Value of spectral CT based iodine concentration for the preoperative prediction of vascular invasion in gastric cancer / 中华放射学杂志

Objective:To investigate the value of spectral CT based iodine concentration (IC) parameters for preoperative prediction of lymphovascular invasion (LVI) in gastric cancer.Methods:Between January 2021 and November 2021, 266 patients diagnosed as gastric adenocarcinomas by endoscopy and undergoing gastrectomy at the Affiliated Cancer Hospital of Zhengzhou University were recruited prospectively. They were divided into LVI and non-LVI groups according to pathological reports. Triple phase contrasted enhanced CT scans, including arterial phase (AP), venous phase (VP) and delayed phase (DP) were performed on a spectral CT platform within one week before surgery. The IC of gastric cancer lesions at three enhanced phases were measured based on iodine maps, and the normalized IC (nIC) was calculated. The thickness of the tumor was measured. Clinicopathological features were collected, including ulceration, pathological tumor staging (pT), pathological node staging (pN), histodifferentiation, Lauren subtype, perineural invasion (PNI), positive node numbers and positive node ratio. Student′s t tes t or Mann-Whitney U test were used to compare the differences of continuous variables between the two groups, while Chi-square test or Fisher′s exact test was used for categorical data. Multivariable logistic regression analysis was used to screen independent risk factors of LVI, and to build a combined parameter based on risk factors. The receiver operating characteristic curve analysis was performed to determine the predictive efficacy of IC parameters and the combined parameter for LVI. DeLong′s test was used to compare the differences among different area under the curve (AUC). Results:There were statistical differences in tumor thickness, ulceration, pT, pN, histodifferentiation, positive node numbers, positive node ratio, Lauren subtype and PNI between LVI and non-LVI groups ( P<0.05). The values of IC VP, IC DP, nIC VP, nIC DP in LVI group were statistically higher than those in non-LVI group ( t=3.77, 4.23, 4.25, 6.12, all P<0.001), with the AUC (95%CI) of 0.674 (0.610-0.738), 0.677 (0.614-0.741), 0.731 (0.671-0.792), 0.700 (0.636-0.764) for predicting LVI, respectively. Multivariable logistic regression analysis revealed that tumor thickness (OR=1.148, 95%CI 1.085-1.237, P<0.001) and nIC VP (OR=209.904, 95%CI 14.874-644.362, P<0.001) were independent predictors for LVI, the combined parameter incorporating these two factors yielded an AUC (95%CI) of 0.790 (0.736-0.937), which was statistically higher than any single parameter of IC VP, IC DP, nIC VP and nIC DP ( Z=3.07, 3.29, 2.10, 2.60, P=0.002, 0.001, 0.036, 0.009). Conclusion:The IC and nIC values of gastric cancer lesions derived from the VP and DP on spectral CT can effectively predict LVI status in gastric adenocarcinomas, and the combination of nIC VP and tumor thickness can further improve the predictive efficacy.

Comparison of Thyroglobulin and Thyroid Function in Pregnant Women between Counties with a Median Urinary Iodine Concentration of 100-149 µg/L and 150-249 µg/L / 生物医学与环境科学（英文）

OBJECTIVE@#This study explored whether thyroglobulin and thyroid disease prevalence rates were higher in pregnant Chinese women with a median urinary iodine concentration of 100-149 µg/L, compared with those with a median urinary iodine concentration of 150-249 μg/L maintained through sustainable universal salt iodization.@*METHODS@#This was a cross-sectional study in which 812 healthy pregnant women were enrolled to collect samples of their household edible salt, urine, and blood during their routine antenatal care in the 18 counties in Fujian Province, China. The levels of salt iodine concentration, urinary iodine concentration (UIC), free triiodothyronine (FT3), free thyroid hormone (FT4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), thyroid peroxidase antibody and thyroglobulin antibody were assessed during the routine antenatal care visits.@*RESULTS@#The median UIC (mUIC) in pregnant women was 130.8 μg/L (interquartile range = 91.5-198.1 μg/L) in the counties with an mUIC of 100-149 μg/L (Group I), and 172.0 μg/L (interquartile range = 123.5-244.4 μg/L) in the counties with an mUIC of 150-249 μg/L (Group II). Goiter prevalence and thyroid nodule detection rates showed no difference between Group I and Group II ( P > 0.05). Except for FT4 values, the TSH, FT4, FT3, Tg and Tg values > 40 (μg/L) and the thyroid diseases prevalence rate (TDR) showed no significant differences between Group I and Group II ( P > 0.05), whether or not iodine supplementation measures were taken.@*CONCLUSION@#Compared with an mUIC of 150-249 μg/L, not only there was no difference in thyroid morphology, but also the Tg value, rate of Tg values > 40 µg/L, and TDR were not higher in pregnant women in the counties with an mUIC of 100-149 μg/L achieved through sustainable universal salt iodization in Fujian Province, China.

