Published online Jun 28, 2022. doi: 10.4329/wjr.v14.i6.155
Peer-review started: December 2, 2021
First decision: April 8, 2022
Revised: April 20, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: June 28, 2022
Processing time: 208 Days and 4.8 Hours
In recent years, the detection rate of ground-glass nodules (GGNs) has been improved dramatically due to the application of low-dose computed tomography (CT) screening and high-resolution CT. The rapidly increasing detection rate requires appropriate managements of the GGNs which depends on a thorough investigation and sufficient knowledge of the GGNs. In most diagnostic studies of the GGNs, morphological factors are used to differentiate benignancy and malignancy. However, evaluation of the dual vascular supply patterns in GGNs with a dynamic volume CT could provide more valuable information for identification and treatment planning.
Studies of the solid lesions suggested that the information of CT perfusion is helpful in identification and treatment planning. Furthermore, quantification of the dual blood supply from the pulmonary and bronchial artery, i.e., the pulmonary flow (PF) and bronchial flow (BF) in lung disorders was recently achieved with a dynamic volume CT and the first-pass dual-input perfusion analysis producing helpful information for differentiations and treatment planning. Based on this, our study is devoted to the assessment of the dual blood supply pattern of GGNs by dynamic CT to provide more valuable information for differentiations and treatment planning.
To assess the dual vascular supply patterns of GGNs with regard to different histopathology and opacities using a dynamic volume CT.
In this prospective study, 47 GGNs from 47 patients were included and underwent the dynamic volume CT. Histopathologic diagnoses were obtained within two weeks after the CT examination. BF and PF as well as the perfusion index [(PI) = PF/ (PF+BF)] were obtained using first-pass dual-input CT perfusion analysis and compared respectively between different histopathology and lesion types (pure or mixed GGN) and correlated with the attenuation values of the lesions, using one-way ANOVA, student’s t test and Pearson correlation analysis.
Forty-seven GGNs including three histopathological types (30 carcinoma, 6 atypical adenomatous hyperplasia and 11 organizing pneumonia). All perfusion parameters (BF, PF and PI) demonstrated no significant difference among the three conditions (all P > 0.05). The PFs were higher than the BFs in all the three conditions (all P < 0.001). Of the 30 GGN carcinomas, 14 showed mixed GGNs and 16 pure GGNs, with a higher PI in the latter (P < 0.01). A negative correlation (r = -0.76, P < 0.001) was demonstrated between the CT attenuation values and the PIs in the 30 GGN carcinomas.
In conclusion, the GGNs are perfused dominantly by the PF regardless of its histopathology while the weight of the BF in the GGN carcinomas increases gradually during the progress of its opacification.
Our future study will expand the GGNs sample size to further investigate potential difference of perfusion parameters between malignant and benign GGNs and to further confirm that the PI is a useful biomarker for distinguishing indolent GGNs carcinomas from aggressive ones.