European Radiology

, Volume 26, Issue 9, pp 2929–2936 | Cite as

Iodine concentration as a perfusion surrogate marker in oncology: Further elucidation of the underlying mechanisms using Volume Perfusion CT with 80 kVp

  • Wolfgang M. Thaiss
  • Ulrike Haberland
  • Sascha Kaufmann
  • Daniel Spira
  • Christoph Thomas
  • Konstantin Nikolaou
  • Marius Horger
  • Alexander W. SauterEmail author
Computed Tomography



To assess the value of iodine concentration (IC) in computed tomography data acquired with 80 kVp, as a surrogate for perfusion imaging in hepatocellular carcinoma (HCC) and lymphoma by comparing iodine related attenuation (IRA) with quantitative Volume Perfusion CT (VPCT)-parameters.


VPCT-parameters were compared with intra-tumoral IC at 5 time points after the aortic peak enhancement (APE) with a temporal resolution of 3.5 sec in untreated 30 HCC and 30 lymphoma patients.


Intra-tumoral perfusion parameters for HCC showed a blood flow (BF) of 52.7 ± 17.0 mL/100 mL/min, blood volume (BV) 12.6 ± 4.3 mL/100 mL, arterial liver perfusion (ALP) 44.4 ± 12.8 mL/100 mL/min. Lesion IC 7 sec after APE was 133.4 ± 57.3 mg/100 mL. Lymphoma showed a BF of 36.8 ± 13.4 mL/100 mL/min, BV of 8.8 ± 2.8 mL/100 mL and IC of 118.2 ± 64.5 mg/100 mL 3.5 sec after APE. Strongest correlations exist for VPCT-derived BF and ALP with IC in HCC 7 sec after APE (r = 0.71 and r = 0.84) and 3.5 sec after APE in lymphoma lesions (r = 0.77). Significant correlations are also present for BV (r = 0.60 and r = 0.65 for HCC and lymphoma, respectively).


We identified a good, time-dependent agreement between VPCT-derived flow values and IC in HCC and lymphoma. Thus, CT-derived ICs 7 sec after APE in HCC and 3.5 sec in lymphoma may be used as surrogate imaging biomarkers for tumor perfusion with 80 kVp.

Key points

Iodine concentration derived from low kVp CT is regarded as perfusion surrogate

Correlation with Perfusion CT was performed to elucidate timing and histology dependencies

Highest correlation was present 7 sec after aortic peak enhancement in hepatocellular carcinoma

In lymphoma, highest correlation was calculated 3.5 sec after aortic peak enhancement

With these results, further optimization of Dual energy CT protocols is possible


Contrast media Perfusion imaging Multislice computed tomography Hepatocellular carcinoma Lymphoma 



Arterial liver perfusion


Arterial peak enhancement


Blood flow


Blood volume


Dual Energy CT


Iodine concentration


Iodine related attenuation


Flow extraction product


Portal venous perfusion


Volume Perfusion CT



The scientific guarantor of this publication is Marius Morger. The authors of this manuscript declare relationships with the following companies: Siemens AG. U.H. is an employee at Siemens Healthcare AG. The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. A.W.S. and W.M.T kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective / experimental performed at one institution.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Wolfgang M. Thaiss
    • 1
  • Ulrike Haberland
    • 2
  • Sascha Kaufmann
    • 1
  • Daniel Spira
    • 1
    • 3
  • Christoph Thomas
    • 1
    • 4
  • Konstantin Nikolaou
    • 1
  • Marius Horger
    • 1
  • Alexander W. Sauter
    • 1
    • 5
    Email author
  1. 1.Department of Radiology, Diagnostic and Interventional RadiologyEberhard Karls UniversityTübingenGermany
  2. 2.Siemens AG, Healthcare Sector, Computed Tomography, H IM CR R&D PA SCForchheimGermany
  3. 3.Diagnostic and Interventional RadiologyUniversity Medical Center HeidelbergHeidelbergGermany
  4. 4.Institute for Diagnostic and Interventional RadiologyUniversity Hospital DüsseldorfDüsseldorfGermany
  5. 5.Department of Radiology and Nuclear Medicine, Division of Nuclear MedicineUniversity Hospital BaselBaselSwitzerland

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