Preoperative assessment of parietal pleural invasion/adhesion of subpleural lung cancer: advantage of software-assisted analysis of 4-dimensional dynamic-ventilation computed tomography

Objective: To evaluate the accuracy of four-dimensional (4D) dynamic-ventilation computed tomography (CT) scanning coupled with our novel image analysis software to diagnose parietal pleural invasion/adhesion of peripheral (subpleural) lung cancer. Methods: Eighteen patients with subpleural lung cancer underwent both 4D dynamic-ventilation CT during free breathing and conventional (static) chest CT during preoperative assessment. The absence of parietal pleural invasion/adhesion was surgically confirmed in 13 patients, while the presence of parietal pleural invasion/adhesion was confirmed in 5 patients. Two chest radiologists, who were blinded to patient status, cooperatively evaluated the presence of pleural invasion/adhesion using two different imaging modalities: (i) conventional high-resolution CT images, reconstructed in the axial, coronal, and sagittal directions, and (ii) 4D dynamic-ventilation CT images combined with a color map created by image analysis software to visualize movement differences between the lung surface and chest wall. Parameters of diagnostic accuracy were assessed, including a receiver operating characteristic analysis. Results: Software-assisted 4D dynamic-ventilation CT images achieved perfect diagnostic accuracy for pleural invasion/adhesion (sensitivity, 100%; specificity, 100%; area under the curve [AUC], 1.000) compared to conventional chest CT (sensitivity, 60%; specificity, 77%; AUC, 0.846). Conclusion: Software-assisted 4D dynamic-ventilation CT can be considered as a novel imaging approach for accurate preoperative analysis of pleural invasion/adhesion of peripheral lung cancer. Key Points: • 4D dynamic-ventilation CT can correctly assess parietal pleural invasion/adhesion of peripheral lung cancer. • A unique color map clearly demonstrates parietal pleural invasion/adhesion. • Our technique can be expanded to diagnose “benign” pleural adhesions for safer thoracoscopic surgery.