Optimal Parameters for Virtual Mono-Energetic Imaging of Liver Solid Lesions / 中国医学科学院学报

Objective To explore the optimal parameters for virtual mono-energetic imaging of liver solid lesions. Methods A retrospective analysis was performed on 60 patients undergoing contrast-enhanced spectral CT of the abdomen.The iodine concentration values of hepatic arterial phase images and the CT values of different mono-energetic images were measured.The correlation coefficient and coefficient of variation were calculated. Results The average correlation coefficients between iodine concentrations and CT values of hepatic solid lesion images at 40,45,50,55,60,65,and 70 keV were 0.996,0.995,0.993,0.989,0.978,0.970,and 0.961,respectively.The correlation coefficients at 40(P=0.007),45(P=0.022),50 keV (P=0.035)were higher than that at 55 keV,and the correlation coefficients at 40 keV(P=0.134) and 45 keV(P=0.368) had no significant differences from that at 50 keV.The coefficients of variation of the CT values at 40,45,and 50 keV were 0.146,0.154,and 0.163,respectively. Conclusion The energy of 40 keV is optimal for virtual mono-energetic imaging of liver solid lesions in the late arterial phase,which is helpful for the diagnosis of liver diseases.

Efficiency of spectral CT iodine concentration value related parameters in diagnosis of regional lymph node metastasis of gastric adenocarcinoma / 中华放射学杂志

Objective:To analyze the efficacy of quantitative parameters related to spectral CT iodine concentration (IC) values in evaluating regional lymph node metastasis in patients with gastric adenocarcinoma.Methods:The clinical data and CT images of 55 patients with gastric adenocarcinoma diagnosed by pathology from June 2021 to June 2022 were collected retrospectively at Shengjing Hospital of China Medical University. Patients were divided into lymph node metastatic lesion group (32 cases) and lymph node non-metastatic lesion group (23 cases) according to whether there were metastatic lymph nodes in all the lymph nodes examined in the pathological results. Then lymph nodes were taken as the research object, and all lymph nodes were divided into the metastatic lymph node group (25 lymph nodes) and the non-metastatic lymph node group (27 lymph nodes) according to the nature of lymph nodes recorded in the pathological report. The IC values and normalized IC (nIC) values of gastric cancer lesions and lymph nodes in the arterial and venous phases (ICa and ICp, nICa and nICp) were obtained. The difference of IC and nIC values between arterial and venous phases (?IC and ?nIC) were calculated, and the arterial enhancement fraction (AEF, ratio of ICa and ICp of lymph nodes ) was calculated. Student′s t test or Mann-Whitney U test was used to compare the differences of quantitative parameters between the two groups. The parameters with statistical differences were analyzed by the receiver operating characteristic curve to obtain the diagnostic efficacy of each parameter in evaluating lymph node metastasis of gastric cancer, and the Z test was used to compare the area under the curve (AUC) of each parameter. Results:The ICp, nICp, ?IC and ?nIC of the lymph node metastatic lesion group were higher than those of the lymph node non-metastatic lesion group (all P<0.05). The AUC were 0.738, 0.746, 0.811 and 0.821. The short diameter, ICa, nICa and AEF values of lymph nodes in the metastatic lymph node group were higher than those in the non-metastatic lymph node group (all P<0.05). The AUC were 0.821, 0.832, 0.734 and 0.863. There were significant differences in AUC between ICp and ?IC, ?nIC ( Z=2.41, 3.29, P=0.016, 0.001), and between nICp and ?IC, ?nIC ( Z=2.10, 3.09, P=0.036, 0.002) in gastric cancer lesions. There were statistically significant differences in AUC between nICa and ICa, AEF ( Z=2.09, 2.41, P=0.037, 0.016) in lymph nodes. Conclusions:The quantitative parameters related to IC values of spectral CT can be applied to evaluate the properties of regional lymph nodes in patients with gastric adenocarcinoma, where ?IC, ?nIC of lesions and AEF of lymph nodes have the best efficacy.

Reproducibility Analysis of Iodine Concentrations of Abdominal Parenchymal Organs Based on Spectral CT / 中国医学科学院学报

