Advertisement

Improved Detection of Bone Metastases from Lung Cancer in the Thoracic Cage using 5- and 1-mm Axial Images versus a New CT Software Generating Rib Unfolding Images

Comparison with Standard 18F-FDG-PET/CT

      Rationale and Objectives

      To evaluate the performance of a dedicated computed tomography (CT) software called “bone reading” generating rib unfolded images for improved detection of rib metastases in patients with lung cancer in comparison to readings of 5- and 1-mm axial CT images and 18F-Fluordeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).

      Materials and Methods

      Ninety consecutive patients who underwent 18F-FDG-PET/CT and chest CT scanning between 2012 and 2014 at our institution were analyzed retrospectively. Chest CT scans with 5- and 1-mm slice thickness were interpreted blindly and separately focused on the detection of rib metastases (location, number, cortical vs. medullary, and osteoblastic vs. sclerotic). Subsequent image analysis of unfolded 1 mm–based CT rib images was performed. For all three data sets the reading time was registered. Finally, results were compared to those of FDG-PET. Validation was based on FDG-PET positivity for osteolytic and mixed osteolytic/osteoblastic focal rib lesions and follow-up for sclerotic PET-negative lesions.

      Results

      A total of 47 metastatic rib lesions were found on FDG-PET/CT plus another 30 detected by CT bone reading and confirmed by follow-up CT. Twenty-nine lesions were osteolytic, 14 were mixed osteolytic/osteoblastic, and 34 were sclerotic. On a patient-based analysis, CT (5 mm), CT (1 mm), and CT (1-mm bone reading) yielded a sensitivity, specificity, and accuracy of 76.5/97.3/93, 81.3/97.3/94, and 88.2/95.9/92, respectively. On segment-based (unfolded rib) analysis, the sensitivity, specificity, and accuracy of the three evaluations were 47.7/95.7/67, 59.5/95.8/77, and 94.8/88.2/92, respectively. Reading time for 5 mm/1 mm axial images and unfolded images was 40.5/50.7/21.56 seconds, respectively.

      Conclusions

      The use of unfolded rib images in patients with lung cancer improves sensitivity and specificity of rib metastasis detection in comparison to 5- and 1-mm CT slice reading. Moreover, it may reduce the reading time.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Parkin D.M.
        • Bray F.
        • Ferlay J.
        • et al.
        Global cancer statistics, 2002.
        CA Cancer J Clin. 2005; 55: 74-108
        • Min J.W.
        • Um S.W.
        • Yim J.J.
        • et al.
        The role of whole-body FDG PET/CT, Tc 99m MDP bone scintigraphy, and serum alkaline phosphatase in detecting bone metastasis in patients with newly diagnosed lung cancer.
        J Korean Med Sci. 2009; 24: 275-280
        • Tsuya A.
        • Kurata T.
        • Tamura K.
        • et al.
        Skeletal metastases in non-small cell lung cancer: a retrospective study.
        Lung Cancer. 2007; 57: 229-232
        • Oster G.
        • Lamerato L.
        • Glass A.G.
        • et al.
        Natural history of skeletal-related events in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems.
        Support Care Cancer. 2013; 21: 3279-3286
        • Kagohashi K.
        • Satoh H.
        • Ishikawa H.
        • et al.
        Bone metastasis as the first manifestation of lung cancer.
        Int J Clin Pract. 2003; 57: 184-186
        • Maccauro G.
        • Spinelli M.S.
        • Mauro S.
        • et al.
        Physiopathology of spine metastasis.
        Int J Surg Oncol. 2011; 2011: 107969
        • Weiss L.
        • Haydock K.
        • Pickren J.W.
        • et al.
        Organ vascularity and metastatic frequency.
        Am J Pathol. 1980; 101: 101-113
        • Nakamoto Y.
        • Osman M.
        • Wahl R.L.
        Prevalence and patterns of bone metastases detected with positron emission tomography using F-18 FDG.
        Clin Nucl Med. 2003; 28: 302-307
      1. A learning based deformable template matching method for automatic rib centreline extraction and labeling in CT images. Available at: http://ieeexplore.ieee.org/xpl/articleDetails.jsp?reload=true&tp=&arnumber=6247774&url=http%3A%2F%2Fieeexplore.ieee.org%2Fxpls%2Fabs_all.jsp%3Farnumber%3D6247774. Accessed November 11, 2014.

        • Moses W.W.
        Fundamental limits of spatial resolution in PET.
        Nucl Instrum Methods Phys Res A. 2011; 648: 236-240
        • Toth D.F.
        • Töpker M.
        • Mayerhöfer M.E.
        • et al.
        Rapid detection of bone metastasis at thoracoabdominal CT: accuracy and efficiency of a new visualization algorithm.
        Radiology. 2014; 270: 825-833
        • Evangelista L.
        • Panunzio A.
        • Polverosi R.
        • et al.
        Early bone marrow metastasis detection: the additional value of FDG-PET/CT vs. CT imaging.
        Biomed Pharmacother. 2012; 66: 448-453
        • Fogelman I.
        • Cook G.
        • Israel O.
        • et al.
        Positron emission tomography and bone metastases.
        Semin Nucl Med. 2005; 35: 135-142
        • Liu N.
        • Ma L.
        • Zhou W.
        • et al.
        Bone metastasis in patients with non-small cell lung cancer: the diagnostic role of F-18 FDG PET/CT.
        Eur J Radiol. 2010; 74: 231-235
        • Qu X.
        • Huang X.
        • Yan W.
        • et al.
        A meta-analysis of 18FDG-PET-CT, 18FDG-PET, MRI and bone scintigraphy for diagnosis of bone metastases in patients with lung cancer.
        Eur J Radiol. 2012; 81: 1007-1015
        • Ozülker T.
        • Küçüköz Uzun A.
        • Ozülker F.
        • et al.
        Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDP bone scintigraphy for the detection of bone metastases in cancer patients.
        Nucl Med Commun. 2010; 31: 597-603
        • Choi H.S.
        • Yoo I.R.
        • Park H.L.
        • et al.
        Role of 18F-FDG PET/CT in differentiation of a benign lesion and metastasis on the ribs of cancer patients.
        Clin Imaging. 2014; 38: 109-114
        • Cook G.J.
        • Fogelman I.
        The role of positron emission tomography in the management of bone metastases.
        Cancer. 2000; 88: 2927-2933
        • Gruden J.F.
        • Ouanounou S.
        • Tigges S.
        • et al.
        Incremental benefit of maximum-intensity-projection images on observer detection of small pulmonary nodules revealed by multidetector CT.
        AJR Am J Roentgenol. 2002; 179: 149-157