Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review
Abstract
:1. Introduction
DECT and Iodine Quantification
2. Materials and Methods
2.1. Search Strategy
2.2. Study Selection
2.3. Quality Assessment
3. Results
3.1. Gastric Tumors
3.2. Colorectal Tumors
3.3. Crohn’s Disease
3.4. Miscellaneous Applications
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
AP | Arterial phase |
CDAI | Crohn’s disease activity index |
CT | Computed tomography |
DECT | Dual-energy Computed Tomography |
DP | Delayed phase |
GIST | Gastrointestinal stromal tumor |
IC | Iodine concentration |
IC-A | Iodine concentration in arterial phase |
IC-V | Iodine concentration in venous phase |
IQ | Iodine quantification |
KeV | Kiloelectron volt |
kVp | Peak kilovoltage |
HU | Hounsfield unit |
MDCT | Multi-detector computed tomography |
MeSH | Medical subject heading |
MSI | Microsatellite instability |
MSS | Microsatellite stability |
MVD | Microvascular density |
nIC | Normalized iodine concentration |
nIC-A | Normalized iodine concentration in arterial phase |
nIC-V | Normalized iodine concentration in venous phase |
nIC-D | Normalized iodine concentration in delayed phase |
PRISMA | Preferred reporting items for systematic reviews and meta-analyses |
QUADAS-2 | Quality Assessment of Diagnostic Accuracy Studies 2 |
RCRG | Rectal cancer regression grade |
RECIST | Response evaluation criteria in solid tumors |
ROI | Region of interest |
VM | Virtual monoenergetic |
VP | Venous phase |
VNC | Virtual non-contrast |
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Author | Year | Focus | Population | DECT Scanner | kV Range | Contrast | Flow Rate | Total Iodine | ROI Placement | Reference | Phase | Normalization | Outcome Measure | Findings |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Pan [36] | 2013 | Degree of differentiation gastric cancer | 96 | Discovery CT750 HD, GE Healthcare | 80/140 | Ultravist 300 mg I/mL | 3 mL/s | 85–110 mL | Lesion and the normal gastric wall. | Pathology | AP/VP | Aorta | nIC-A, nIC-V | Significant difference between well-differentiated and poorly differentiated adenocarcinoma in both phases (nIC-A: p < 0.02, nIC-V: p < 0.05). Significant difference between metastatic and non-metastatic lymph nodes. nIC had no correlation with cancer subtypes. |
Tang [45] | 2015 | Evaluating the response of gastric carcinomas to neoadjuvant chemotherapy | 20 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 3.5 mL/s | 1.5 mL/kg | N/A | Pathology | AP/VP | N/A | IC-A, IC-V, | % decrease in IC-A was significantly different in good response group vs. poor response group (p = 0.012) |
Yang [40] | 2015 | Assessment of IC in perigastric fat in gastric cancer patients with and without serosal invasion (Stage T4a) | 54 | SOMATOM Definition Flash, Siemens Healthcare | 100/140 | Omnipaque 300 mg I/mL | 3.0 mL/s | 2 mL/kg | Perigastric fat adjacent to tumor | Pathology | AP/VP | N/A | IC-A, IC-V | Significant difference between patients with and without serosal invasion in both phases (p < 0.001) |
Liang [37] | 2017 | Correlation with clinicopathologically determined prognostic factors in gastric adenocarcinoma (TNM, MVD) | 34 | Discovery CT750 HD, GE Healthcare | N/A | Optiray 320 mg I/mL | 3 mL/s | 1.5 mL/kg | Area that encompassed the entire tumor, away from any peripheral fat and necrotic areas. | Pathology | AP/VP | Aorta | nIC-A, nIC-V | Significant difference between moderately and poorly differentiated adenocarcinoma (nIC-A: p = 0.005, nIC-V: p = 0.013). Positive correlation between nIC and MVD (nIC-A: r = 0.423, nIC-V: r = 0.542). No correlation with lymphatic metastasis or TNM stage (nIC-A: r = 0.119, nIC-V: r = 0.097) |