Objective To investigate the intra-and inter-observer reproducibility of iodine concentrations of abdominal parenchymal organs based on spectral CT.Methods The water-free iodine images of the venous phase were retrospectively obtained from 50 patients with abdominal dynamic spectral CT scans.The iodine concentrations were measured in the left,right and caudate lobes of liver,spleen,pancreas and bilateral kidneys.Intraclass correlation coefficient(ICC)and Bland-Altman plot were employed to analyze the intra-and inter-observer reproducibility.Results The intra-observer ICCs of the left,right and caudate lobes of liver,spleen,pancreas,and left and right kidneys were 0.938(0.894,0.965),0.932(0.884,0.961),0.939(0.895,0.965),0.947(0.909,0.970),0.912(0.851,0.949),0.946(0.906,0.969)and 0.907(0.842,0.946),which indicated good intra-observer reproducibility.The inter-observer ICCs of the left,right and caudate lobes of liver,spleen,pancreas,and left and right kidneys were 0.947(0.909,0.970),0.927(0.875,0.958),0.943(0.902,0.968),0.956(0.924,0.975),0.934(0.887,0.962),0.927(0.875,0.958)and 0.892(0.818,0.937),which indicated good inter-observer reproducibility.Bland-Altman plots presented that more than 95% points of the intra-observer differences located within 95% CI of limits of agreement for the caudate lobe of liver,spleen,pancreas and bilateral kidneys,which was same as inter-observer differences of the caudate lobe of liver,spleen and right kidney.Conclusion The iodine concentration measurement based on the spectral CT presented good intra-and inter-observer reproducibility for the caudate lobe of liver and spleen.

Optimal Mono-energy in Mono-energetic Spectral Computed Tomography of Enhanced Renal Cortex in Cortical Phase Based on Iodine Concentration / 中国医学科学院学报

Objective To identify the optimal mono-energetic enhanced spectral CT for renal cortex in cortical phase based on the iodine concentration. Methods Fifty patients with normal renal function received the abdominal enhanced spectral CT examination.The iodine concentration and CT values of the multiple mono-energetic spectral images were measured on renal cortex in cortical phase,and the correlation between the iodine concentration and the CT values and the coefficient of variation(CV)were analyzed. Results The correlation analysis demonstrated that the correlation coefficient was 0.994,0.994,0.993,0.987,0.976,0.960,and 0.938 between mono-energetic spectral CT images(40-100 keV with interval 10 keV,respectively)and iodine concentration(all

Clinical value of quantitative parameters by spectral CT in parotid gland tumor / 华西口腔医学杂志

OBJECTIVE@#This study aimed to investigate the value of normalized iodine concentration (NIC), spectral attenuation curve slope (SACS), area under curve (AUC), and iodine concentration difference (ICD) generated from spectral CT in the assessment of parotid gland tumors.@*METHODS@#Ninety-two patients with pathologically confirmed parotid gland tumors underwent arterial phase- and venous phase-enhanced CT in spectral CT. The patients were divided into the pleomor-phic adenoma group (group A), Warthin tumor group (group B), basal cell tumor group (group C), and malignant tumor group (group D). The SACS, AUC, NIC, ICD were measured and analyzed. Statistical analyses were performed by one-way ANOVA, and statistical significance was set at P<0.05.@*RESULTS@#SACS(AP), AUC(AP), and NIC(AP) in group A were lower than those in other groups; SACS(VP) and AUC(VP) in group C were higher than those in other groups; NIC(AP) and NIC(VP) in group D were higher than those in other groups; and ICD in group B was a positive number. The difference in SACS(AP) and AUC(AP) in groups B and C, SACS(VP) and AUC(VP) in groups C and D, and ICD in groups A and C were not statistically significant. By contrast, the diffe-rence between the other groups was statistically significant (P<0.05). The difference in NIC(AP) between groups A and B and groups C and D and the difference in NIC(VP) between groups A and C, groups A and D, and groups B and C were statistically significant (P=0.005, 0.025, 0.002, 0.038, and 0.049, respectively).@*CONCLUSIONS@#Multi-quantitative parameters from spectral CT might be helpful in differentiating various types of parotid gland tumors.

Effect of Reduction in Iodine Content of Edible Salt on the Iodine Status of the Chinese Population / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>The aim of this study was to evaluate the impact of the revised Chinese National Standard GB26878-2011 'Iodine Content in Edible Salt' on the iodine status among the Chinese population.</p><p><b>METHODS</b>In 2011 and 2014, the probability proportionate to size sampling (PPS) was used in each Chinese province to obtain the representative data. In each sampling unit, school children aged 8-10 years and pregnant women were selected. Key indicators included urinary iodine concentration (UIC), thyroid volume (TV), and the iodine content in edible household salt.</p><p><b>RESULTS</b>The median urinary iodine concentration (MUIC) decreased between 2011 and 2014 from 238.6 to 197.9 µg/L in school-age children. The number of provinces with iodine excess decreased to zero. The proportion of children whose UIC was > 300 µg/L was 18.8% and decreased to 11% compared with 29.8% in 2011. There was no significant difference in UIC < 50 µg/L between 2014 (4.3%) and 2011 (3.7%) (P > 0.05). The MUIC among pregnant women in 2014 was more concentrated between 110 and 230 µg/L. The goiter rate among children aged 8-10 years was unchanged, both the goiter rate of 2011 and 2014 remaining below 5%, in view of the sustainable elimination of iodine deficiency disorders.</p><p><b>CONCLUSION</b>The National Standard GB26878-2011 'Iodine Content in Edible Salt' that was introduced in March 2012 resulted in an overall improvement in iodine status, reducing the risk of excessive iodine intake in the Chinese population.</p>

