Spectral computed tomography in advanced gastric cancer: Can iodine concentration non-invasively assess angiogenesis?
OBJECTIVE
To investigate the correlation of iodine concentration (IC) generated by spectral computed tomography (CT) with micro-vessel density (MVD) and vascular endothelial growth factor (VEGF) expression in patients with advanced gastric carcinoma (GC).


METHODS
Thirty-four advanced GC patients underwent abdominal enhanced CT in the gemstone spectral imaging mode. The IC of the primary lesion in the arterial phase (AP) and venous phase (VP) were measured, and were then normalized against that in the aorta to provide the normalized IC (nIC). MVD and VEGF were detected by immunohistochemical assays, using CD34 and VEGF-A antibodies, respectively. Correlations of nIC with MVD, VEGF, and clinical-pathological features were analyzed.


RESULTS
Both nICs correlated linearly with MVD and were higher in the primary lesion site than in the normal control site, but were not correlated with VEGF expression. After stratification by clinical-pathological subtypes, nIC-AP showed a statistically significant correlation with MVD, particularly in the group with tumors at stage T4, without nodular involvement, of a mixed Lauren type, where the tumor was located at the antrum site, and occurred in female individuals. nIC-VP showed a positive correlation with MVD in the group with the tumor at stage T4 and above, had nodular involvement, was poorly differentiated, was located at the pylorus site, of a mixed and diffused Lauren subtype, and occurred in male individuals. nIC-AP and nIC-VP showed significant differences in terms of histological differentiation and Lauren subtype.


CONCLUSIONS
The IC detected by spectral CT correlated with the MVD. nIC-AP and nIC-VP can reflect angiogenesis in different pathological subgroups of advanced GC.
Xiao-Hua Chen, Pan Liang, Ya-Ru Chai, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Xiao-Hua
XH
Chen
Xiao-Hua Chen, Pan Liang, Ya-Ru Chai, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Ke
K
Ren
Xiao-Hua Chen, Pan Liang, Ya-Ru Chai, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Pan
P
Liang
Xiao-Hua Chen, Pan Liang, Ya-Ru Chai, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Ya-Ru
YR
Chai
Xiao-Hua Chen, Pan Liang, Ya-Ru Chai, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Kui-Sheng
KS
Chen
Xiao-Hua Chen, Pan Liang, Ya-Ru Chai, Jian-Bo Gao, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
Jian-Bo
JB
Gao
D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D001706:Biopsy; D002277:Carcinoma / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007455:Iodine / Q000737:chemistry*; D016014:Linear Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009389:Neovascularization, Pathologic; D011857:Radiographic Image Interpretation, Computer-Assisted; D011860:Radiography, Abdominal; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D018952:Antigens, CD34; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D007455:Iodine
Gastric cancer; Iodine concentration; Micro-vessel density; Spectral computed tomography; Vascular endothelial growth factor