Iodine uptake of adrenal glands: A novel and reliable spectral dual-layer computed tomographic-derived biomarker for acute septic shock. Issue 156 (November 2022)

• Record Type: Journal Article
• Authors: Langguth, P.; Aludin, S.; Horr, A.; Campbell, G.M.; Lebenatus, A.; Salehi Ravesh, M.; Schunk, D.; Austein, F.; Larsen, N.; Syrek, H.; Both, M.; Jansen, O.; Sedaghat, S.
• Is Part Of: European journal of radiology. Issue 156(2022)
• Publication Date: 2022-11
• Subjects: Septic shock -- Sepsis -- Adrenal gland -- Iodine density -- Computed tomography (CT) -- Spectral CT -- Hypoperfusion complex -- Imaging biomarker; AUC Area under the curve -- CT Computed tomography -- SDCT Dual-layer spectral detector computed tomography -- IDCT Iodine density SDCT images -- CECT Contrast-enhanced CT -- DECT Dual-energy computed tomography -- ROI Region of interest -- HU Hounsfield unit -- IVC Inferior vena cava -- SIRS Systemic inflammatory response syndrome -- MODS Multiple organ dysfunction syndrome -- ICU Intensive care unit -- IB Imaging biomarker -- kVp Kilovoltage peak; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2022.110492
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Iodine concentration of the adrenal glands is a valuable imaging biomarker for identifying patients in acute septic shock. An uptake of >3.5 mg/ml of at least one adrenal gland or/and a combined iodine uptake of both adrenal glands of >7 mg/ml seems to identify patients in acute septic shock. Iodine concentration (mg/ml) in abdominal organs significantly correlates with the Hounsfield units (HU) and could therefore serve as an alternative measure to the commonly used HU. Abstract: Objectives: Septic shock is a potentially fatal condition. This study aims to assess whether iodine uptake and iodine density of abdominal organs on dual-layer spectral detector computed tomography (SDCT) could serve as a new imaging biomarker for patients in septic shock. Methods: Here, 95 patients who received contrast-enhanced abdominal CT examinations were included and separated into two groups: group A – septic shock; group B – no shock condition. Preselected abdominal (right and left adrenal gland, right and left kidney, infrarenal inferior vena cava (IVC), pancreas, spleen, and liver) localizations were independently evaluated by two radiologists, who measured iodine concentrations (mg/ml) and Hounsfield units (HU). Results: In all, 1520 measurements of iodine concentrations in mg/ml and HU were performed, with 27 patients in group A and 68 in group B. Iodine concentrations in mg/ml and HU correlated significantly in all organs measured. The corresponding correlation coefficient (r) ranged from 0.809 (pancreas) to 0.963 (right kidney). Inter-rater reliability (IRR) was very good for mg/ml (κ = 0.8; p < 0.01) and good for HU (κ = 0.773; p < 0.01) measurements. The mean iodine concentration and HU of the adrenal glands in septic and nonseptic patients was 4.88 ± 1.16 mg/ml/153 ± 36 HU and 2.67 ± 1.07 mg/ml/112 ± 41 HU, respectively. Iodine concentrations in the adrenal glands were significantly higher in group A than in group B patients (p < 0.01). The other organs remained unaffected and no significant difference was observed between patients in group A and B. Patients in group A presented significantly more often with an iodine uptake of >3.5 mg/ml of one adrenal gland (sensitivity = 0.926, specificity = 0.849, AUC = 0.951) or/and a combined concentration of >7 mg/ml of both adrenal glands (sensitivity = 0.889, specificity = 0.836, AUC = 0.928). Conclusion: SDCT-derived iodine concentration of the adrenal glands could serve as a novel imaging biomarker for patients in acute septic shock. Our data suggest that an iodine uptake of >3.5 mg/ml of at least one adrenal gland or a combined iodine uptake of >7 mg/ml in both adrenal glands identifies patients in this condition.