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Iodine overlays to improve differentiation between peritoneal carcinomatosis and benign peritoneal lesions

  • Computed Tomography
  • Published:
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Abstract

Objectives

Peritoneal carcinomatosis (PC) is a prognostically relevant metastatic disease which may be difficult to depict in postoperative patients, particularly in early stages. This study aimed to determine whether PC could be diagnosed more accurately when using a combination of spectral detector CT (SDCT)-derived conventional images (CI) and iodine overlay images (IO) compared with CI only.

Methods

Thirty patients with PC and 30 patients with benign peritoneal alterations (BPA) who underwent portal-venous abdominal SDCT were included. Four radiologists determined the presence/absence of PC for each patient and assessed lesion conspicuity, diagnostic certainty, and image quality using 5-point Likert scales. Subjective assessment was conducted in two sessions comprising solely CI and CI/IO between which a latency of 6 weeks was set. Iodine uptake and HU attenuation were determined ROI-based to analyze quantitative differentiation of PC/BPA.

Results

Specificity for PC was significantly higher when using CI/IO compared with using CI only (0.86 vs. 0.78, p ≤ 0.05), while sensitivity was comparable (0.79 vs. 0.81, p = 1). In postoperative patients, the increase in specificity was the highest (0.93 vs. 0.80, p ≤ 0.05). Lesion conspicuity was rated higher in CI/IO (4 (3–5)) compared with that in CI only (3 (3–4); p ≤ 0.05). Diagnostic certainty was comparable (both 4 (3–5); p = 0.5). CI/IO received the highest rating for overall image quality and assessability (CI/IO 5 (4–5) vs. CI 4 (4–4) vs. IO 4 (3–4); p ≤ 0.05). Area under the receiver operating characteristics curve (AUC) for quantitative differentiation between PC and BPA was higher for iodine (AUCIodine = 0.95, AUCHU = 0.90).

Conclusions

Compared with CI, combination of CI/IO improves specificity in the assessment of peritoneal carcinomatosis at comparable sensitivity, particularly in postoperative patients.

Key Points

• Combination of iodine overlays and conventional images improves specificity when assessing patients with peritoneal carcinomatosis at comparable sensitivity.

• Particularly in postsurgical patients, iodine overlays could help to avoid false-positive diagnosis of peritoneal disease.

• Iodine overlays alone provided inferior image quality and assessability than conventional images, while the combination of both received the highest ratings. Iodine overlays should therefore be used in addition to and not as a substitute for conventional images.

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Abbreviations

AUC:

Area under the receiver operating characteristics curve

BPA:

Benign peritoneal alterations

CI:

Conventional images

CT:

Computed tomography

DECT:

Dual-energy CT

IO:

Iodine overlays

PC:

Peritoneal carcinomatosis

ROI:

Region of interest

SDCT:

Spectral detector computed tomography

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Funding

This work was funded through the Else Kröner-Fresenius Stiftung (2016-Kolleg-19 to SL and Grant 2018_EKMS34 to NGH).

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA

    Simon Lennartz

  2. Institute for Diagnostic and Interventional Radiology, University Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Straße 62, 50937, Cologne, Germany

    Simon Lennartz, David Zopfs, Nuran Abdullayev, Grischa Bratke, Markus Le Blanc, Karin Slebocki, Anton Wagner, Christian Wybranski, David Maintz, Nils Große Hokamp & Thorsten Persigehl

  3. Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931, Cologne, Germany

    Simon Lennartz

  4. Department of General, Visceral, Cancer and Transplant Surgery, University Hospital of Cologne, University of Cologne, Cologne, Germany

    Roger Wahba

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  1. Simon Lennartz
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  2. David Zopfs
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Corresponding author

Correspondence to Simon Lennartz.

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Guarantor

The scientific guarantor of this publication is Thorsten Persigehl.

Conflict of interest

SL received institutional research support from Philips Healthcare for research not related to this project. NGH, DM received speaker’s honoraria from Philips Healthcare. NGH receives research support from Philips Healthcare unrelated to this project.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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• Retrospective

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Lennartz, S., Zopfs, D., Abdullayev, N. et al. Iodine overlays to improve differentiation between peritoneal carcinomatosis and benign peritoneal lesions. Eur Radiol 30, 3968–3976 (2020). https://doi.org/10.1007/s00330-020-06729-5

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  • DOI: https://doi.org/10.1007/s00330-020-06729-5

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