Deficiencia de yodo en mujeres lactantes / Iodine deficiency in breastfeeding mothers

El yodo es un elemento esencial para la síntesis de hormonas tiroideas (HT), necesarias para el desarrollo del cerebro. Los grupos más vulnerables a la deficiencia de yodo (DY) son las embarazadas, mujeres lactantes y niños menores de dos años. La ingesta de yodo y el estado nutricional del yodo en la madre lactante, está fuertemente relacionada con la secreción del micronutriente en leche materna (LM). Como la mayor parte del yodo absorbido por el organismo es excretada en orina, la mediana de concentración de yodo urinario (CYU), es el mejor indicador bioquímico empleado para evaluar la situación nutricional del yodo en mujeres lactantes y niños menores de dos años. Con base en la CYU en escolares de la mayoría de los países de Latinoamérica, la ingesta de yodo resultó adecuada. Sin embargo, la suficiencia de yodo en escolares no siempre se corresponde con una adecuada ingesta de yodo en mujeres lactantes. Se ha dedicado escasa atención a las consecuencias adversas de la DY durante la lactancia. En esta corta revisión, se examina la importancia del estado nutricional del yodo en la mujer lactante y se recomienda instaurar su vigilancia y monitoreo a través del análisis de yodo en orina, implementar medidas de intervención apropiadas a fin de contribuir a garantizar un óptimo estado de salud y nutrición en la madre y prevenir la aparición de trastornos por DY en lactantes y niños pequeños.

Iodine is an essential component of thyroid hormones (TH). TH are necessary for brain development. The most susceptible groups to iodine deficiency (ID) are pregnant and lactating women and children under two years of age. Maternal nutritional status and iodine intake strongly affect the amount of this nutrient secreted in breast milk (BM). Most of the iodine absorbed by the body is eventually excreted in the urine. For this reason, the median urinary iodine concentration (UIC) is the best indicator to assess the iodine nutritional status of lactating women and children less than two years of age. With base on the UIC in most of Latin American school-aged children, iodine intake was normal. However, iodine sufficiency in school age children not always corresponds with an adequate intake in lactating mothers. Little attention has been paid to the adverse consequences of ID during lactation. The objective of this short review was to examine the importance of iodine nutritional status in lactating women. We recommend to establish surveillance and monitoring of iodine status in lactating women through urine iodine levels, to implement measures to help promote an optimal health and nutrition of the mother to prevent iodine deficiency disorders (IDD) of infants and young children.

Dual energy CT in diagnosis of central cervical metastatic lymph nodes in patients with papillary thyroid cancer / 中国医学影像技术

Objective To investigate the diagnostic value of dual energy CT for small central cervical metastatic lymph nodes in patients with papillary thyroid cancer.Methods The data of 43 patients with thyroid papillary carcinoma confirmed by pathology were retrospectively analyzed.All of the patients underwent dual energy CT scan before operation.The short diameter,iodine concentration and normalized iodine concentration (NIC) of enhanced arterial and venous phases and the slope of the energy spectrum curve were analyzed between metastatic central cervical lymph nodes and non-metastatic lymph nodes.ROC curve was used to analyze the diagnosis efficacy of iodine concentration and NIC for metastatic lymph nodes of thyroid carcinoma.Results Totally there were 119 lymph nodes in 43 patients included 55 thyroid papillary carcinoma metastasis lymph nodes (metastasis group) and 64 non-metastatic lymph nodes (non-metastasis group).There was significant differences of the mean short diameter of the lymph nodes between the two groupos (t=-2.20,P=0.03).In arterial phase,the average iodine concentration of metastasis group and non-metastasis group were (2.93±1.62)mg/ml and (2.17±1.09)mg/ml;the NIC were 0.33±0.21 and 0.19 ± 0.12;and the slope of the energy spectrum curve were 0.79±0.43 and 0.63±0.37 respectively.In venous phase,the average iodine concentration of metastasis group and non-metastasis group were (2.68± 1.54) mg/ml and (2.17 ± 1.01) mg/ml;the NIC were 0.51 ± 0.18 and 0.43 ± 0.15;the slope of the energy spectrum curve were 0.54 ± 0.42 and 0.62 ± 0.39 respectively.The iodine concentration and NIC in both phases and the slope of spectrum curve in arterial phase had statistical differences between the metastasis and non-metastasis groups (all P＜0.05).ROC curve showed that the area under the curve (AUC) of iodine concentration and NIC in the diagnosis of metastatic lymph nodes were 0.62 and 0.73 in arterial phase,respectively.And the AUC of iodine concentration and NIC were 0.61 and 0.63 in venous phase,respectively.Conclusion There are differences of iodine concentration,NIC in arterial and venous phases and curve slope in arterial phase of dual-energy between malignant and benign central cervical lymph nodes in thyroid papillary carcinoma.Dual energy CT technology is helpful in identifying of metastatic from non-metastatic small central cervical lymph nodes.

