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DOI:10.2214/AJR.04.0898
AJR 2006; 186:1450-1457
© American Roentgen Ray Society

Original Research

Quantitative Analysis and Effect of Attenuation Correction on Lymph Node Staging of Non-Small Cell Lung Cancer on SPECT and CT

Shinya Shiraishi1, Seiji Tomiguchi1, Daisuke Utsunomiya1, Koichi Kawanaka1, Kazuo Awai1, Syoji Morishita1, Tomoko Okuda1, Koichi Yokotsuka2 and Yasuyuki Yamashita1

1 Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto-city, Kumamoto 860-8556, Japan.
2 Nuclear Medicine Department, Hitachi Medical Corporation, Tokyo, Japan.

OBJECTIVE. The purpose of our study was to assess quantitative indexes and the effect of attenuation correction on the evaluation of lymph node metastasis in the staging of non-small cell lung cancer (NSCLC) using fused thallium-201 SPECT/CT images.

MATERIALS AND METHODS. We evaluated 156 lymph nodes (66 metastatic, 90 nonmetastatic) from 29 patients with NSCLC. Using our combined SPECT/CT system, all patients underwent 201Tl SPECT and CT examinations immediately (early images) and 3 hr after (delayed images) the injection of 201Tl. SPECT images were reconstructed with and without attenuation correction. For the quantitative evaluation of lymph node metastasis, we calculated the early ratio, the delayed ratio, and the washout ratio for SPECT images and the short-axis diameter for CT images. Receiver operating characteristic (ROC) analysis was performed in each index for the differentiation between metastatic and nonmetastatic lymph nodes. Visual analysis was also performed by two experienced radiologists.

RESULTS. The area under the ROC curve (Az) showed that early ratio and delayed ratio were superior to short-axis diameter for the assessment of lymph node metastasis. In addition, early and delayed ratios on attenuation-corrected images were superior to those ratios on images without attenuation correction. However, the Az value for washout ratio was smaller than that for short-axis diameter. Early ratio on attenuation-corrected images was the most useful index (Az = 0.94). The sensitivity, specificity, and accuracy for early ratio on attenuation-corrected images were 78.8%, 94.4%, and 87.8% for the diagnosis of lymph node metastasis and 84.6%, 100%, and 93.1% for clinical staging (N0-N1 vs N2-N3), respectively. Fused images showed significantly higher diagnostic accuracy than CT images on visual analysis.

CONCLUSION. Quantitative assessment using fused SPECT/CT images is useful for the diagnosis of lymph node metastasis in patients with NSCLC.

Keywords: cancer • CT • lung • lymph node • SPECT • staging


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