Chest Wall Vessel Involvement on Ultra-High-Resolution CT in Lung Cancer Diagnosis

Overview

This study evaluated the diagnostic utility of detecting chest wall vessel involvement (CWVI) using ultra-high-resolution CT (UHR-CT) in primary lung cancer with chest wall infiltration. CWVI was identified as a novel imaging marker correlating with pathological chest wall invasion, potentially improving preoperative assessment.

Background

Chest wall infiltration in lung cancer corresponds to T3 staging and significantly impacts treatment and prognosis. Traditional imaging methods focus on rib destruction and tumor contact with the chest wall but often struggle to detect early pleural or fascial invasion. Lung cancers may develop feeding vessels from intercostal arteries when infiltrating the chest wall. UHR-CT offers enhanced spatial resolution to visualize these minute vascular changes, potentially aiding in the diagnosis of chest wall infiltration.

Data Highlights

The study retrospectively analyzed postoperative histopathology and UHR-CT imaging of primary lung cancer cases from January 2020 to April 2022. UHR-CT parameters included 0.25 mm slice thickness and deep-learning reconstruction. Two observers independently assessed CWVI, rib destruction, pleural effusion, and ground-glass opacity, with consensus for discrepancies. CWVI was defined as visible vessels from intercostal arteries extending into the tumor on arterial phase contrast-enhanced UHR-CT.

Key Findings

• CWVI was frequently observed in lung cancers with pathological chest wall infiltration (pl3), distinguishing them from tumors without chest wall invasion (pl1 and pl2).
• UHR-CT enabled visualization of minute vessels from intercostal arteries within tumors, a finding not easily detected by conventional CT or MRI.
• Rib destruction was easier to diagnose but less sensitive for early chest wall invasion compared to CWVI detection.
• Dynamic contrast-enhanced UHR-CT arterial phase imaging was critical for identifying CWVI.
• Interobserver agreement improved after training, supporting the reproducibility of CWVI assessment on UHR-CT.

Clinical Implications

Detection of CWVI on UHR-CT can serve as a valuable imaging biomarker for diagnosing chest wall infiltration in primary lung cancer, facilitating more accurate preoperative staging. This may guide surgical planning, particularly the need for en bloc lung and chest wall resection. Incorporating CWVI assessment could improve patient selection and prognostic evaluation.

Conclusion

Ultra-high-resolution CT imaging with contrast enhancement allows for the identification of chest wall vessel involvement, providing a novel and sensitive method to diagnose chest wall infiltration in lung cancer. This technique enhances preoperative evaluation and may influence therapeutic strategies.

References

1. UICC TNM Classification 8th Edition -- Lung Cancer Staging
2. Studies on Chest Wall Infiltration and Imaging Modalities (References 1-17)
3. Technical Details of Ultra-High-Resolution CT and Reconstruction Algorithms (References 18-24)