{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T16:00:50Z","timestamp":1769270450030,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2019,7,8]],"date-time":"2019-07-08T00:00:00Z","timestamp":1562544000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Tumour response in lung cancer treatment is monitored by measuring lesion size in computed tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>). Spectral <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>) offers additional information on tumour tissue besides morphology. We evaluated <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content> iodine content (<jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content>) and performed spectral slope analysis to assess the response of non\u2010small\u2010cell lung cancer (<jats:styled-content style=\"fixed-case\">NSCLC<\/jats:styled-content>) to chemoradiotherapy (<jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eighty\u2010three patients with advanced <jats:styled-content style=\"fixed-case\">NSCLC<\/jats:styled-content> treated by <jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content> prospectively underwent single\u2010phase, contrast\u2010enhanced <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content>. Evaluation of all patients included treatment response (<jats:styled-content style=\"fixed-case\">RECIST<\/jats:styled-content> 1.1), quantitative measurements as well as <jats:styled-content style=\"fixed-case\">SCT IC<\/jats:styled-content> determination and spectral slope analysis in <jats:styled-content style=\"fixed-case\">NSCLC<\/jats:styled-content> primaries. Measurements were performed at the maximum cross\u2010diameter of tumours and in areas with high iodine values (hotspot analysis). Iodine difference (\u0394<jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content>) was calculated. Secondary outcome parameters were <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> and spectral slopes in mediastinal lymph nodes (<jats:italic>n<\/jats:italic>\u00a0=\u00a061).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty\u2010four patients (29%) showed complete remission after <jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content>. Thirty\u2010four patients (41%) had stable disease (<jats:styled-content style=\"fixed-case\">SD<jats:sub>SCT<\/jats:sub><\/jats:styled-content>) or partial regression (<jats:styled-content style=\"fixed-case\">PR<jats:sub>SCT<\/jats:sub><\/jats:styled-content>). Progressive disease (<jats:styled-content style=\"fixed-case\">PD<jats:sub>SCT<\/jats:sub><\/jats:styled-content>) was seen in 25 patients (30%). Hotspot analysis showed significantly higher iodine values in <jats:styled-content style=\"fixed-case\">PD<jats:sub>SCT<\/jats:sub><\/jats:styled-content> than in <jats:styled-content style=\"fixed-case\">SD<jats:sub>SCT<\/jats:sub><\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">PR<jats:sub>SCT<\/jats:sub><\/jats:styled-content> (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Ten patients (12%) with initially stable disease in <jats:styled-content style=\"fixed-case\">SCT<\/jats:styled-content> showed progressive disease during follow\u2010up for up to 18\u00a0months (<jats:styled-content style=\"fixed-case\">PD<jats:sub>FU<\/jats:sub><\/jats:styled-content>). These patients also had significantly higher hotspot iodine values and \u0394<jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> in the initial scan compared to patients with <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> throughout the follow\u2010up period (<jats:styled-content style=\"fixed-case\">SD<jats:sub>FU<\/jats:sub><\/jats:styled-content>) (29%) (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). Enlarged lymph nodes showed significantly lower iodine content and a lower spectral slope pitch than normal\u2010sized nodes (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003 to 0.029).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Spectral <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\u2010derived iodine content of <jats:styled-content style=\"fixed-case\">NSCLC<\/jats:styled-content> following <jats:styled-content style=\"fixed-case\">CRT<\/jats:styled-content> may help in predicting recurrence. Hotspot analysis and iodine heterogeneity allow the identification of residual vascularisation as an indicator of vital tumour tissue, indicating that <jats:styled-content style=\"fixed-case\">IC<\/jats:styled-content> might be a suitable imaging biomarker for predicting tumour progression. Iodine content and spectral slope analysis might also help in identifying metastatic lymph nodes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1754-9485.12926","type":"journal-article","created":{"date-parts":[[2019,7,8]],"date-time":"2019-07-08T08:36:47Z","timestamp":1562575007000},"page":"641-649","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Tumour response in non\u2010small\u2010cell lung cancer patients treated with chemoradiotherapy \u2013 Can spectral <scp>CT<\/scp> predict recurrence?"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3622-3268","authenticated-orcid":false,"given":"Uli","family":"Fehrenbach","sequence":"first","affiliation":[{"name":"Radiology Charit\u00e9 University Medicine Berlin Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5664-7693","authenticated-orcid":false,"given":"Felix","family":"Feldhaus","sequence":"additional","affiliation":[{"name":"Radiology Charit\u00e9 University Medicine Berlin Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Kahn","sequence":"additional","affiliation":[{"name":"Radiology Charit\u00e9 University Medicine Berlin Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"B\u00f6ning","sequence":"additional","affiliation":[{"name":"Radiology Charit\u00e9 University Medicine Berlin Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin H","family":"Maurer","sequence":"additional","affiliation":[{"name":"Radiology University Hospital\/Inselspital Bern Bern Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Renz","sequence":"additional","affiliation":[{"name":"Radiology University Hospital Jena Jena Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaj","family":"Frost","sequence":"additional","affiliation":[{"name":"Internal Medicine \u2013 Pulmonology Charit\u00e9 University Medicine Berlin Berlin Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Streitparth","sequence":"additional","affiliation":[{"name":"Radiology Charit\u00e9 University Medicine Berlin Berlin Germany"},{"name":"Radiology University Hospital Munich Ludwig\u2010Maximilians University (LMU) Munich Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,7,8]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"GLOBOCAN 2012 v1.0 Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. 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