Stefania Rizzo1, Davide Radice2, Marco Femia3, Paolo De Marco4, Daniela Origgi4, Lorenzo Preda5,6, Massimo Barberis7, Raffaella Vigorito3, Giovanni Mauri8, Alberto Mauro9, Massimo Bellomi10,11. 1. Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy. stefania.rizzo@ieo.it. 2. Department of Epidemiology and Biostatistics, via Ramusio,1, 20141, Milan, Italy. 3. Department of Health Sciences, Università di Milano, via Festa del Perdono 7, 20142, Milan, Italy. 4. Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy. 5. Division of Radiology, National Centre of Oncological Hadrontherapy (CNAO Foundation), Str. Campeggi 53, 27100, Pavia, Italy. 6. Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy. 7. Department of Pathology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy. 8. Division of Interventional Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy. 9. GE Medical Systems Italia SpA, via Galeno 36, 20126, Milan, Italy. 10. Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141, Milan, Italy. 11. Department of Oncology, Università di Milano, via Festa del Perdono 7, 20142, Milan, Italy.
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.
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.
Entities:
Keywords:
Computed tomography; Iodine; Lymph nodes; Lymphatic metastasis; Tissue distribution
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