Semi-Quantitative Analysis for Determining the Optimal Threshold Value on CT to Measure the Solid Portion of Pulmonary Subsolid Nodules

PURPOSE: This study aimed to investigate the optimal threshold value in Hounsfield units (HU) on CT to detect the solid components of pulmonary subsolid nodules using pathologic invasive foci as reference. MATERIALS AND METHODS: Thin-section non-enhanced chest CT scans of 25 patients with pathologically confirmed minimally invasive adenocarcinoma were retrospectively reviewed. On CT images, the solid portion was defined as the area with higher attenuation than various HU thresholds ranging from −600 to −100 HU in 50-HU intervals. The solid portion was measured as the largest diameter on axial images and as the maximum diameter on multiplanar reconstruction images. A linear mixed model was used to evaluate bias in each threshold by using the pathological size of invasive foci as reference. RESULTS: At a threshold of −400 HU, the biases were lowest between the largest/maximum diameter of the solid portion of subsolid nodule and the size of invasive foci of the pathological specimen, with 0.388 and −0.0176, respectively. They showed insignificant difference (p = 0.2682, p = 0.963, respectively) at a threshold of −400 HU. CONCLUSION: For quantitative analysis, −400 HU may be the optimal threshold to define the solid portion of subsolid nodules as a surrogate marker of invasive foci.