Whole-lesion iodine map histogram analysis in the risk classification of gastrointestinal stromal tumors: comparison with single-slice iodine concentration measurements

To evaluate and compare the diagnostic performances of whole-lesion iodine map (IM) histogram analysis and single-slice IM measurement in the risk classification of gastrointestinal stromal tumors (GISTs). Thirty-seven patients with GISTs, including 19 with low malignant underlying GISTs (LG-GISTs) and 18 with high malignant underlying GISTs (HG-GISTs), were evaluated with dual-energy computed tomography (DECT). Whole-lesion IM histogram parameters (mean; median; minimum; maximum; standard deviation; variance; 1st, 10th, 25th, 50th, 75th, 90th, and 99th percentile; kurtosis, skewness, and entropy) were computed for each lesion. In other sessions, iodine concentrations (ICs) were derived from the IM by placing regions of interest (ROIs) on the tumor slices and normalizing them to the iodine concentration in the aorta. Both quantitative analyses were performed on the venous phase images. The diagnostic accuracies of the two methods were assessed and compared. The minimum, maximum, 1st, 10th, and 25th percentile of the whole-lesion IM histogram and the IC and normalized IC (NIC) of the single-slice IC measurement significantly differed between LG- and HG-GISTs (p < 0.001 – p = 0.042). The minimum value in the histogram analysis (AUC = 0.844) and the NIC in the single-slice measurement analysis (AUC = 0.886) showed the best diagnostic performances. The NIC of single-slice measurements had a diagnostic performance similar to that of the whole-lesion IM histogram analysis (p = 0.618). Both whole-lesion IM histogram analysis and single-slice IC measurement can differentiate LG-GISTs and HG-GISTs with similar diagnostic performances.