Dual-Energy CT Material Decomposition: The Value in the Detection of Lymph Node Metastasis from Breast Cancer

• Published in: Diagnostics (Basel) 2024-02, Vol.14 (5), p.466
• Main Authors: Yel, Ibrahim, D'Angelo, Tommaso, Gruenewald, Leon D, Koch, Vitali, Golbach, Rejane, Mahmoudi, Scherwin, Ascenti, Giorgio, Blandino, Alfredo, Vogl, Thomas J, Booz, Christian, Bucolo, Giuseppe M
• Format: Article
• Language: English
• Subjects: Algorithms; Biopsy; Breast cancer; Cancer therapies; Contrast agents; CT imaging; Decomposition; Diagnostic imaging; dual energy; fat fraction; Health aspects; Iodine; lymphatic metastases; Lymphatic system; Medical diagnosis; Medical imaging; Medical imaging equipment; Metastasis; Patients; Performance evaluation; Statistical analysis; Surgery; Tomography; Women
• ISSN: 2075-4418; 2075-4418
• DOI: 10.3390/diagnostics14050466

To evaluate the diagnostic performance of a dual-energy computed tomography (DECT)-based material decomposition algorithm for iodine quantification and fat fraction analysis to detect lymph node metastases in breast cancer patients. 30 female patients (mean age, 63.12 ± 14.2 years) diagnosed with breast cancer who underwent pre-operative chest DECT were included. To establish a reference standard, the study correlated histologic repots after lymphadenectomy or confirming metastasis in previous/follow-up examinations. Iodine concentration and fat fraction were determined through region-of-interest measurements on venous DECT iodine maps. Receiver operating characteristic curve analysis was conducted to identify the optimal threshold for differentiating between metastatic and non-metastatic lymph nodes. A total of 168 lymph nodes were evaluated, divided into axillary (metastatic: 46, normal: 101) and intramammary (metastatic: 10, normal: 11). DECT-based fat fraction values exhibited significant differences between metastatic (9.56 ± 6.20%) and non-metastatic lymph nodes (41.52 ± 19.97%) ( < 0.0001). Absolute iodine concentrations showed no significant differences (2.25 ± 0.97 mg/mL vs. 2.08 ± 0.97 mg/mL) ( = 0.7999). The optimal fat fraction threshold for diagnosing metastatic lymph nodes was determined to be 17.75%, offering a sensitivity of 98% and a specificity of 94%. DECT fat fraction analysis emerges as a promising method for identifying metastatic lymph nodes, overcoming the morpho-volumetric limitations of conventional CT regarding lymph node assessment. This innovative approach holds potential for improving pre-operative lymph node evaluation in breast cancer patients, offering enhanced diagnostic accuracy.