Diagnostic and prognostic value of an integrated assessment of clinical parameters, laboratory biomarkers and quantitative CT histogram analysis of adrenal gland attenuation: A prospective single-center cohort study in patients with suspected septic condition

• Applicant: Dr. Sonja Janssen
• Subject Area: Nuclear Medicine, Radiotherapy, Radiobiology
• Term: from 2016 to 2019
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 314834869

Introduction: The therapy and the clinical course of septic patients is often prolonged and costly with high morbidity and mortality rates of 50% at the same time. The best therapeutic options are in case of early diagnosis and accurate assessment of the severity of the septic condition. Elderly, immune-deficient and intensive care patients have a higher risk of developing a sepsis. Their number rises steadily. Sepsis, severe sepsis and septic shock are to date primarily clinically-driven diagnoses, supported by laboratory testing for infectious condition and proof of an infectious focus by means of imaging. In clinical routine, normally in this patient group contrasted-enhanced whole-body computed tomography (CT) is the modality of choice. Quantitative CT parameters used to evaluate the severity of a septic condition and for prognostic purposes in the way of imaging biomarkers are to date not yet systematically assessed in the course of these CT studies and if so, they are not sufficiently evaluated in an integrated approach together with the clinical parameters and laboratory testing results. Yet, there is published evidence that the finding of so-called hyper-attenuating adrenal glands in contrast-enhanced CT is associated with severely ill patients suffering from trauma or severe internal pathologic conditions, e.g. sepsis. Aims: In the light of steadily improving medical developments in the field of intensive care and the growing range of potent but costly pharmacologic treatment options there is a pressing socio-economic need to improve diagnosis and prognostic evaluation of patients with suspected sepsis. Therefore, all interdisciplinary available parameters should be taken into consideration. Methods: The good reproducibility of density values in CT due to Hounsfield-scale linearity could be used to assess in the framework of the whole body CT scans patients with suspected sepsis do undergo to assess additional quantitative parameters, more specifically density-based histogram data from the adrenal glands. With these data, in analogy to e.g. laboratory biomarkers, this newly-developed imaging biomarkers could be used to improve diagnosis, severity grading, and prognostic evaluation of this patient cohort (Radiomics approach). Perspectives: The aim of this project is therefore to firstly assess in a big data approach the relevance of each and every single interdisciplinary measured qualitative or quantitative sepsis parameter and to evaluate in a second step with a special radiological focus on the value of imaging biomarkers if any CT parameter alone or any combination of the assessed parameters adds to diagnosis and/or prognostic assessment in the study cohort of intensive care patients with suspected sepsis.

• DFG Programme: Research Grants