Co-registration of pre-operative CT with ex vivo surgically excised ground glass nodules to define spatial extent of invasive adenocarcinoma on in vivo imaging: a proof-of-concept study

• Published in: European radiology Vol. 27; no. 10; pp. 4209 - 4217
• Main Authors: Rusu, Mirabela, Rajiah, Prabhakar, Gilkeson, Robert, Yang, Michael, Donatelli, Christopher, Thawani, Rajat, Jacono, Frank J., Linden, Philip, Madabhushi, Anant
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2017; Springer Nature B.V
• Subjects: Adenocarcinoma; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Computed tomography; Computer Applications; Diagnostic Radiology; Digitization; Female; Glass; Histology; Humans; Imaging; In vivo methods and tests; Internal Medicine; Interventional Radiology; Invasiveness; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Lung nodules; Male; Mapping; Medicine; Medicine & Public Health; Methodology; Middle Aged; Misalignment; Multiple Pulmonary Nodules - diagnostic imaging; Neoplasm Invasiveness - diagnostic imaging; Neuroradiology; Nodules; Pathology; Proof of Concept Study; Radiology; Reconstruction; Spatial distribution; Tomography, X-Ray Computed - methods; Tumors; Ultrasound; Computer-assisted image processing; Pathology; Multimodal imaging; Lung adenocarcinoma; Computed tomography
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-017-4813-0

Objective To develop an approach for radiology-pathology fusion of ex vivo histology of surgically excised pulmonary nodules with pre-operative CT, to radiologically map spatial extent of the invasive adenocarcinomatous component of the nodule. Methods Six subjects (age: 75 ± 11 years) with pre-operative CT and surgically excised ground-glass nodules (size: 22.5 ± 5.1 mm) with a significant invasive adenocarcinomatous component (>5 mm) were included. The pathologist outlined disease extent on digitized histology specimens; two radiologists and a pulmonary critical care physician delineated the entire nodule on CT (in-plane resolution: <0.8 mm, inter-slice distance: 1–5 mm). We introduced a novel reconstruction approach to localize histology slices in 3D relative to each other while using CT scan as spatial constraint. This enabled the spatial mapping of the extent of tumour invasion from histology onto CT. Results Good overlap of the 3D reconstructed histology and the nodule outlined on CT was observed (65.9 ± 5.2%). Reduction in 3D misalignment of corresponding anatomical landmarks on histology and CT was observed (1.97 ± 0.42 mm). Moreover, the CT attenuation (HU) distributions were different when comparing invasive and in situ regions. Conclusion This proof-of-concept study suggests that our fusion method can enable the spatial mapping of the invasive adenocarcinomatous component from 2D histology slices onto in vivo CT. Key Points • 3D reconstructions are generated from 2D histology specimens of ground glass nodules. • The reconstruction methodology used pre-operative in vivo CT as 3D spatial constraint. • The methodology maps adenocarcinoma extent from digitized histology onto in vivo CT. • The methodology potentially facilitates the discovery of CT signature of invasive adenocarcinoma.