Surveillance and Analysis of Urinary Iodine Level in Pregnant Women in Xiaogan Prefecture / 国际检验医学杂志

Objective To monitor the level of urinary iodine in pregnant women in Xiaogan area,to understand the iodine nutri-tional status of pregnant women during pregnancy,and to provide theoretical basis for scientific guidance of iodine intake in preg-nant women.Methods The urine iodine levels of 2 956 pregnant women in Xiaogan Hospital Affiliated to Wuhan University of Sci-ence and Technology from March 2016 to May 2017 were examined and analyzed.Results In Xiaogan area,the median concentra-tions of urinary iodine in the early,middle and late stages of pregnant women were 145.73 μg/L,176.88 μg/L and 170.37 μg/L. 996 pregnant women were with urinary iodine concentration of over 150 μg/L,accounting for 33.69%;1372 pregnant women were with urinary iodine concentration of 150-249 μg/L,accounting for 46.41%;556 pregnant women were with urinary iodine concen-tration of 250-499 μg/L,accounting for 18.81%;32 pregnant women were with urinary iodine concentration of over 500 μg/L,ac-counting for 1.08%.The incidence rates of iodine deficiency in pregnant women at early,middle and late stage were 42.86%, 32.95% and 40.00%,and the difference was statistically significant(P<0.05).The incidence rate of iodine deficiency was 32.33%in pregnant women with age ≤ 30 years old,the incidence of iodine deficiency was 36.89% in pregnant women with age > 30 years old,and the difference was statistically significant(P<0.05).Conclusion At this stage,in Xiaogan,there are no overall maternal i-odine deficiency,but there was iodine malnutrition in pregnant women in early pregnancy,and some pregnant women lack awareness of iodine.

Breast Milk Iodine and Iodine Status of Breast-Fed Infants.

Background: Breast milk is the only source of iodine for exclusively breast-fed infants. Iodine status of breast-fed infants depends on iodine in breast milk and also number of feeding in 24 hours. Iodine deficiency and iodine excess both have bad impact on infant’s health. Objective: To measure the iodine in breast milk and to evaluate iodine status of their breast-fed infants. Materials and method: This observational analytical study was carried out in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka with active cooperation of Kumudini Women’s Medical College Hospital, Mirzapur, Tangail involving fifty lactating mothers and their exclusively breast-fed infants. Early morning urine and breast milk samples were collected in dry and clean plastic container free from any chemical contamination. Urinary iodine was used as indicator for assessing iodine status. All statistical analyses were done by using SPSS (statistical programme for social science) 12 version software package for Windows. Results: The median (range) urinary iodine concentration of lactating mothers and their breast-fed infants were 225.25 μg/L (61.50-530.00) and 225.75 μg/L (100.50-526.00) respectively. The median (range) breast-milk iodine concentration was 157 μg/L (54.50-431.50) which was more than three times of recommended minimum concentration (50 μg/L). Only 2 (4%) lactating mothers had mild biochemical iodine deficiency (UIE, 50-99 μg/L). There was no biochemical iodine deficiency of breast-fed infants. Iodine in breast milk of lactating mothers was positively correlated with their urinary iodine excretion (p<0.01). Infant’s urinary iodine was positively correlated with iodine concentration in breast milk (p<0.01) and with urinary iodine of lactating mothers (p<0.01). Conclusion: Lactating mothers and their breast-fed infants in this study were iodine sufficient. If iodine content of breast-milk is within normal range, 10-12 numbers of feeding in 24 hours for infants is enough to get sufficient iodine from their mother’s milk.

Iodine Status after a 3-Year Universal Salt Iodisation in Sarawak, Malaysia

Following the reveal of borderline iodine sufficiency among the Sarawakians from the 2008 National Iodine Deficiency Disorders (IDDs) survey, a mandatory universal salt iodization (USI) was implemented in Sarawak thereafter. This study aimed to determine the current status of USI in Sarawak after a 3-year implementation of USI from 2008 to 2011. The IDD survey was conducted between Jun 2011 to July 2011 involving six districts in Sarawak (Sarikei, Mukah, Kapit, Sibu, Bintulu and Miri). The schools were selected via multistage proportionate-to-population size sampling technique and the children were randomly selected via systematic sampling. A total of 19 schools and 661 children were recruited into the survey. Thyroid size was determined by palpation and was and graded according to the classification of the World Health Organization (grade 0-2). The iodine excretion level in spot morning urine was measured using in-house microplate method. The urinary iodine concentration (UIC) values were compared by Kruskal-Wallis test and Chi-square tests were used to compare categorical variables. A total of 610 school children were participated in the study (92.3%). The TGR of grade 1 and 2 was found to be 0.3% (n = 2). Overall the median UIC level was 154.2 (IQR, 92.7 - 229.8) µg/L, with the highest median UIC been observed in Sarikei [178.0 (IQR, 117.6 - 308.9) µg/L], followed by Mukah [174.8 (IQR, 99.0 - 224.3) µg/L)], Miri [158.6 (IQR, 92.3 - 235.4) µg/L], Sibu [147.0 (IQR, 89.8 - 221.4) µg/L], Bintulu [142.3 (IQR, 52.8 - 245.1) µg/L] and Kapit [131.0 (IQR, 88.6 - 201.9) µg/L]. One in every ten child was of iodine deficient (UIC < 50µg/L) while a third of the child (32%) were of adequate level of UIC. The present findings indicate that the mandatory USI successfully improves the iodine level of children in Sarawak. However, regular and proper monitoring of the UIC level in the communities is needed to prevent excessive iodine intake.​

