Iodine Parameters in Triple-Bolus Dual-Energy CT Correlate With Perfusion CT Biomarkers of Angiogenesis in Renal Cell Carcinoma

• Published in: American journal of roentgenology (1976) Vol. 214; no. 4; pp. 808 - 816
• Main Authors: Manoharan, Dinesh, Netaji, Arjunlokesh, Das, Chandan J., Sharma, Sanjay
• Format: Journal Article
• Language: English
• Published: United States 01.04.2020
• Subjects: Adult; Aged; Carcinoma, Renal Cell - diagnostic imaging; Contrast Media - pharmacokinetics; Female; Humans; Iohexol - pharmacokinetics; Kidney Neoplasms - diagnostic imaging; Male; Middle Aged; Neovascularization, Pathologic - diagnostic imaging; Prospective Studies; Radiographic Image Interpretation, Computer-Assisted; Radiography, Dual-Energy Scanned Projection - methods; Tomography, X-Ray Computed - methods; perfusion imaging; renal cell carcinoma; iodine; MDCT; radiation exposure
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.19.21969

The purpose of this study is to determine the degree of the relationship between perfusion CT (PCT) parameters and iodine concentration metrics derived from triple-bolus dual-energy CT (DECT) and to compare the radiation dose delivered. This single-center prospective study was conducted from October 2015 to September 2017. Twenty-three consenting adults (15 men and eight women; mean [± SD] age, 56 ± 13 years [range, 25-78 years]) with renal cell carcinomas underwent consecutive PCT and triple-bolus DECT examinations. Triple-bolus DECT consisted of synchronous corticomedullary, nephrographic, and delayed phase scans acquired using a dual-source DECT scanner. Two readers independently analyzed blood flow, blood volume, and permeability, as measured by PCT, and iodine density and iodine ratio, as measured by triple-bolus DECT. Size-specific dose estimates were calculated for both groups. Interreader agreement was good for permeability (intraclass correlation coefficient [ICC] =.812) and blood flow (ICC = 0.849) and excellent for blood volume (ICC = 0.956), iodine density (ICC = 0.961), and iodine ratio (ICC = 0.956). Very strong positive correlations were found between blood volume and iodine density ( < 0.001) and between blood volume and iodine ratio ( < 0.001). Strong positive correlations were found between blood flow and iodine density ( < 0.001) and between blood flow and iodine ratio ( < 0.001). The correlations between permeability and iodine density ( = 0.01) and between permeability and iodine ratio ( = 0.02) were moderate. The mean size-specific dose estimate of triple-bolus DECT was approximately 15 times lower than that of PCT ( < 0.001). Quantitative iodine metrics derived from triple-bolus DECT showed significant correlation with CT parameters in renal cell carcinoma, with a significantly lower radiation dose.