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Comparison of dual-energy CT-derived iodine content and iodine overlay of normal, inflammatory and metastatic squamous cell carcinoma cervical lymph nodes

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To evaluate whether dual-energy computed tomography (DECT)-derived iodine content and iodine overlay could differentiate between normal, inflammatory and metastatic squamous cell carcinoma (SCC) cervical lymph nodes.


This study was approved by the institutional review board. Sixteen patients with normal lymph nodes, 20 patients with enlarged nodes draining deep cervical inflammations and 23 patients with pathologically proved metastatic SCC nodes who underwent contrast enhanced DECT were retrospectively identified. Iodine content and overlay of 36 normal, 43 inflammatory and 52 metastatic lymph nodes were calculated using circular regions of interest and compared among the three groups. A receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of iodine content and overlay for diagnosis of metastatic nodes.


Iodine content (mg/ml) was significantly lower for metastatic lymph nodes (2.34 ± 0.45) than for normal (2.86 ± 0.37) and inflammatory (3.53 ± 0.56) lymph nodes, P < 0.0001. Iodine overlay (HU) was also significantly lower for metastatic lymph nodes (47 ± 11.6) than normal (57.4 ± 8.2) and inflammatory nodes (69.3 ± 11.5), P < 0.0001. The areas under the ROC curve for iodine content and iodine overlay were 0.923 and 0.896.


DECT-derived iodine content and overlay differ significantly among normal, inflammatory and metastatic SCC cervical lymph nodes.

Key points

Derived iodine content can be calculated from contrast-enhanced dual-energy CT.

Derived iodine content and iodine overlay could help characterise cervical lymph nodes.

Iodine parameters were significantly lower in metastatic lymph nodes than normal/inflammatory lymph nodes.

Iodine content appears more sensitive than iodine overlay for lymph node characterisation.

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An oral presentation containing some data from this article was presented by the same authors in ECR 2012, with the title “Dual energy CT-derived iodine content and iodine overlay for characterisation of enlarged cervical lymph nodes”.

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Correspondence to Ahmed M. Tawfik.

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Tawfik, A.M., Razek, A.A., Kerl, J.M. et al. Comparison of dual-energy CT-derived iodine content and iodine overlay of normal, inflammatory and metastatic squamous cell carcinoma cervical lymph nodes. Eur Radiol 24, 574–580 (2014).

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