Skip to main content

Advertisement

Log in

Comparison of dual-energy CT-derived iodine content and iodine overlay of normal, inflammatory and metastatic squamous cell carcinoma cervical lymph nodes

  • Head and Neck
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate whether dual-energy computed tomography (DECT)-derived iodine content and iodine overlay could differentiate between normal, inflammatory and metastatic squamous cell carcinoma (SCC) cervical lymph nodes.

Methods

This study was approved by the institutional review board. Sixteen patients with normal lymph nodes, 20 patients with enlarged nodes draining deep cervical inflammations and 23 patients with pathologically proved metastatic SCC nodes who underwent contrast enhanced DECT were retrospectively identified. Iodine content and overlay of 36 normal, 43 inflammatory and 52 metastatic lymph nodes were calculated using circular regions of interest and compared among the three groups. A receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of iodine content and overlay for diagnosis of metastatic nodes.

Results

Iodine content (mg/ml) was significantly lower for metastatic lymph nodes (2.34 ± 0.45) than for normal (2.86 ± 0.37) and inflammatory (3.53 ± 0.56) lymph nodes, P < 0.0001. Iodine overlay (HU) was also significantly lower for metastatic lymph nodes (47 ± 11.6) than normal (57.4 ± 8.2) and inflammatory nodes (69.3 ± 11.5), P < 0.0001. The areas under the ROC curve for iodine content and iodine overlay were 0.923 and 0.896.

Conclusions

DECT-derived iodine content and overlay differ significantly among normal, inflammatory and metastatic SCC cervical lymph nodes.

Key points

Derived iodine content can be calculated from contrast-enhanced dual-energy CT.

Derived iodine content and iodine overlay could help characterise cervical lymph nodes.

Iodine parameters were significantly lower in metastatic lymph nodes than normal/inflammatory lymph nodes.

Iodine content appears more sensitive than iodine overlay for lymph node characterisation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Mack M, Rieger J, Baghi M, Bisdas S, Vogl T (2008) Cervical lymph nodes. Eur J Radiol 66:493–500

    Article  PubMed  Google Scholar 

  2. Chong V (2004) Cervical lymphadenopathy: what radiologists need to know. Cancer Imaging 4:116–120

    Article  PubMed Central  PubMed  Google Scholar 

  3. Nakamura T, Sumi M (2007) Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes. Eur Radiol 17:1235–1241

    Article  PubMed  Google Scholar 

  4. Zenk J, Bozzato A, Steinhart H, Greess H, Iro H (2005) Metastatic and inflammatory cervical lymph nodes as analyzed by contrast-enhanced color-coded Doppler ultrasonography: quantitative dynamic perfusion patterns and histopathologic correlation. Ann Otol Rhinol Laryngol 114:43–47

    PubMed  Google Scholar 

  5. Bisdas S, Baghi M, Huebner F et al (2007) In vivo proton MR spectroscopy of primary tumours, nodal and recurrent disease of the extracranial head and neck. Eur Radiol 17:251–257

    Article  PubMed  Google Scholar 

  6. Bisdas S, Baghi M, Smolarz A et al (2007) Quantitative measurements of perfusion and permeability of oropharyngeal and oral cavity cancer, recurrent disease, and associated lymph nodes using 1st-pass contrast-enhanced computed tomography studies. Investig Radiol 42:172–179

    Article  Google Scholar 

  7. Vandecaveye V, De Keyzer F, Vander Poorten V et al (2009) Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 251:134–146

    Article  PubMed  Google Scholar 

  8. Abdel Razek A, Gaballa G (2011) Role of perfusion MR imaging in cervical lymphadenopathy. J Comput Assist Tomogr 35:21–25

    Article  PubMed  Google Scholar 

  9. Nakagawa T, Yamada M, Suzuki Y (2008) 18F-FDG uptake in reactive neck lymph nodes of oral cancer: relationship to lymphoid follicles. J Nucl Med 49:1053–1059