Liu [46] | 2017 | Value of DECT in Gastric schwanomma and GIST | 12 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 3–4 mL/s | 1.0 mL/kg | Tumor; avoiding necrosis and cystic areas, calcification, and larger vessels | Pathology | AP/VP | N/A | IC-A, IC-V | Significant difference in IC betweengastric schwanommas and GIST (p < 0.001) |
Chen [38] | 2017 | Correlation with MVD in gastric cancer patients | 34 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 350 mg I/mL | 2.5–4.5 mL/s | 60–110 mL | Lesion; avoiding artifacts, necrosis, and vessels | Pathology | AP/VP | Aorta | nIC-A, nIC-V | Significant difference between well and poorly differentiated adenocarcinoma (nIC-A: p < 0.003, nIC-V: p < 0.001). Positive correlation between nIC and MVD (nIC-A: r = 0.423, nIC-V: r = 0.606). |
Meng [47] | 2017 | Differentiation between malignant and benign gastric lesions (Cancer, Inflammation, normal) | 161 | Discovery CT750 HD, GE Healthcare | 80/140 | Ultravist 370 mg I/mL | 3–4 mL/s | 1.0 mL/kg | Lesion; avoiding cystic, necrosis, and hemorrhage | Pathology | AP/VP | Aorta | nIC-A, nIC-V, IC-A, IC-V | nIC and IC in gastric cancer differed significantly from normal mucosa and gastric inflammation (p < 0.05, aside from nIC-A: p = 0.116) |
Xie [41] | 2018 | T and N staging of gastric cancer | 71 | SOMATOM Definition Flash, Siemens Healthcare | 100/140 | Omnipaque 350 mg I/mL | 2.5–3 mL/s | 70 mL | Tumor and extraserosal fat | Pathology | AP/VP/DP | Aorta | nIC-A, nIC-V, nIC-D | Significant difference between T3 and T4 in extraserosal fat in arterial and dealyed phase (nIC-A: p = 0.004, nIC-D: p = 0.001). No significant findings between differentiated vs. Undifferetiated adenocarcinoma (nIC-A: p = 0.06, nIC-V: p = 0.07, nIC-D: p = 0.09) with ROI placement on tumor |
Yang [42] | 2018 | IC in perigastric adipose tissue in the assessment of Serosal Invasion in Patients with Gastric Cancer after Neoadjuvant Chemotherapy | 43 | SOMATOM Definition Flash, Siemens Healthcare | 100/140 | Omnipaque 300 mg I/mL | 3.0 mL/s | 2 mL/kg | Perigastric adipose tissue without blood vessels or other tissues | Pathology | AP/VP | Aorta | nIC-V, IC-V | Significant difference between patients with and without serosal invasion pre- and post neoadjuvant chemotherapy (p < 0.05) aside from nIC in patients with serosal invasion prior to chemotherapy (p = 0.10) |
Cheng [44] | 2018 | Correlation with Ki-67 protein level expression in advanced & early Gastric cancer | 162 | Discovery CT750 HD, GE Healthcare | 80/140 | Iopamidol 370 mg I/mL | 3.0 mL/s | 1.8 mL/kg | Solid tumor; avoiding necrotic and fat areas | Pathology | AP/VP/DP | Aorta | nIC-A, nIC-V, nIC-D, IC-A, IC-V, IC-D | Significant difference between early (confined to mucosa/submucosa) vs. advanced gastric cancer (invasion of the submucosa) in nIC-V/D (p = 0.002, p = 0.000) and IC-V/D (p = 0.029, p = 0.002). Ki/67 correlates well with nIC-V/D (r = 0.753, r = 0.745) and IC-V/D (r = 0.818, r = 0.730) |
