RECIST and WHO Criteria Evaluation of Cervical, Thoracic and Abdominal Lymph Nodes in Patients with Malignant Lymphoma: Manual versus Semi-Automated Measurement on Standard MDCT Slices

Zusammenfassung

Ziel: Da semi-automatische Quantifizierung von Läsionen präziser als manuelle ein- und zweidimensionale Messungen sein könnten, war das Ziel dieser Studie, beide Messmethoden in Bezug auf zervikale, thorakale und abdominelle Lymphknoten bei Lymphompatienten miteinander zu vergleichen. Material und Methoden: 62 Lymphompatienten wurden mittels kontrastmittelangehobener 16-Zeilen-Mehrschicht-Spiral-CT untersucht (16 × 0,7 mm coll., 120 kV, zervikal/thorakal/abdominell: 150 / 120 / 160 mAseff., 1 / 1,25 / 1 pitch, 4 / 3 – 5 / 4 – 5 / 4 Schichtdicke/Rekonstruktionsinkrement). Anhand von Standardschichtdicken wurden sämtliche Lymphknoten in Bezug auf RECIST- sowie dessen längsten orthograden Durchmesser mittels eines Softwarealgorithmus (Syngo CT Oncology, Siemens Medical Solutions, Forchheim, Deutschland) und manuell durch einen erfahrenen Radiologen evaluiert. Der Grad der Übereinstimmung zwischen manueller und semi-automatischer Quantifizierung wurde statistisch mittels des Konkordanzkorrelationskoeffizienten κ und grafisch anhand korrespondierender Bland-Altman-Plots ausgewertet. Ergebnisse: 74 / 80 zervikale, 51 / 80 thorakale and 75 / 80 abdominelle Lymphknoten wurden regelrecht von der Software quantifiziert. Ein hohes Maß an Übereinstimmung zwischen beiden Messtechniken (RECIST: κ = 0,97 (zervikal)/ 0,98 (thorakal)/ 0,99 (abdominell); längster orthograder Durchmesser: κ = 0,97 / 0,93 / 0,97). Schlussfolgerung: Semi-automatische Messungen von zervikalen, thorakalen und abdominellen Lymphknoten zeigten eine große Übereinstimmung gegenüber manuellen Messungen anhand von Standard-CT-Schichten, allerdings aufgrund der relativ hohen Rate von Fehlsegmentierungen thorakal hier mit gewissen Einschränkungen.

Abstract

Purpose: Since semi-automated lesion quantification may be more precise than manual uni- and bidimensional measurements, the purpose of this study was to compare semi-automated with manual evaluations of cervical, thoracic and abdominal lymph nodes in patients with malignant lymphoma. Materials and Methods: 62 patients with known malignant lymphoma underwent staging with contrast-enhanced 16-MDCT (16x0.7 mm coll., 120 kV, cervical/thoracic/abdominal: 150 / 120 / 160 mAseff., 1 / 1.25 / 1 pitch, 4 / 3 – 5 / 4 – 5 / 4 slice thickness/reconstruction increment). On the basis of these standard reconstructed slices, each lesion was quantified in terms of RECIST and its longest orthographic diameter using a semi-automated software tool (Syngo CT Oncology, Siemens Medical Solutions, Forchheim, Germany) and manually by an experienced radiologist. The degree of agreement between manual measurements and software quantification was statistically assessed by computing the concordance correlation coefficient κ and represented graphically in corresponding Bland-Altman plots. Results: 74 / 80 cervical, 51 / 80 thoracic and 75 / 80 abdominal lymph nodes were correctly evaluated by the software. A strong degree of agreement between both measurement techniques (RECIST diameter: κ = 0.97 (cervical)/ 0.98 (thoracic)/ 0.99 (abdominal); longest orthographic diameter: κ = 0.97 / 0.93 / 0.97) was obtained. Conclusion: Semi-automated measurement of cervical, thoracic and abdominal lymph nodes showed valid results on standard axial reconstructions compared to manual quantification with the limitation of a high false segmentation rate in thoracic lymph nodes.

Key words

malignant lymphoma - semi-automated measurement - MDCT

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