Dual-energy computed tomography in the early evaluation of acute radiation pneumonia

Zong-Sheng Wang; Jing Wu; Gang Yuan; Yong-Bao Liu; Xiao-Ping He

doi:10.1186/s40001-024-01650-9

Dual-energy computed tomography in the early evaluation of acute radiation pneumonia

Eur J Med Res. 2024 Feb 16;29(1):126. doi: 10.1186/s40001-024-01650-9.

Authors

Zong-Sheng Wang¹, Jing Wu², Gang Yuan¹, Yong-Bao Liu¹, Xiao-Ping He³

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, No. 6 of Zhenhua East Street, Haizhou District, Lianyungang, 222000, Jiangsu, China.
² Department of Oncology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, Lianyungang, 222000, Jiangsu, China.
³ Department of Radiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, The First People's Hospital of Lianyungang, No. 6 of Zhenhua East Street, Haizhou District, Lianyungang, 222000, Jiangsu, China. hexiaopinghxpm7@126.com.

Abstract

Objective: To investigate the value of dual-energy dual-source computed tomography (DSCT) in evaluating pulmonary perfusion changes before and after radiotherapy for esophageal cancer, and its clinical use in the early diagnosis of acute radiation pneumonia (ARP).

Methods: We selected 45 patients with pathologically confirmed esophageal cancer who received radiotherapy (total irradiation dose of 60 Gy). Dual-energy DSCT scans were performed before and after radiotherapy and the normalized iodine concentrations (NIC) in the lung fields of the areas irradiated with doses of > 20 Gy, 10-20 Gy, 5-10 Gy, and < 5 Gy were measured. We also checked for the occurrence of ARP in the patients, and the differences in NIC values and NIC reduction rates before and after radiotherapy were calculated and statistically analyzed.

Results: A total of 16 of the 45 patients developed ARP. The NIC values in the lung fields of all patients decreased at different degrees after radiotherapy, and the NIC values in the area where ARP developed, decreased significantly. The rate of NIC reduction and incidence rate of ARP increased gradually with the increasing irradiation dose, and the inter-group difference in NIC reduction rate was statistically significant (P < 0.05). Based on the receiver operating characteristic (ROC) curve analysis, the areas under the curves of NIC reduction rate versus ARP occurrence in the V_{5-10 Gy}, V_{10-20 Gy}, and V_{> 20 Gy} groups were 0.780, 0.808, and 0.772, respectively. Sensitivity of diagnosis was 81.3%, 75.0%, and 68.8% and the specificity was 65.5%, 82.8%, and 79.3%, when taking 12.50%, 16.50%, and 26.0% as the diagnostic thresholds, respectively. The difference in NIC values in the lung fields of V_{<5 Gy} before and after radiotherapy was not statistically significant (P > 0.05).

Conclusion: The dual-energy DSCT could effectively evaluate pulmonary perfusion changes after radiotherapy for esophageal cancer, and the NIC reduction rate was useful as a reference index to predict ARP and provide further reference for decisions in clinical practice.

Keywords: Dual-energy; Esophageal cancer; Perfusion imaging; Radiotherapy; X-ray computer.

MeSH terms

Acute Lung Injury*
Esophageal Neoplasms* / diagnostic imaging
Esophageal Neoplasms* / radiotherapy
Humans
Iodine*
Lung
ROC Curve
Radiation Pneumonitis* / diagnostic imaging
Tomography, X-Ray Computed / methods

Substances

Iodine