Li [39] | 2018 | Discrimination between benign and malignant & correlation to degree of differention | 87 | Discovery CT750 HD, GE Healthcare | 80/140 | Ultravist 370 mg I/mL | 3.0 mL/s | 1.5 mL/kg | Solid part of the tumor; avoiding peripheral fat, visible vessel, calcification and cystic/necrotic areas. | Pathology | AP/VP | Aorta | nIC-A, nIC-V, IC-A, IC-V | Significant difference between well-differentiated and poorly differentiated adenocarcinoma in all phases (p < 0.0001, except nIC-A: p = 0.0445). |
Küpeli [43] | 2019 | IC measurements in the perigastric fat and its’ correlation with gastric cancer TNM staging | 41 | Aquilion, Toshiba Medical Systems | 80/130 | (nonionic contrast agent) | 4.0 mL/s | 2 mL/kg | Normal gastric tissue, tumor and perigastric fat | Pathology | AP/VP | N/A | IC-A, IC-V | Significant difference in IC-A (p < 0.001) and IC-V (p < 0.001) between patients with serosal invasion (T4) vs. Absent(T1-3) |
Author | Year | Focus | Population | DECT Scanner | kVp Range | Contrast | Flow Rate | Total Iodine | ROI Placement | Reference | Phase | Normalization | Outcome Measure | Findings |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Gong [48] | 2016 | Colorectal cancer differentiation degree | 81 | Discovery CT750 HD, GE Healthcare | N/A | Iopamidol 370 mg I/mL | 3.5 mL/s | 1.8 mL/kg | Solid tumor regions avoiding areas with obvious features of cystic or necrotic change | Pathology | VP | Psoas muscle | nIC-A, nIC-V, IC-A, IC-V | Significant difference between well and moderately differentiated vs. Poorly differentiated colonic adenocarcinoma in all phases (p = 0.000) |
Al-Najami [50] | 2017 | Regression assessment in rectal cancer patients following neoadjuvant chemoradiotherapy treatment | 11 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 3 mL/s | 1 mL/kg | Tumor; based on a macroscopic evaluation of the most representative images of associated MRI scan | Pathology (RCRG) | N/A | N/A | IC | Significant difference in IC in partial and complete response group following neoadjuvant chemoradiotherapy treatment (p < 0.05) |
Chaung-bo [49] | 2017 | Colon cancer differentiation degree | 47 | Discovery CT750 HD, GE Healthcare | N/A | Iohexol 300 mg I/mL | 3–4 mL/s | 0.8–1 mL/kg | Tumor tissue; avoiding areas of necrosis, calcification, and artifacts caused by the gas and liquid interface | Pathology | AP/VP | Aorta or iliac artery | nIC-A, nIC-V, IC-A, IC-V | Significant difference in nIC-A (p = 0.02) and IC-A (p = 0.001) between poorly and well-dffierentiated colon cancer |
Fan [53] | 2017 | Correlation with Ki-67 and HIF-1α in rectal cancer | 80 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 2.5 mL/s | 1.2 mL/kg | Solid tumor regions avoiding areas with obvious features of cystic or necrotic change | Ki-67 and HIF-1α | 70 s | External Iliac artery | nIC-V | Postively correlated with Ki-67 value (r = 0.344, p = 0.002) and HIF-1α levels (r = 0.598, p < 0.001) in rectal cancer patients |
Sun [52] | 2018 | Accuracy of Combined CT Colonography and DECT iodine mapping for Detecting Colorectal masses | 28 | SOMATOM Definition Flash, Siemens Healthcare | 100/140 | Omnipaque 350 mg I/mL | 4.0 mL/s | 60 mL | Tumor | Optical colonoscopy and Pathology | 4 s (post bolus tracking) | N/A | IC-A | Significant difference in IC between stool and colonic neoplasia (p < 0.01). Significant difference nIC between colonic adenomas and adenocarcinomas (p < 0.01) |
