Dynamic perfusion area-detector CT in non-small cell lung cancer with progressive fibrosing interstitial lung disease

Objectives: To determine the capability of dynamic contrast-enhanced (CE-) perfusion area-detector CT (ADCT) for detecting pathological structural changes in stage I non-small cell lung cancer (NSCLC) patients. Materials and methods: Sixty-three consecutive stage I NSCLC patients with progressive fibrosing interstitial lung disease (PF-ILD) underwent dynamic CE-perfusion ADCT analyzed by dual-input maximum slope (DMS) methods for total, pulmonary arterial and systemic arterial perfusion (TP_DMS, PAP_DMS and SAP_DMS) maps, surgical treatment and pathological examination. Multicentric ROIs were then placed over sites assessed as normal lung, pulmonary emphysema, GGO or reticular pattern without traction bronchiectasis, reticular pattern with traction bronchiectasis and honeycombing in the resected lung. Next, an analysis of variance (ANOVA) followed by Tukey’s honest significant difference (HSD) multiple comparison test was performed for a comparison of each of the perfusion parameters for five groups. Finally, discrimination accuracy for evaluation of lung parenchymal change was compared for all indexes and combined methods. Results: PAP_DMSs of abnormal lungs were significantly lower than that of normal lungs (p < 0.0001). SAP_DMSs of normal or emphysematous lungs were significantly lower than those of others (p < 0.0001). SAP_DMS of GGO or reticular pattern without traction bronchiectasis was significantly lower than that for reticular pattern with traction bronchiectasis and honeycombing (p < 0.0001). Discrimination accuracy of combined perfusion index was significantly higher than that of each index (p < 0.0001). Conclusion: Dynamic CE-perfusion ADCT is useful for detecting pathological structural changes in stage I NSCLC patients with PF-ILD. Key Points: Question Can dynamic first-pass contrast-enhanced perfusion matrices evaluate parenchymal lung changes and disease severity of parenchymal diseases in stage I non-small cell lung cancer (NSCLC) patients? Findings Perfusion indexes differentiated significantly among normal lung, emphysema, GGO or reticular pattern without traction bronchiectasis, reticular pattern with traction bronchiectasis and honeycombing and significantly improved discrimination accuracy by combined methods. Clinical relevance Dynamic first-pass contrast-enhanced perfusion area-detector CT has the potential to assess underlying pathologies and pulmonary functional changes in stage I non-small cell carcinoma patients with progressive fibrosing interstitial lung disease.