J Korean Soc Radiol.  2013 Aug;69(2):131-138. 10.3348/jksr.2013.69.2.131.

Dynamic Contrast-Enhanced CT in Advanced Lung Cancer after Chemotherapy with/without Radiation Therapy: Can It Predict Treatment Responsiveness of the Tumor?

• Yoo MR
• Whang SH
• Park CH
• Kim SJ
• Kim TH

• KMID: 2208816
• DOI: http://doi.org/10.3348/jksr.2013.69.2.131

Abstract

PURPOSE
To evaluate the contrast enhancement patterns of lung cancer after chemotherapy using a dynamic contrast-enhanced (DCE) CT and to determine whether the enhancement patterns of tumors at early stages of treatment can predict treatment responses.
MATERIALS AND METHODS
Forty-two patients with advanced lung cancers underwent DCE-CT and follow-up CT after chemotherapy. We evaluated peak and net enhancement (PE and NE, respectively) and time-density curves (TDCs) (type A, B, C, and D) on DCE-CT images. Treatment responses were evaluated using revised Response Evaluation Criteria in Solid Tumor criteria.
RESULTS
NE and PE values were significantly higher in the progressive disease (PD) groups than in the stable disease (SD) or partial response (PR) groups (p < 0.05). Types B, C, and D on TDCs were observed mostly in the PR and SD groups (96.0%), whereas type A was most frequent in the SD and PD groups (97.2%), which were significantly different in terms of PE and NE.
CONCLUSION
Contrast enhancement pattern regarding the response of treatment on DCE-CT images could be helpful in predicting treatment response of advanced lung cancer after treatment.

MeSH Terms

Follow-Up Studies
Humans
Lung
Lung Neoplasms

Figure

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  Fig. 1 A 69-year-old men with stage IV non-small cell carcinoma in the left upper lobe with lung to lung metastasis. A. Dynamic contrast-enhanced CT images at pre-contrast, 30, 60, 90, 120 sec, and 5 minutes over the lesion after chemotherapy with a cisplatin regimen. B. The time-density curve shows early wash-in and wash-out pattern consistent with type A. Net enhancement and peak enhancement values were 44 HU and 81 HU, respectively. The lesion was categorized as progressive disease according to the Response Evaluation Criteria in Solid Tumor criteria. Note.-HU = Hounsfield unit, TAV = tumor attenuation value

• 

  Fig. 2 An 83-year-old woman with stage IV adenocarcinoma in the left upper lobe. A. Dynamic contrast-enhanced CT images at pre-contrast, 30, 60, 90, 120 sec, and 5 minutes over the lesion after chemotherapy with agefinitib regimen. B. The time-density curve shows early wash-in and continuous acceleration pattern consistent with type C. Net enhancement and peak enhancement values were 40 HU and 70 HU, respectively. The lesion was categorized as stable disease according to the Response Evaluation Criteria in Solid Tumor criteria. Note.-HU = Hounsfield unit, TAV = tumor attenuation value

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  Fig. 3 Mean values of net and peak enhancement in 61 lesions among three groups according to the Response Evaluation Criteria in Solid Tumor criteria on the dynamic contrast-enhanced CT images in 41 patients with advanced lung cancer. A. Net enhancement (NE) differed significantly between the PD group and the PR or SD groups (p < 0.05). B. Peak enhancement (PE) differed significantly between the PD group and the PR or SD groups (p < 0.05). Note.-HU = Hounsfield unit, PD = progressive disease, PR = partial response, SD = stable disease

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  Fig. 4 Receiver operating characteristic curves of peak enhancement (PE) and net enhancement (NE) values. Sensitivity and specificity for differentiating between the PD group and the PR or SD groups were 62.5% and 82.2%, respectively, at a cutoff NE value of 60.3 HU, and 75.0% and 75.6%, respectively, at a cutoff PE value of 94.5 HU. Note.-HU = Hounsfield unit, PD = progressive disease, PR = partial response, SD = stable disease

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