Kang [54] | 2018 | Correlation with perfusion CT parameters in colorectal cancer | 41 | SOMATOM Definition Flash, Siemens Healthcare | 80/140 | Bonorex 350 mg I/mL | 4–5 mL/s | 1.125 mL/kg | Tumor | Perfusion CT measurements (Blood flow, blood volume, permeability, mean transit time) | 50 s | Aorta and inferior vena cava | nIC-V, IC-V | IC-V correlates with some perfusion CT parameteres (Blood volume: r = 0.32, p = 0.04; permeability: r = 0.34, p = 0.03; mean transit time: r = −0.38, p = 0.02) |
Wu [55] | 2019 | Discriminating MSI from MSS in human colorectal cancer | 114 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 3–3.5 mL/s | 1.2 mL/kg | Solid tumor; avoiding bleeding, necrosis, and cystic portions | Pathology (Immunohistochemical staining) | AP/VP/DP | External Iliac artery | nIC-A, nIC-V, nIC-D | Significant difference in nIC between MSS and MSI in all phases (p < 0.001) |
Al-Najami [51] | 2019 | Differentiation between malignant and benign rectal tumors | 16 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 3 mL/s | 1 mL/kg | Tumor; most representative areas of evident tumor tissue | Pathology | N/A | N/A | IC | Z-effective was significant between malignant * and benign group (p = 0.03), however IC was nonsignificant (p > 0.05) |
Author | Year | Focus | Population | kVp Range | DECT Scanner | Contrast | Flow Rate | Total Iodine | ROI Placement | Reference | Phase | Normalization | Outcome Measure | Findings: |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Peng [30] | 2016 | Disease activity in ileocolonic crohns disease | 50 | 80/140 | Discovery CT750 HD, GE Healthcare | Iopamidol 370 mg I/mL | 4 mL/s | 1.5 mL/kg | Placed on iodine concentration maps and encompassed the high-enhancing areas | Endoscopy (Simple Endoscopic Score for Crohn’s Disease) | 45 s | Artery (not specified) | nIC-V | Significant differences in nIC-V between endoscopic normal and mild (p = 0.002) as well as mild and severe lesions (p < 0.001) |
Kim [56] | 2018 | Correlation with disease activity index | 39 | 120 | IQon Spectral CT, Philips Healthcare | Iohexol, 350 mg I/mL | 3–5 mL/s | 1.6 mL/kg | Bowel wall with strongest enhancement on iodine concentration maps | Crohn’s disease activity index (CDAI) | VP | N/A | IC-V | Iodine concentrations correlates well with CDAI score (r = 0.744, p < 0.001) |
DeKock [58] | 2019 | Distinguishing normal small bowel from active inflammatory crohns | 40 | 80/140 | SOMATOM Definition Flash, Siemens Healthcare | Visipaque, GE healthcare | 3.5 mL/s | 100 mL | Normal bowel wall = ROI over entire bowel wall. Crohns = ROI placed on mucosa (brightest area) | Endoscopy, biochemistry and clinical symptoms | 70 s | Aorta | nIC-V, IC-V | Significant difference between disease and control group (p < 0.001) |
Dane [57] | 2020 | Correlation with disease activity | 22 | 80/150 | SOMATOM FORCE, Siemens Healthcare | Ultravist 300 mg I/mL | 3–4 mL/s | 1.5 mL/kg | Brightest involved bowel wall segment | Crohn’s disease activity index (CDAI) | 60 s | Aorta | IC-V (Min, max and weighted average) | The ICmax and ICmin of affected bowel differed significantly from normal bowel (p < 0.0001) |