    Article  PubMed  Google Scholar 

  10. Ng SH, Yen TC, Liao CT et al (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143

    PubMed  Google Scholar 

  11. Miles KA (1999) Tumour angiogenesis and its relation to contrast enhancement on computed tomography: a review. Eur J Radiol 30:198–205

    Article  CAS  PubMed  Google Scholar 

  12. Swensen SJ, Brown LR, Colby TV, Weaver AL (1995) Pulmonary nodules: CT evaluation of enhancement with iodinated contrast material. Radiology 194:393–398

    CAS  PubMed  Google Scholar 

  13. Chae EJ, Song JW, Krauss B et al (2010) Dual-energy computed tomography characterization of solitary pulmonary nodules. J Thorac Imaging 25:301–310

    Article  PubMed  Google Scholar 

  14. Chandarana H, Megibow AJ, Cohen BA et al (2011) Iodine quantification with dual-energy CT: phantom study and preliminary experience with renal masses. AJR Am J Roentgenol 196:693–700

    Article  Google Scholar 

  15. Godoy MC, Naidich DP, Marchiori E et al (2009) Basic principles and postprocessing techniques of dual-energy CT: illustrated by selected congenital abnormalities of the thorax. Thorac Imaging 24:152–159

    Article  Google Scholar 

  16. Vogl TJ, Schulz B, Bauer RW, Stöver T, Sader R, Tawfik AM (2012) Dual-energy CT applications in head and neck imaging. AJR Am J Roentgenol 199:34–39

    Article  Google Scholar 

  17. Neville AM, Gupta RT, Miller CM, Merkle EM, Paulson EK, Boll DT (2011) Detection of renal lesion enhancement with dual-energy multidetector CT. Radiology 259:173–183

    Article  PubMed  Google Scholar 

  18. Toepker M, Moritz T, Krauss B et al (2012) Virtual non-contrast in second-generation, dual-energy computed tomography: reliability of attenuation values. Eur J Radiol 81:398–405

    Article  Google Scholar 

  19. Kaufmann S, Sauter A, Spira D et al (2013) Tin-filter enhanced dual-energy-CT: image quality and accuracy of CT numbers in virtual noncontrast imaging. Acad Radiol 20:596–603

    Article  PubMed  Google Scholar 

  20. Chae EJ, Song JW, Seo JB, Krauss B, Jang YM, Song KS (2008) Clinical utility of dual-energy CT in the evaluation of solitary pulmonary nodules: initial experience. Radiology 249:671–681

    Article  PubMed  Google Scholar 

  21. Song KD, Kim CK, Park BK, Kim B (2011) Utility of iodine overlay technique and virtual unenhanced images for the characterization of renal masses by dual-energy CT. AJR Am J Roentgenol 197:1076–1082

    Google Scholar 

  22. Ascenti G, Mileto A, Krauss B et al (2013) Distinguishing enhancing from nonenhancing renal masses with dual-source dual energy CT: iodine quantification versus standard enhancement measurements. Eur Radiol 23:2288–2295

    Article  PubMed  Google Scholar 

  23. Fischbein NJ, Noworolski SM, Henry RG, Kaplan M, Dillon W, Nelson S (2003) Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 24:301–311

    PubMed  Google Scholar 

  24. Naresh KN, Nerurkar AY, Borges AM (2001) Angiogenesis is redundant for tumour growth in lymph node metastases. Histopathology 38:466–470

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

An oral presentation containing some data from this article was presented by the same authors in ECR 2012, with the title “Dual energy CT-derived iodine content and iodine overlay for characterisation of enlarged cervical lymph nodes”.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ahmed M. Tawfik.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tawfik, A.M., Razek, A.A., Kerl, J.M. et al. Comparison of dual-energy CT-derived iodine content and iodine overlay of normal, inflammatory and metastatic squamous cell carcinoma cervical lymph nodes. Eur Radiol 24, 574–580 (2014). https://doi.org/10.1007/s00330-013-3035-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-3035-3

Keywords

Navigation