Iodine accumulation of the liver in patients treated with amiodarone can be unmasked using material decomposition from multiphase spectral-detector CT

Kai Roman Laukamp,Simon Lennartz,Thorsten Persigehl,Nikhil Ramaiya,Vivian Ho,Ahmad Hashmi,Amit Gupta,Markus Obmann,Frank Philipp Graner,Robert Gilkeson,Nils Große Hokamp

doi:10.1038/s41598-020-64002-7

Abstract

Amiodarone accumulates in the liver, where it increases x-ray attenuation due to its iodine content. We evaluated liver attenuation in patients treated and not treated with amiodarone using true-non-contrast (TNC) and virtual-non-contrast (VNC) images acquired with spectral-detector-CT (SDCT). 142 patients, of which 21 have been treated with amiodarone, receiving SDCT-examinations (unenhanced-chest CT [TNC], CT-angiography of chest and abdomen [CTA-Chest, CTA-Abdomen]) were included. TNC, CTA-Chest, CTA-Abdomen, and corresponding VNC-images (VNC-Chest, VNC-Abdomen) were reconstructed. Liver-attenuation-index (LAI) was calculated as difference between liver- and spleen-attenuation. Liver-attenuation and LAI derived from TNC-images of patients receiving amiodarone were higher. Contrary to TNC, liver-attenuation and LAI were not higher in amiodarone patients in VNC-Chest and in VNC-Abdomen. To verify these initial results, a phantom scan was performed and an additional patient cohort included, both confirming that VNC is viable of accurately subtracting iodine of hepatic amiodarone-deposits. This might help to monitor liver-attenuation more accurately and thereby detect liver steatosis as a sign of liver damage earlier as well as to verify amiodarone accumulation in the liver.

Highlights

Amiodarone is an antiarrhythmic drug that has shown its effectiveness for several decades to treat various forms of tachyarrhythmia[1,2]
Five patients showed signs of severe liver steatosis indicated by a reduced liver attenuation (
This study quantitatively evaluated liver and spleen attenuation in patients with and without amiodarone treatment using TNC and virtual non-contrast images (VNC) from spectral-detector CT

Summary

Introduction

Amiodarone is an antiarrhythmic drug that has shown its effectiveness for several decades to treat various forms of tachyarrhythmia[1,2]. Atrial fibrillation yes n/a yes no no yes yes yes no yes n/a yes no n/a yes similarities to iodinated contrast media regarding the molecular structure It is a di-iodinated benzofuran derivate, as a drug it is usually orally delivered as amiodarone hydrochloride (C25H30ClI2NO3, molecular mass of 681.8 g/mol). Material decomposition can be used for the identification of iodine and thereby the creation of virtual non-contrast images (VNC) that offer a way to eliminate the iodine-associated attenuation from images This technique is used to remove iodine resulting from contrast media administration but it should be able to remove iodine bound to amiodarone[21,23,24,25]. Recently suggested[13], no study investigated the application of dual-energy CT for subtraction of the iodine in amiodarone patients

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Conclusion