Author | Year | Focus | Population | DECT Scanner | kVp Range | Contrast | Flow Rate | Total Iodine | ROI Placement | Reference | Phase | Normalization | Outcome Measure | Findings: |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Winklhofer [63] | 2016 | Reduction of peristalsis-related gastrointestinal streak artifacts | 100 | Discovery CT750 HD, GE Healthcare | 80/140 | N/A | N/A | N/A | The most visibly bright area of streak artifact in the 70 keV axial images | ROI measurements in streak artifacts vs. non artifact in 70 keV, 120 keV and water (iodine) | VP | N/A | N/A | ROI measurements in areas with and without streak artifcts were non-significant in iodine/water (p = 0.088) compared to monoenergetic images and water/iodine (p < 0.001). Streak artifacts are reduced in iodine/water images |
Lourenco [62] | 2018 | Applications in Acute Bowel ischemia | 60 | SOMATOM Definition Flash, Siemens Healthcare | 100/140 | Omnipaque 350 mg I/mL | 3.5 mL/s | 90 mL | Ischemic and normalbowel | Electronic medical record, procedrual and pathology reports | VP | N/A | IC-V | 65% reduction in IC among patients with confirmed ischemia * |
Ge [59] | 2018 | Iodine concentrations in esophageal cancer before and after chemoradiotherapy | 45 | SOMATOM Definition Flash, Siemens Healthcare | 100/140 | Iohexol 300 mg I/mL | 3 mL/s | 70 mL | Tumor; avoiding tumor margins and necrotic areas | RECIST criteria | AP/VP | Aorta | nIC-A, nIC-V | Significantly lower nIC-A and nIC-V in effective group vs. ineffective group post-chemoradiotherapy (p < 0.05) |
Zhou [31] | 2019 | Differentiation between squamous cell carcinoma and adenocarcinoma in the gastroesophageal junction | 61 | Discovery CT750 HD, GE Healthcare | 80/140 | Iobitrido 350 mg I/mL | 3 mL/s | 1.5 mL/kg | Around the entire lesion | Pathology | AP/VP | Arota | nIC-A, nIC-V (nIC difference, nIC ratio) | Significant difference between squamous cell carcinoma and adenocarcinoma in both phases (nIC-A: p = 0.02, nIC-V: p = 0.00) |
Yang [60] | 2019 | Differetiation between small bowel adenocarcinoma and primary small intestinal lymphoma | 42 | Discovery CT750 HD, GE Healthcare | 80/140 | Omnipaque 300 mg I/mL | 3–4 mL/s | 0.8–1.0 mL/kg | Tumor; avoiding focal necrosis, calcification, and blood vessels | Pathology | AP/VP | Aorta | nIC-A, nIC-V, IC-A, IC-V | Significant difference between small bowel adenocarcinoma and primary small intestinal lymphoma in nIC-A (p = 0.001), nIC-V (p = 0.002) and IC-A (p = 0.003) |
Zhang [32] | 2019 | Value of IC paramenters in gastrointestinal stromal tumor risk stratification | 86 | Discovery CT750 HD, GE Healthcare | N/A | Omnipaque 300 mg I/mL | 3.5–4.0 mL/s | 1.2 mL/kg | Primary lesion and normal intestinal wall | Pathology (GIST recurrence risk stratification criteria) | AP/VP/DP | Aorta | nIC-A, nIC-V, nIC-D | Significant difference between high risk and intermediate/low risk GIST patients in all phases (p < 0.001) |
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Xu, J.J.; Taudorf, M.; Ulriksen, P.S.; Achiam, M.P.; Resch, T.A.; Nielsen, M.B.; Lönn, L.B.; Hansen, K.L. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review. Diagnostics 2020, 10, 814. https://doi.org/10.3390/diagnostics10100814
Xu JJ, Taudorf M, Ulriksen PS, Achiam MP, Resch TA, Nielsen MB, Lönn LB, Hansen KL. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review. Diagnostics. 2020; 10(10):814. https://doi.org/10.3390/diagnostics10100814
Chicago/Turabian StyleXu, Jack Junchi, Mikkel Taudorf, Peter Sommer Ulriksen, Michael Patrick Achiam, Timothy Andrew Resch, Michael Bachmann Nielsen, Lars Birger Lönn, and Kristoffer Lindskov Hansen. 2020. "Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review" Diagnostics 10, no. 10: 814. https://doi.org/10.3390/diagnostics10100814