Accuracy of the CT numbers of simulated lung nodules imaged with multi-detector CT scanners

A study was performed to determine the accuracies and reproducibilities of the CT numbers of simulated lung nodules imaged with multi-detector CT scanners. The nodules were simulated by spherical balls of three diameters (4.8, 9.5, and 16 mm) and two compositions (50 and 100 mg/cc CaCO3 in water-equivalent plastic). All were scanned in a liquid-water-filled container at the center of a water-equivalent-plastic phantom and in air cavities within the same phantom using GE multi-detector CT scanners. The nodules were also scanned within simulated lung regions in an anthropomorphic thorax section phantom that was bolused on both sides with water-equivalent slabs. Results were compared for three scanning protocols--the protocol for the National Lung Screening Trial (NLST), the protocol for the Lung Tissue Research Consortium (LTRC) study, and a high resolution (small pitch, thin slice and small scan interval) higher dose "gold standard" protocol. Scans were repeated three times with each protocol to assess reproducibility. The CT numbers of the nodules in water were found to be nearly independent of nodule size. However, the presence and the size of an air cavity surrounding a nodule had a significant effect (e.g., the CT number of a 50 mg/cc nodule was 64 HU in water, 37 HU in a 1.8 cm diameter air cavity, and 19 HU in a 4.4 cm diameter air cavity). This variability of CT number with size of air cavity may affect the results of the LTRC study in which patients are scanned at both full inspiration and full expiration. The CT numbers of the 9.5 and 16 mm diameter nodules within the anthropomorphic phantom were highly reproducible (average standard deviations of 2 HU or less) for all protocols. On the other hand, both accuracy and reproducibility were significantly degraded for the 4.8 mm diameter nodules, especially for the NLST (2.5 mm thickness, 2 mm slice interval) technique. Use of thinner slice (1.25 mm) and slice interval (1.25 mm) scans that can be reconstructed retrospectively from the multi-detector helical CT projection data of the standard NLST protocol yield CT numbers for the 4.8 mm diameter nodules that are more accurate and reproducible than those of the standard NLST technique. In general, the CT numbers of the nodules were found to be lower at positions near the centers of the lungs and near the spine, which is probably due to increased beam hardening in those regions. Also, larger nodules were found to have higher CT numbers than smaller nodules, consistent with results obtained on early single slice GE CT scanners. Until manufacturers develop quantitative CT scanners with improved x-ray beam hardening and scatter corrections, it is recommended that reference phantoms be employed to more accurately assess the calcium contents of patient lung nodules in screening and tissue characterization studies and in eventual computer-aided detection and diagnosis applications.