Preoperative normalized iodine concentration derived from spectral CT is correlated with early recurrence of hepatocellular carcinoma after curative resection

Luo, Ningbin; Li, Wenzhu; Xie, Jing; Fu, Danhui; Liu, Lidong; Huang, Xuanping; Su, Danke; Jin, Guanqiao

doi:10.1007/s00330-020-07330-6

Cited by 7 publications

(9 citation statements)

References 35 publications

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“…Compared with traditional mixed-energy CT, spectral CT has diverse imaging parameters, including base material and single-energy CT imaging. Previous studies showed that the IoD can reflect the tumor microvessel density [ 22 , 33 ]. Tumor microvessels lack the normal vascular wall composition, resulting in retention or extravasation of iodine in the tumor.…”

Section: Discussionmentioning

confidence: 99%

“…As a new imaging modality, multiparametric spectral CT has been widely used to evaluate liver diseases [ 19 ]. Due to its multiparametric imaging characteristics, this method can evaluate tumor cell proliferation [ 20 ], microvessel density [ 21 ], and fiber structure [ 22 ], and it is widely used in clinical practice. In addition, bevacizumab does not lead to reduced size of the lesion in early post-chemotherapy phase but caused decreased iodine concentration.…”

Section: Introductionmentioning

confidence: 99%

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Early evaluation of liver metastasis using spectral CT to predict outcome in patients with colorectal cancer treated with FOLFOXIRI and bevacizumab

Yuan

Yue

et al. 2023

Cancer Imaging

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Purpose Early evaluation of the efficacy of first-line chemotherapy combined with bevacizumab in patients with colorectal cancer liver metastasis (CRLM) remains challenging. This study used 2-month post-chemotherapy spectral computed tomography (CT) to predict the overall survival (OS) and response of CRLM patients with bevacizumab-containing therapy. Method This retrospective analysis was performed in 104 patients with pathologically confirmed CRLM between April 2017 and October 2021. Patients were treated with 5-fluorouracil, leucovorin, oxaliplatin or irinotecan with bevacizumab. Portal venous phase spectral CT was performed on the target liver lesion within 2 months of commencing chemotherapy to demonstrate the iodine concentration (IoD) of the target liver lesion. The patients were classified as responders (R +) or non-responders (R −) according to the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 at 6 months. Multivariate analysis was performed to determine the relationships of the spectral CT parameters, tumor markers, morphology of target lesions with OS and response. The differences in portal venous phase spectral CT parameters between the R + and R − groups were analyzed. Receiver operating characteristic (ROC) curves were used to evaluate the predictive power of spectral CT parameters. Results Of the 104 patients (mean age ± standard deviation: 57.73 years ± 12.56; 60 men) evaluated, 28 (26.9%) were classified as R + . Cox multivariate analysis identified the iodine concentration (hazard ratio [HR]: 1.238; 95% confidence interval [95% CI]: 1.089–1.408; P < 0.001), baseline tumor longest diameter (BLD) (HR: 1.022; 95% CI: 1.005–1.038, P = 0.010), higher baseline CEA (HR: 1.670; 95% CI: 1.016–2.745, P = 0.043), K-RAS mutation (HR: 2.027; 95% CI: 1.192–3.449; P = 0.009), and metachronous liver metastasis (HR: 1.877; 95% CI: 1.179–2.988; P = 0.008) as independent risk factors for patient OS. Logistic multivariate analysis identified the IoD (Odds Ratio [OR]: 2.243; 95% CI: 1.405–4.098; P = 0.002) and clinical N stage of the primary tumor (OR: 4.998; 95% CI: 1.210–25.345; P = 0.035) as independent predictor of R + . Using IoD cutoff values of 4.75 (100ug/cm3) the area under the ROC curve was 0.916, sensitivity and specificity were 80.3% and 96.4%, respectively. Conclusions Spectral CT IoD can predict the OS and response of patients with CRLM after 2 months of treatment with bevacizumab-containing therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early evaluation of liver metastasis using spectral CT to predict outcome in patients with colorectal cancer treated with FOLFOXIRI and bevacizumab

Yuan

Yue

et al. 2023

Cancer Imaging

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“…Most recently, two studies found dual-energy CT parameters including iodine concentration to be useful for the identification of pulmonary nodules regarding primary lung cancer and pulmonary metastasis in thyroid cancer 24 25 . Moreover, iodine concentration was found to be a useful marker for vascularization in treatment response assessment in lung cancer 8 26 , renal cell cancer 27 , hepatocellular carcinoma 9 28 , and gastrointestinal stroma tumor 29 . In a recent study on the local recurrence of pancreatic ductal adenocarcinoma, iodine concentration was also identified as a potential tool for differentiating non-specific post-operative tissue proliferation 30 .…”

