Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2017; 23(9): 1666-1675
Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1666
Spectral computed tomography in advanced gastric cancer: Can iodine concentration non-invasively assess angiogenesis?
Xiao-Hua Chen, Ke Ren, Pan Liang, Ya-Ru Chai, Kui-Sheng Chen, Jian-Bo Gao
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 Ren, Surgery of Gastroenterology, Luohe Central Hospital, Luohe 462000, Henan Province, China
Kui-Sheng Chen, Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Chen XH and Ren K performed the research, data analysis and wrote the paper; Liang P contributed to the statistical analysis; Chai YR collected the data and assigned the forms; Chen KS performed the pathological examinations; Gao JB designed the research and contributed to the paper revisions.
Supported by the National Natural Science Foundation of China, No. 81271573.
Institutional review board statement: The study was reviewed and approved by the institutional review boards of the First Affiliated Hospital of Zhengzhou University.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Bo Gao, Professor, Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No. 1, East Jianshe Road, Zhengzhou 450052, Henan Province, China. jianbogaochina@163.com
Telephone: +86-371-67966890 Fax: +86-371-66970906
Received: November 24, 2016
Peer-review started: November 26, 2016
First decision: January 10, 2017
Revised: January 19, 2017
Accepted: February 7, 2017
Article in press: February 8, 2017
Published online: March 7, 2017
Processing time: 101 Days and 20.9 Hours
Abstract
AIM

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.

CONCLUSION

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.

Keywords: Micro-vessel density; Iodine concentration; Spectral computed tomography; Vascular endothelial growth factor; Gastric cancer

Core tip: We investigated the correlation between iodine concentration (IC) value generated from spectral computed tomography (CT) and angiogenesis in gastric cancer (GC) with clinical-pathological data. Our results showed that normalized IC (nIC) in both the arterial (AP) and venous phases (VP) had a positive linear correlation with micro-vessel density. nIC-AP reflected the angiogenesis in relatively earlier and well-differentiated GC, while nIC-VP reflected this in further advanced and poorly differentiated GC. Spectral CT with quantitative IC value offers a new choice for evaluating the angiogenesis of gastric cancer noninvasively.