Quantitative parameters in iodine overlay image based on dual-source dual-energy computed tomography in differentiating benign and malignant thyroid nodules / 中华放射学杂志

Objective To investigate the application of quantitative parameters associated with iodine concentration derived from iodine overlay image by dual-source dual-energy computed tomographic (CT) in differentiating benign and malignant thyroid nodules. Methods Seventy-eight patients (total 112 nodules, including 64 benign and 48 malignant nodules) with thyroid nodules who underwent plain scan (PS), arterial phase (AP) and venous phase (VP) enhanced scan by DSCT (80 kVp/ Sn140 kVp) were analyzed retrospectively. Iodine overlay images were obtained by the dual energy post-processing software. The mean iodine concentrations in the normal thyroid parenchyma (ICThy), the lesion (ICLes), and the carotid artery(ICCar) of PS, AP and VP were measured from iodine overlay images. The iodine concentration difference (ICD), the iodine concentration difference-to-normal parenchyma ratio (ICDNR) and the normalized iodine concentration ratio (NIC) were calculated. The two-sample t test was performed to compare quantitative parameters between the benign and malignant nodules. ROC curve with quantitative parameters of three phases was used to analyze the diagnostic efficiency of ICD, ICDNR, NIC and ICles. Results During PS, mean ICDNR, ICD and ICLes of malignant nodules were respectively 1.04 ± 0.95, (2.20 ± 1.82) mg/ml, (-0.04 ± 1.65) mg/ml, ICDNR, ICD and ICLes of benign nodules were respectively 0.04 ± 0.41, (0.35 ± 0.97) mg/ml, (2.19 ± 0.55) mg/ml. ICDNR and ICD of malignant nodules were higher than benign nodules (t'=6.63, 6.39, P<0.05), while ICles of malignant nodules were lower than benign nodules (t=10.13, P<0.05). During AP , mean ICDNR, ICD, ICLes of malignant nodules were 0.39 ± 0.29, (2.23 ± 1.77) mg/ml, (3.81 ± 1.50) mg/ml, and benign nodules were 0.49 ± 0.22, (2.97 ± 1.91) mg/ml, (3.17 ± 1.64) mg/ml, respectively. ICDNR, ICD of malignant nodules were lower than benign nodules (t'=2.08, t=2.12;P<0.05),while ICles of malignant nodules were higher than benign nodules (t=2.12, P< 0.05). During VP, mean NIC of the malignant and benign nodules were 0.45 ± 0.21, 0.58 ± 0.37, respectively. NIC of malignant nodules were lower than benign nodules (t'=2.35, P< 0.05). AUC of ICDNR during PS was 0.892, the sensitivity was 83.3% and the specificity were 90.5%. Conclusion Quantitative parameters associated with iodine concentration by dual-source dual-energy CT may increase the efficiency and accuracy in differentiating benign and malignant thyroid nodules.

Iodine Deficiency Disorder and Goitre among School Children in Sarawak -A Nationwide Study

Iodine deficiency disorders (IDD), is one of the most important micronutrient deficiencies which has multiple adverse effects on growth and development. The aim of this study was to determine the prevalence of IDD among school children and to elucidate the distribution of iodized salt at household level in Sarawak, East Malaysia. This cross-sectional study was conducted among school children aged 8 to 10 years in 2008. A multi-stage probability proportionate to population size (PPS) cluster sampling method was used to obtain a representative state sample of 1200 school children. Spot urine samples were collected for the determination of urinary iodine concentration while the iodine content in salt was determined using field rapid test kits. The thyroid status was determined by palpation. Response rate was 92.0% (n=1104/1200). The prevalence of goitre among school children in Sarawak was 2.9% (5.2% in urban, 0.7% in rural). The median urinary iodine concentration (UIC) among the school children was 102.1 µg/L (IQR, 62.3-146.5 µg/L). Urban children had significantly higher median UIC of 109.3 µg/L (IQR, 72.4-159.0 µg/L) than their rural counterparts [91.9 µg/L (IQR, 55.7-140.2 µg/L)]. The salt samples tested by rapid test kit (RTK) showed only 46.0% of household salt contained iodine. The present study revealed that the population in Sarawak were of borderline iodine sufficient with mild IDD seen in rural areas. Hence, the state IDD control programmes need to encourage and advocate the consumption of iodized salt in order to eliminate IDD-related health problems in Sarawak.

