 55905; Div of Pulmonary Medicine (R.W.V.), Dept of Diagnostic Radiology (J.R.M.), and Section of Biostatistics (A.L.W.), Mayo Clinic Scottsdale, Ariz; Dept of Diagnostic Radiology, Vancouver General Hospital, British Columbia, Canada (N.L.M.); Dept of Diagnostic Radiology, Memorial Medical Center, Springfield, Ill (A.S.); Dept of Diagnostic Radiology, Shiga Health Insurance Hospital, Otsu, Japan (K.Y.); Dept of Diagnostic Radiology, New York University Medical Center, NY (D.P.N.); Dept of Diagnostic Radiology, Duke University Medical Center, Durham, NC (E.F.P.). Supported in part by grants from GE Medical Systems, Bracco Diagnostics, and the Mayo Foundation. Recd Sept 22, 1998; revision reqd Nov 10; final revision recd Apr 15, 1999; accepted Apr 22. Address reprint requests to S.J.S.
PURPOSE: To test the hypothesis that absence of statistically significant lung nodule enhancement (
15 HU) at computed tomography (CT) is strongly predictive of benignity.
MATERIALS AND METHODS: 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.
RESULTS: 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).
CONCLUSION: Absence of significant lung nodule enhancement (15 HU) at CT is strongly predictive of benignity.
Index terms: Lung, CT, 60.12112, 60.12115 • Lung, nodule, 60.281 • Lung neoplasms, CT, 60.12112, 60.12115 • Lung neoplasms, diagnosis, 60.30
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