Abstract
Objectives
To evaluate quantification of iodine uptake in metastatic and non-metastatic lymph nodes (LNs) by dual-energy CT (DECT) and to assess if the distribution of iodine within LNs at DECT correlates with the pathological structure.
Methods
Ninety LNs from 37 patients (23 with lung and 14 with gynaecological malignancies) were retrospectively selected. Information of LNs sent for statistical analysis included Hounsfield units (HU) at different energy levels; decomposition material densities fat–iodine, iodine–fat, iodine–water, water–iodine. Statistical analysis included evaluation of interobserver variability, material decomposition densities and spatial HU distribution within LNs.
Results
Interobserver agreement was excellent. There was a significant difference in iodine–fat and iodine–water decompositions comparing metastatic and non-metastatic LNs (p < 0.001); fat–iodine and water–iodine did not show significant differences. HU distribution showed a significant gradient from centre to periphery within non-metastatic LNs that was significant up to 20–30% from the centre, whereas metastatic LNs showed a more homogeneous distribution of HU, with no significant gradient.
Conclusions
DECT demonstrated a lower iodine uptake in metastatic compared to non-metastatic LNs. Moreover, the internal iodine distribution showed an evident gradient of iodine distribution from centre to periphery in non-metastatic LNs, and a more homogeneous distribution within metastatic LNs, which corresponded to the pathological structure.
Key points
• This study demonstrated a lower iodine uptake in metastatic than non-metastatic LNs.
• Internal distribution of HU was different between metastatic and non-metastatic lymph nodes.
• The intranodal iodine distribution disclosed a remarkable correlation with the histological LN structure.
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Abbreviations
- DECT:
-
Dual-energy computed tomography
- HU:
-
Hounsfield units
- keV:
-
Kilo electron volt
- kV:
-
Kilovolt
- LN(s):
-
Lymph node(s)
- LS:
-
Least-squares
- SE:
-
Standard error
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Acknowledgements
The English text has been revised by Anne Prudence Collins (Editor and Translator Medical & Scientific Publications).
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Guarantor
The scientific guarantor of this publication is Stefania Rizzo, MD, Istituto Europeo di Oncologia.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Alberto Mauro is an employee of GE healthcare, who helped the authors in setting the CT protocol, and did not alter in any way the data collected for this article.
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Funding
The authors state that this work has not received any funding.
Statistics and biometry
One of the authors (Davide Radice) has significant statistical expertise.
Informed consent
Written informed consent was obtained from all patients in this study.
Ethical approval
Institutional review board approval was obtained.
Methodology
• retrospective
• observational
• performed at one institution
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Rizzo, S., Radice, D., Femia, M. et al. Metastatic and non-metastatic lymph nodes: quantification and different distribution of iodine uptake assessed by dual-energy CT. Eur Radiol 28, 760–769 (2018). https://doi.org/10.1007/s00330-017-5015-5
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DOI: https://doi.org/10.1007/s00330-017-5015-5