Iodine nutrition in elementary state schools of Queretaro, Mexico: correlations between urinary iodine concentration with global nutrition status and social gap index / Consumo de iodo em escolas de ensino fundamental de Querétaro, México: correlação entre a concentração urinária de iodo, o estado nutricional geral e o índice de desigualdade social

OBJECTIVE AND METHODS: To estimate median urinary iodine concentration (UIC), and to correlate it with global nutrition indicators and social gap index (SGI) in 50 elementary state schools from 10 municipalities in the State of Queretaro, Mexico. RESULTS: 1,544 students were enrolled and an above of requirements of iodine intake was found (median UIC of 297 µg/L). Iodine status was found as deficient, adequate, more than adequate and excessive in 2, 4, 19 and 25 schools, respectively. Seventy seven percent of table salt samples showed adequate iodine content (20-40 ppm), while 9.6% of the samples had low iodine content (< 15 ppm). Medians of UIC per school were positively correlated with medians of body mass index (BMI) by using the standard deviation score (SDS) (r = 0.47; p < 0.005), height SDS (r = 0.41; p < 0.05), and overweight and obesity prevalence (r = 0.41; p < 0.05). Medians of UIC per school were negatively correlated with stunting prevalence (r = -0.39; p = 005) and social gap index (r = -0.36; p < 0.05). Best multiple regression models showed that BMI SDS and height were significantly related with UIC (p < 0.05). CONCLUSIONS: There is coexistence between the two extremes of iodine intake (insufficient and excessive). To our knowledge, the observed positive correlation between UIC and overweight and obesity has not been described before, and could be explained by the availability and consumption of snack food rich in energy and iodized salt.

OBJETIVO E MÉTODOS: Estimar a concentração de iodo urinário (CIU) mediana e correlacioná-la com os indicadores de nutrição geral e com o índice de desigualdade social (IDS) de 50 escolas estaduais de ensino fundamental de 10 municípios do estado de Querétaro, no México. RESULTADOS: Utilizou-se um total de 1.544 crianças e encontrou-se uma ingestão acima das necessidades de iodo (CIU mediana de 297 µg/L). O nível de iodo determinado foi deficiente, adequado, mais do que adequado e excessivo em 2, 4, 19 e 25 escolas, respectivamente. Setenta e sete por cento de amostras de sal de mesa mostraram uma quantidade de iodo adequada (20-40 ppm), enquanto 9,6% das amostras tinham um teor de iodo baixo (< 15 ppm). As medianas de CIU por escola foram correlacionadas positivamente com as medianas do índice de massa corporal (IMC) usando o desvio-padrão da contagem (DP) (r = 0,47; p < 0.005), o DP da altura (r = 0,41; p < 0.05) e a prevalência de sobrepeso e de obesidade (r = 0,41; p < 0,05). As medianas de CUI por escola foram correlacionadas negativamente com a prevalência de desnutrição (r = -0.39; p = 005) e com o índice de desigualdade social (r = -0.36; p < 0,05). Os melhores modelos de regressão múltipla mostraram que a DP do IMC e a altura foram relacionados significativamente com a CIU (p < 0,05). CONCLUSÃO: Existe uma convivência entre os dois extremos de ingestão de iodo (insuficiente e excessiva). Em nosso conhecimento, a correlação positiva entre a CIU, o excesso de peso e a obesidade não foi descrita anteriormente e poderia ser explicada pela disponibilidade e consumo de alimentos ou refeições ricos(as) em energia e sal iodado.

Nutrición de yodo en escolares de Calama, Chile: persitencia de niveles elevados de yodo urinario / Iodine nutrition in school children of Calama city, Chile: persistence of high urinary iodine levels

Introducción: El año 2000 se determinó que la mediana de la concentración urinaria de yodo (CUI) en escolares de educación básica de Calama estaba en 2600 ug/L, valor muy elevado, el que descendió a 487 ug/L el año 2004 después de reducir los niveles oficiales de yodación de la sal de 100 ppm a 40 ppm el año 2000. Objetivo: Investigar la nutrición de yodo en escolares de Calama, 12 años después del cambio de legislación. Sujetos y métodos: 332 escolares de ambos sexos de una escuela municipal de educación básica de Calama fueron evaluados sobre la prevalencia de bocio mediante la palpación de la glándula tiroides; al 22% de los mismos (72) se les evaluó la nutrición de yodo mediante la determinación de CUI en muestras casuales de orina por espectrofotometría. Se recolectaron 58 muestras de sal de consumo humano, seleccionadas aleatoriamente en locales comerciales, comedores de la escuela y en los hogares de los escolares, para determinar su contenido de yodo por la técnica de almidón. Adicionalmente, en todos los escolares se registró peso, talla e IMC. Resultados: Se encontró una prevalencia de bocio de 8.2%, todos del grado 1. La mediana de la concentración urinaria de yodo fue 448 ug/L. La concentración de yodo en la sal fue 31,4 ± 17.8 ppm, valor dentro de los estándares oficiales establecidos en el Reglamento Sanitario de los Alimentos (RSA) del Ministerio de Salud de Chile. Comentarios y conclusiones: Los resultados muestran un leve aumento en la prevalencia de bocio y que persiste una alta CUI en escolares de Calama, probablemente debido a una excesiva ingesta de yodo, no obstante que el promedio de contenido de yodo en la sal para consumo humano estuvo dentro del rango recomendado por OMS-UNICEF-ICCIDD (20-40 ppm). Estos hallazgos plantean la necesidad de investigar otras probables fuentes de ingesta de yodo, como causa del exceso de yodo que persiste en Calama.

