Differentiation of intrathoracic lymph node histopathology by volumetric dual energy CT radiomic analysis

To determine the performance of volumetric dual energy low kV and iodine radiomic features for the differentiation of intrathoracic lymph node histopathology, and influence of contrast protocol.

Intrathoracic lymph nodes with histopathologic correlation (neoplastic, granulomatous sarcoid, benign) within 90 days of DECT chest imaging were volumetrically segmented. 1691 volumetric radiomic features were extracted from iodine maps and low-kV images, totaling 3382 features. Univariate analysis was performed using 2-sample t-test and filtered for false discoveries. Multivariable analysis was used to compute AUCs for lymph node classification tasks.

129 lymph nodes from 72 individuals (mean age 61 ± 15 years) were included, 52 neoplastic, 51 benign, and 26 granulomatous-sarcoid. Among all contrast enhanced DECT protocol exams (routine, PE and CTA), univariable analysis demonstrated no significant differences in iodine and low kV features between neoplastic and non-neoplastic lymph nodes; in the subset of neoplastic versus benign lymph nodes with routine DECT protocol, 199 features differed (p = .01- < 0.05). Multivariable analysis using both iodine and low kV features yielded AUCs >0.8 for differentiating neoplastic from non-neoplastic lymph nodes (AUC 0.86), including subsets of neoplastic from granulomatous (AUC 0.86) and neoplastic from benign (AUC 0.9) lymph nodes, among all contrast protocols.

Volumetric DECT radiomic features demonstrate strong collective performance in differentiation of neoplastic from non-neoplastic intrathoracic lymph nodes, and are influenced by contrast protocol.