European Radiology

, Volume 29, Issue 4, pp 2098–2106 | Cite as

Precision and reliability of liver iodine quantification from spectral detector CT: evidence from phantom and patient data

  • Nils Große HokampEmail author
  • Nuran Abdullayev
  • Thorsten Persigehl
  • Max Schlaak
  • Christian Wybranski
  • Jasmin A Holz
  • Thomas Streichert
  • Hatem Alkadhi
  • David Maintz
  • Stefan Haneder
Computed Tomography



To comprehensively assess precision, reproducibility, and repeatability of iodine maps from spectral detector CT (SDCT) in a phantom and in patients with repetitive examination of the abdomen.


Seventy-seven patients who underwent examination two (n = 52) or three (n = 25) times according to clinical indications were included in this IRB-approved, retrospective study. The anthropomorphic liver phantom and all patients were scanned with a standardized protocol (SSDE in patients 15.8 mGy). In patients, i.v. contrast was administered and portal venous images were acquired using bolus-tracking technique. The phantom was scanned three times at three time points; in one acquisition, image reconstruction was repeated three times. Region of interest (ROI) were placed automatically (phantom) or manually (patients) in the liver parenchyma (mimic) and the portal vein; attenuation in conventional images (CI [HU]) and iodine map concentrations (IM [mg/ml]) were recorded. The coefficient of variation (CV [%]) was used to compare between repetitive acquisitions. If present, additional ROI were placed in cysts (n = 29) and hemangioma (n = 29).


Differences throughout all phantom examinations were < 2%. In patients, differences between two examinations were higher (CV for CI/IM: portal vein, 2.5%/3.2%; liver parenchyma, -0.5%/-3.0% for CI/IM). In 80% of patients, these differences were within a ± 20% limit. Differences in benign liver lesions were even higher (68% and 38%, for CI and IM, respectively).


Iodine maps from SDCT allow for reliable quantification of iodine content in phantoms; while in patients, rather large differences between repetitive examinations are likely due to differences in biological distribution. This underlines the need for careful clinical interpretation and further protocol optimization.

Key Points

Spectral detector computed tomography allows for reliable quantification of iodine in phantoms.

In patients, the offset between repetitive examinations varies by 20%, likely due to differences in biological distribution.

Clinically, iodine maps should be interpreted with caution and should take the intra-individual variability of iodine distribution over time into account.


Contrast media Reproducibility of results Phantoms, imaging Liver Tomography, X-ray computed 



Acquisition number


Conventional images


(modified) Coefficient of variation


Dual-energy computed tomography


Hepatocellular carcinoma


Iodine maps


Response evaluation criteria in solid tumors


Reconstruction number


Spectral detector computed tomography


Time point



Parts of this study were funded under a research agreement between Case Western Reserve University, University Hospitals Cleveland Medical Center, and Philips Healthcare.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Nils Große Hokamp.

Conflict of interest

NGH and DM are on the speaker’s bureau of Philips Healthcare. DM received speaker’s honoraria from Philips Healthcare, not related to this project. NA, MS, CW, TS, AJH, TP, AH, and SH have nothing to disclose.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2018_5744_MOESM1_ESM.docx (2.8 mb)
ESM 1 (DOCX 2865 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Nils Große Hokamp
    • 1
    • 2
    • 3
    Email author
  • Nuran Abdullayev
    • 1
  • Thorsten Persigehl
    • 1
  • Max Schlaak
    • 4
  • Christian Wybranski
    • 1
  • Jasmin A Holz
    • 1
  • Thomas Streichert
    • 5
  • Hatem Alkadhi
    • 6
  • David Maintz
    • 1
  • Stefan Haneder
    • 1
  1. 1.Institute for Diagnostic and Interventional RadiologyUniversity Hospital CologneCologneGermany
  2. 2.Department of RadiologyCase Western Reserve UniversityClevelandUSA
  3. 3.Department of RadiologyUniversity Hospitals Medical CenterClevelandUSA
  4. 4.Department of DermatologyUniversity Hospital CologneCologneGermany
  5. 5.Institute for Laboratory MedicineUniversity Hospital CologneCologneGermany
  6. 6.Institute of Diagnostic and Interventional Radiology, University Hospital ZurichUniversity of ZurichZurichSwitzerland

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