Section: Discussionmentioning

confidence: 99%

“…Clinical studies have already shown the benefit of iodine concentration as a marker of lesion vascularization for different solid tumors. For instance, recent studies found iodine concentration to be a useful indicator for evaluating tumor angiogenesis and prognosis in lung cancer [8] and hepatocellular carcinoma [9].…”

Section: Introductionmentioning

confidence: 99%

Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity

Gehling

Mokry

Duong

et al. 2022

Rofo

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Purpose In patients with malignant lymphoma, disease activity is recommended to be assessed by FDG-PET/CT and the Deauville five-point scale (5-PS). The purpose of this study was to explore the potential of iodine concentration measured in contrast-enhanced dual-layer spectral detector CT (SDCT) as an alternative surrogate parameter for lymphoma disease activity by investigating its correlation with maximum standardized uptake values (SUVmax) and 5-PS. Materials and Methods 25 patients were retrospectively analyzed. Contrast-enhanced SDCT and FDG-PET/CT were performed in the same treatment interval within at most 3 months. CT attenuation values (AV), absolute iodine concentrations (aIC), and normalized iodine concentrations (nIC) of lymphoma lesions were correlated with SUVmax using Spearman’s rank correlation coefficient. The performance of aIC and nIC to detect lymphoma activity (defined as 5-PS > 3) was determined using ROC curves. Results 60 lesions were analyzed, and 31 lesions were considered active. AV, aIC, and nIC all correlated significantly with SUVmax. The strongest correlation (Spearman ρ = 0.71; p < 0.001) and highest area under the ROC curve (AUROC) for detecting lymphoma activity were observed for nIC normalized to inferior vena cava enhancement (AUROC = 0.866). The latter provided sensitivity, specificity, and diagnostic accuracy of 87 %, 75 %, and 80 %, respectively, at a threshold of 0.20. ROC analysis for AV (AUROC = 0.834) and aIC (AUROC = 0.853) yielded similar results. Conclusion In malignant lymphomas, there is a significant correlation between metabolic activity as assessed by FDG-PET/CT and iodine concentration as assessed by SDCT. Iodine concentration shows promising diagnostic performance for detecting lymphoma activity and may represent a potential imaging biomarker. Key Points: Citation Format

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“…Medical imaging is an integral component of the routine management of patients with HCC. As imaging closely correlates with histopathologic traits of the tumor, some imaging features may reasonably predict early HCC tumor recurrence ( 16 – 18 ).…”

Section: Introductionmentioning

confidence: 99%

Use of radiomics containing an effective peritumoral area to predict early recurrence of solitary hepatocellular carcinoma ≤5 cm in diameter

Wang

Cheng

et al. 2022

Front. Oncol.

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BackgroundHepatocellular carcinoma (HCC) is the sixth leading type of cancer worldwide. We aimed to develop a preoperative predictive model of the risk of early tumor recurrence after HCC treatment based on radiomic features of the peritumoral region and evaluate the performance of this model against postoperative pathology.MethodOur model was developed using a retrospective analysis of imaging and clinicopathological data of 175 patients with an isolated HCC ≤5 cm in diameter; 117 patients were used for model training and 58 for model validation. The peritumoral area was delineated layer-by-layer for the arterial and portal vein phase on preoperative dynamic enhanced computed tomography images. The volume area of interest was expanded by 5 and 10 mm and the radiomic features of these areas extracted. Lasso was used to select the most stable features.ResultsThe radiomic features of the 5-mm area were sufficient for prediction of early tumor recurrence, with an area under the curve (AUC) value of 0.706 for the validation set and 0.837 for the training set using combined images. The AUC of the model using clinicopathological information alone was 0.753 compared with 0.786 for the preoperative radiomics model (P >0.05).ConclusionsRadiomic features of a 5-mm peritumoral region may provide a non-invasive biomarker for the preoperative prediction of the risk of early tumor recurrence for patients with a solitary HCC ≤5 cm in diameter. A fusion model that combines the radiomic features of the peritumoral region and postoperative pathology could contribute to individualized treatment of HCC.

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Preoperative normalized iodine concentration derived from spectral CT is correlated with early recurrence of hepatocellular carcinoma after curative resection

Cited by 7 publications

References 35 publications

Early evaluation of liver metastasis using spectral CT to predict outcome in patients with colorectal cancer treated with FOLFOXIRI and bevacizumab

Early evaluation of liver metastasis using spectral CT to predict outcome in patients with colorectal cancer treated with FOLFOXIRI and bevacizumab

Dual-Layer Spectral Detector CT in Comparison with FDG-PET/CT for the Assessment of Lymphoma Activity

Use of radiomics containing an effective peritumoral area to predict early recurrence of solitary hepatocellular carcinoma ≤5 cm in diameter

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