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A Novel Method Using Dual-Energy Computed Tomography for Detecting Amiodarone-Induced Lung Injury: A Cohort Pilot
Naama R Bogot1, Ariel Rokach2,3, Irith Hadas-Halperen1,3
1Department of Radiology, Hebrew University of Jerusalem, Jerusalem, Israel.
Background And Objective:
Amiodarone is an antiarrhythmic agent containing iodine. Amiodarone-induced lung disease (AILD) is a serious adverse effect that is difficult to diagnose. We aimed to evaluate the added value of identifying iodine deposition using the dual-energy-computed-tomography (DECT) technique for its diagnosis.
Material And Methods:
Patients with suspected AILD who underwent DECT were analysed. Two radiologists evaluated AILD probability on a 2-point scale (low vs. high) based on lung abnormalities and lung and liver amiodarone iodine deposition. In addition, two pulmonologists blinded to DECT findings assessed the AILD clinical probability on a 2-point scale using symptoms, dyspnoea questionnaires, pulmonary function tests, and standard CT. Cohen's k test was used to assess the reliability of the radiological and clinical assessments.
Results:
Eighty-one DECT exams were included in the final analysis. Twenty-one (25.9%) patients were considered to have a high AILD probability. Ground-glass opacities (GGO) were the commonest abnormality (39 [48.1%] patients) and showed the highest iodine deposition (grade 2 in 16 [19.8%] patients). Per the clinical assessments, 24 (29.6%) patients had a high AILD probability; dyspnoea was the commonest symptom (73 [90.1%] patients). A substantial correlation was found between the clinical evaluation and radiological evaluation using DECT with Cohen's k = 0.61. Specifically, moderate correlation was found in cases of iodine deposition in GGO and lung atelectasis.
Conclusion:
DECT facilitated detection of iodine deposition in AILD-associated lung abnormalities and in the liver. Radiological evaluation of AILD using DECT showed substantial correlation with clinical AILD and may help in difficult diagnoses.
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