Head and neck squamous cell carcinoma: evaluation of iodine overlay maps and low-energy virtual mono-energetic images acquired with spectral detector CT

D Zopfs; S Lennartz; N Große Hokamp; K Rau; C Zaeske; K R Laukamp; C Houbois; J C Luers; D Maintz; M Puesken

doi:10.1016/j.crad.2022.02.013

Head and neck squamous cell carcinoma: evaluation of iodine overlay maps and low-energy virtual mono-energetic images acquired with spectral detector CT

Clin Radiol. 2022 Jun;77(6):e425-e433. doi: 10.1016/j.crad.2022.02.013. Epub 2022 Mar 26.

Authors

D Zopfs¹, S Lennartz², N Große Hokamp³, K Rau³, C Zaeske³, K R Laukamp³, C Houbois⁴, J C Luers⁵, D Maintz³, M Puesken³

Affiliations

¹ University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany. Electronic address: david.zopfs@uk-koeln.de.
² University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany; Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
³ University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany.
⁴ University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, Cologne, Germany; Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁵ Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

PMID: 35351291
DOI: 10.1016/j.crad.2022.02.013

Abstract

Aim: To evaluate the diagnostic value of spectral detector computed tomography (SDCT)-derived iodine overlay maps and low-energy virtual mono-energetic images (VMI) for the initial locoregional assessment of primary, therapy-naive head and neck cancer.

Materials and methods: Fifty-six patients with histologically confirmed untreated squamous cell carcinoma of the head and neck who underwent SDCT of the neck for staging purposes were included in this retrospective study. Attenuation, image noise as well as signal- and contrast-to-noise ratios (S-/CNR) in VMI_40-70keV were obtained from region of interest (ROI)-based measurements in the tumour and important anatomical landmarks (sternocleidomastoid muscle, subcutaneous fat, thyroid gland, submandibular gland, carotid artery, and jugular vein). Tumour conspicuity and delineation, as well as subjective image quality, were rated for conventional images, VMI_40-70keV, and iodine overlay maps using five-point Likert scales.

Results: The CNR of the tumour versus the floor of the mouth and the CNR of the tumour versus the sternocleidomastoid muscle was significantly higher in VMI_40keV in comparison to conventional images (10.0 ± 7.3 versus 3.8 ± 3.3 and 11.3 ± 7.6 versus 3.6 ± 2.8; p<0.05 each). This was supported by qualitative results, as tumour conspicuity and delineation received superior ratings in iodine overlay maps and VMI_40keV compared to conventional images (5 [3-5] and 5 [4-5] versus 3 [2-5]; 5 [2-5] and 5 [3-5] versus 3 [2-4], respectively, all p<0.05). VMI_40keV yielded the highest score among all included image reconstructions for overall image quality (p<0.05 all).

Conclusion: Iodine overlay maps and low-energy VMI derived from SDCT improve initial assessment of primary squamous cell carcinoma of the head and neck compared to conventional images.

MeSH terms

Head and Neck Neoplasms* / diagnostic imaging
Humans
Iodine*
Radiographic Image Interpretation, Computer-Assisted / methods
Retrospective Studies
Signal-To-Noise Ratio
Squamous Cell Carcinoma of Head and Neck / diagnostic imaging
Tomography, X-Ray Computed / methods

Substances

Iodine