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Metastatic and non-metastatic lymph nodes: quantification and different distribution of iodine uptake assessed by dual-energy CT

  • Computed Tomography
  • Published:
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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).

Author information

Authors and Affiliations

  1. Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy

    Stefania Rizzo & Massimo Bellomi

  2. Department of Epidemiology and Biostatistics, via Ramusio,1, 20141, Milan, Italy

    Davide Radice

  3. Department of Health Sciences, Università di Milano, via Festa del Perdono 7, 20142, Milan, Italy

    Marco Femia & Raffaella Vigorito

  4. Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy

    Paolo De Marco & Daniela Origgi

  5. Division of Radiology, National Centre of Oncological Hadrontherapy (CNAO Foundation), Str. Campeggi 53, 27100, Pavia, Italy

    Lorenzo Preda

  6. Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy

    Lorenzo Preda

  7. Department of Pathology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy

    Massimo Barberis

  8. Division of Interventional Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy

    Giovanni Mauri

  9. GE Medical Systems Italia SpA, via Galeno 36, 20126, Milan, Italy

    Alberto Mauro

  10. Department of Oncology, Università di Milano, via Festa del Perdono 7, 20142, Milan, Italy

    Massimo Bellomi

Authors
  1. Stefania Rizzo
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  2. Davide Radice
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  3. Marco Femia
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  4. Paolo De Marco
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  5. Daniela Origgi
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  6. Lorenzo Preda
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  7. Massimo Barberis
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  8. Raffaella Vigorito
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  9. Giovanni Mauri
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  10. Alberto Mauro
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  11. Massimo Bellomi
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Corresponding author

Correspondence to Stefania Rizzo.

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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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Cite this article

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

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