Iodine uptake of adrenal glands: A novel and reliable spectral dual-layer computed tomographic-derived biomarker for acute septic shock

P Langguth; S Aludin; A Horr; G M Campbell; A Lebenatus; M Salehi Ravesh; D Schunk; F Austein; N Larsen; H Syrek; M Both; O Jansen; S Sedaghat

doi:10.1016/j.ejrad.2022.110492

Iodine uptake of adrenal glands: A novel and reliable spectral dual-layer computed tomographic-derived biomarker for acute septic shock

Eur J Radiol. 2022 Nov:156:110492. doi: 10.1016/j.ejrad.2022.110492. Epub 2022 Sep 10.

Authors

P Langguth¹, S Aludin², A Horr², G M Campbell³, A Lebenatus², M Salehi Ravesh², D Schunk⁴, F Austein⁵, N Larsen², H Syrek⁶, M Both², O Jansen², S Sedaghat⁷

Affiliations

¹ Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany. Electronic address: Patrick.Langguth@uksh.de.
² Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
³ Philips GmbH Market DACH, Hamburg, Germany.
⁴ Department for Interdisciplinary Emergency, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
⁵ Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁶ Mediri GmbH, Heidelberg, Germany.
⁷ Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Department of Radiology, University of California San Diego, San Diego, CA, United States.

PMID: 36108480
DOI: 10.1016/j.ejrad.2022.110492

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.

Keywords: Adrenal gland; Computed tomography (CT); Hypoperfusion complex; Imaging biomarker; Iodine density; Sepsis; Septic shock; Spectral CT.