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01-06-2019 | Musculoskeletal

Accuracy of iodine density thresholds for the separation of vertebral bone metastases from healthy-appearing trabecular bone in spectral detector computed tomography

Authors: Jan Borggrefe, Victor-Frederic Neuhaus, Markus Le Blanc, Nils Grosse Hokamp, Volker Maus, Anastasios Mpotsaris, Simon Lennartz, Daniel Pinto dos Santos, David Maintz, Nuran Abdullayev

Published in: European Radiology | Issue 6/2019

Abstract

Purpose

To evaluate quantitative iodine density mapping (IDM) with spectral detector computed tomography (SDCT) as a quantitative biomarker for separation of vertebral trabecular bone metastases (BM) from healthy-appearing trabecular bone (HTB).

Materials and methods

IRB-approved retrospective single-center-study of portal venous SDCT datasets acquired between June 2016 and March 2017. Inclusion of 43 consecutive cancer patients with BM and 40 without. Target lesions and non-affected control vertebrae were defined using follow-up imaging, MRI, and/or bone scintigraphy. ID and standard deviation were determined with ROI measures by two readers in (a) bone metastases, (b) HTB of BM patients and controls, and (c) ID of various vessels. Volumetric bone mineral density (vBMD) of the lumbar spine and age were recorded. Multivariate ROC analyses und Wilcoxon test were used to determine thresholds for separation of BM and HTB. p < 0.05 was considered significant.

Results

ID measurements of 40 target lesions and 83 reference measurements of HTB were acquired. Age (p < 0.0001) and vBMD (p < 0.05) affected ID measurements independently in multivariate models. There were significant differences of ID between metastases (n = 43) and HTB ID (n = 124; mean 5.5 ± 0.9 vs. 3.5 ± 0.9; p < 0.0001), however, with considerable overlap. In univariate analysis, increased ID discriminated bone lesions (AUC 0.90) with a maximum combined specificity/sensitivity of 77.5%/90.7% when applying a threshold of 4.5 mg/ml. Multivariate regression models improved significantly when considering vBMD, the noise of ID, and vertebral venous ID (AUC 0.98).

Conclusion

IDM of SDCT yielded a statistical separation of vertebral bone lesions and HTB. Adjustment for confounders such as age and lumbar vBMD as well as for vertebral venous ID and lesion heterogeneity improved discrimination of trabecular lesions.

Key Points

• SDCT iodine density mapping provides the possibility for quantitative analysis of iodine uptake in tissue, which allows to differentiate bone lesions from healthy bone marrow.

• Age and vBMD have a significant impact on iodine density measurements.

• Iodine density measured in SDCT yielded highest sensitivity and specificity for the statistical differentiation of vertebral trabecular metastases and healthy trabecular bone using an iodine density threshold of 4.5 mg/ml (most performant)–5.0 mg/ml (optimized for specificity).

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Title: Accuracy of iodine density thresholds for the separation of vertebral bone metastases from healthy-appearing trabecular bone in spectral detector computed tomography
Authors: Jan Borggrefe
Victor-Frederic Neuhaus
Markus Le Blanc
Nils Grosse Hokamp
Volker Maus
Anastasios Mpotsaris
Simon Lennartz
Daniel Pinto dos Santos
David Maintz
Nuran Abdullayev
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 6/2019
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5843-y

At a glance: The STEP trials

Springer Medicine

Accuracy of iodine density thresholds for the separation of vertebral bone metastases from healthy-appearing trabecular bone in spectral detector computed tomography

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Key Points

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