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. 2021 May;11(5):2085-2092.
doi: 10.21037/qims-20-917.

Initial evaluation of dual-energy computed tomography as an imaging biomarker for hepatic metastases from neuroendocrine tumor of the gastrointestinal tract

Eddiel Cruz-Hernández  1 , Usman Mahmood  2 , Jennifer S Golia Pernicka  3 , Viktoriya Paroder  3 , Iva Petkovska  3 , Marc J Gollub  3 , Jinru Shia  4 , Karuna Ganesh  5 , David D B Bates  3
Affiliations

Initial evaluation of dual-energy computed tomography as an imaging biomarker for hepatic metastases from neuroendocrine tumor of the gastrointestinal tract

Eddiel Cruz-Hernández et al. Quant Imaging Med Surg. 2021 May.

Abstract

Background: To evaluate quantitative iodine parameters from the arterial phase dual-energy computed tomography (DECT) scans as an imaging biomarker for tumor grade (TG), mitotic index (MI), and Ki-67 proliferation index of hepatic metastases from neuroendocrine tumors (NETs) of the gastrointestinal (GI) tract. Imaging biomarkers have the potential to provide relevant clinical information about pathologic processes beyond lesion morphology. NETs are a group of rare, heterogeneous neoplasms classified by World Health Organization (WHO) TG, which is derived from MI and Ki-67 proliferation index. Imaging biomarkers for these pathologic features and TG may be useful.

Methods: Between January 2014 and April 2019, 73 unique patients with hepatic metastases from NET of the GI tract underwent DECT of the abdomen with an arterial phase were analyzed after exclusions. Using GSIViewer software (GE Healthcare, Madison, Wisconsin), elliptical regions of interest (ROIs) were placed over selected hepatic metastases by a fellowship trained abdominal radiologist. Quantitative iodine concentration (IC) data was extracted from the lesion ROIs, and the normalized IC (lesion IC/aorta IC) and relative IC (lesion IC/liver IC) for each liver were calculated. Spearman correlation was calculated for lesion mean IC, normalized IC, and relative IC to both Ki-67 proliferation and mitotic indices. Student's t-test was performed to compare lesion mean IC, normalized IC and relative IC between WHO TGs.

Results: There was very weak correlation between both normalized IC and relative IC for both Ki-67 proliferation and mitotic indices. A significant difference was not observed between normalized IC and relative IC to distinguish metastases from G1 and G2/3 tumors.

Conclusions: Our study finds limited potential for quantitative parameters from DECT to distinguish neuroendocrine hepatic metastases by WHO TG, as well as limited potential as an imaging biomarker for Ki-67 proliferation and mitotic indices in this setting. Our findings of a lack of correlation between Ki-67 and quantitative iodine parameters stands in contrast to existing literature that reports positive correlations for these parameters in the rectum and stomach.

Keywords: Neuroendocrine tumor (NET); dual energy computed tomography (DECT); hepatic metastases; imaging biomarker; iodine quantification.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-917). Dr. DDBB reports research support from GE Healthcare. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flowchart is shown representing the patient selection for the study cohort. DECT, dual-energy computed tomography.
Figure 2
Figure 2
A 71-year-old female with grade 1 neuroendocrine tumor of the ileum and hepatic metastases. Representative image showing an arterial phase iodine map derived from DECT through the upper abdomen. Sample segmentations are shown, with an elliptical region of interest (16) over the neuroendocrine tumor metastasis, the normal background hepatic parenchyma and abdominal aorta. Extracted iodine concentrations are then used to calculate the normalized and relative iodine concentrations for analysis. DECT, dual-energy computed tomography.
Figure 3
Figure 3
Violin plot showing distribution of values for normalized iodine concentration of hepatic metastases from GI NET comparing WHO G1 and G2/3. There was not a significant difference between the two groups (P=0.8453; 95% CI: −0.0287 to 0.0349). NET, neuroendocrine tumor; WHO, World Health Organization.
Figure 4
Figure 4
Violin plot showing distribution of values for relative iodine concentration of hepatic metastases from GI NET comparing WHO G1 and G2/3. There was not a significant difference between the two groups (P=0.3915; 95% CI: −0.6933 to 0.2746). NET, neuroendocrine tumor; WHO, World Health Organization.
See this image and copyright information in PMC

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