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Lung Nodules: Dual-Kilovolt Peak Analysis with CT-Multicenter Study¹

¹ From the Department of Diagnostic Radiology (S.J.S., C.H.M.), the Division of Pulmonary and Critical Care Medicine (D.E.M.), and the Section of Biostatistics (A.L.W.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; the Department of Diagnostic Radiology, Shiga Health Insurance Hospital, Japan (K.Y.); the Division Pulmonary and Critical Care Medicine (R.W.V.) and the Department of Diagnostic Radiology (J.R.M.), Mayo Clinic, Scottsdale, Ariz; and the Department of Diagnostic Radiology, Duke University Medical Center, Durham, NC (E.F.P.). Received January 6, 1999; revision requested February 18; revision received April 7; accepted April 26. Address reprint requests to S.J.S. (e-mail: swensen.stephen@mayo.edu).

PURPOSE: To test the following hypothesis: The greater the increase in the mean computed tomographic (CT) number of a radiologically indeterminate lung nodule from the CT number on a 140-kVp CT image to that on an 80-kVp CT image, the more likely the nodule is benign (ie, contains calcium).

MATERIALS AND METHODS: Two hundred forty indeterminate lung nodules were prospectively studied at four institutions: Mayo Clinic Scottsdale, Ariz (n = 160); Mayo Clinic Rochester, Minn (n = 50); Shiga Health Insurance Hospital, Otsu, Japan (n = 25); and Duke University Medical Center, Durham, NC (n = 5). Of the 240 nodules, 157 met the entrance criteria for this study and had a diagnosis. All nodules included were solid, 5–40-mm diameter, relatively spherical, homogeneous, and without visible evidence of calcification or fat. Each nodule was evaluated by using 3-mm-collimation, nonenhanced CT scans with both 140- and 80-kVp x-ray beams.

RESULTS: There were 86 (55%) benign and 71 (45%) malignant nodules. The median increase in the nodule mean CT number from the CT number on 140-kVp images to that on 80-kVp images was 2 HU for benign nodules and 3 HU for malignant nodules. This difference was not statistically significant. The area under the receiver operating characteristic curve was 0.505.

CONCLUSION: Dual–kilovolt peak analysis with current CT technology does not appear to be helpful in the identification of benign lung nodules.

Index terms: Lung, CT, 60.12111, 60.12115 • Lung, nodule, 60.281 • Lung neoplasms, CT, 60.12111, 60.12115, 60.30 • Lung neoplasms, diagnosis, 60.281, 60.30

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