Introduction: In the year2000 it was determined that the median of the urinary iodine concentration (UIE) in primary school children from Calama was 2600 ug/L, a very high level which went down to 487 ugI/L in 2004, after the standards of the Food Sanitary Regulation were scaled down from 100 ppm to 40 ppm in the year 2000. Objective: To search the current iodine nutrition in school children of Calama, 12 years after the change in the legislation. Subjects and methods: 332 primary school children from Municipal School D-48 ofthe City ofCalama were assessed in relation to their prevalence of goiter determined through palpation of the thyroid gland. In 22% ofthem (72 children), UIE was determined by spectrophotometry. 58 samples ofsalt for human consumption saltwere randomly collected from local shops, school canteens and from the children's homes to determine their iodine concentration through the starch technique. In addition, the school children were measured and weighed to determine the adequacy of their height and Body Mass Index (BMI). Results: An 8.2% prevalence ofgoiter was found; all were grade 1. The iodine concentration in the salt was 31.4 ± 17.8 in the 58 samples analyzed, the average met the adequate range of the current Food Sanitary Regulation (FSR) of Health Ministry of Chile. Conclusion and comments: A non significant increase in the prevalence ofgoiter was found, the average of UIE continue being high, possible due to an excessive intake ofiodine, nevertheless average iodine concentration in the salt for human consumption is within de recommended range by WHO-UNICEF-ICCIDD (20-40 ppm). These findings prompt to search another sources of iodine intake, as an explanation of the persistent elevation of UIE in these children.

Low Iodine Diet for Preparation for Radioactive Iodine Therapy in Differentiated Thyroid Carcinoma in Korea

Preparation for radioactive iodine (RAI) therapy includes an increased serum thyroid stimulating hormone level and a low iodine diet (LID). Because of extremely high iodine intake, some physicians have advocated a more stringent LID for greater than 2 weeks in Korean patients with thyroid cancer prior to RAI therapy; however, it is very difficult to maintain a stringent LID for a longer period of time. According to recent reports in Korea, a nonstringent, simple LID for only 1 week might be enough prior to RAI therapy, if the patients can be educated intensively by specially trained staff. The measurement of simple urinary iodine concentration (UIC; microg/L) may underestimate daily iodine excretion in patients with a urinary volume of more than 1 L/day and can also be affected by dilution status. Simple UIC had a weaker correlation than the iodine/creatinine (I/Cr) ratio. Therefore, the urinary I/Cr ratio can replace 24-hour urine iodine excretion instead of simple UIC, although it may overestimate iodine intake in patients with malnutrition or poor muscle mass. The measurement of serum iodine level might be useful as an adjunct parameter for assessing LID preparation, but its sensitivity and specificity were relatively low compared to the urinary I/Cr ratio.

Iodine concentration in common potable water sources in the estates of Ratnapura district and thyroid status of children.

Introduction: Iodine deficiency is the single most important cause of hypothyroidism. Drinking water is an important source of iodine for humans. Objective: To identify the common potable water sources available to the estate population in the Ratnapura District, to determine the iodine concentrations in different water sources and to ascertain the relationship between water iodine concentrations and thyroid status of children 5 to 9 years of age. Method: A descriptive cross sectional study was carried out in three phases in 20 randomly selected estates in the Ratnapura district of Sri Lanka from September to November 2009. In phase 1, 1,683 households in the selected estates were surveyed to identify the drinking water sources. In phase 2, blood samples from 519 randomly selected children aged 5-9 years from the same estates were taken to assay TSH levels after obtaining informed written consent from parents. In phase 3, water samples from 23 identified sources (wells, rivers and springs) were analysed for iodine levels by the catalytic reduction method. Water sources were grouped on elevation above mean sea level. The mean TSH levels and water iodine concentrations were correlated. Results: The main source of drinking water was spring water (83.7%). Spring water at low altitudes had significantly higher iodine concentrations than that located at higher altitudes (p<0.01). The mean iodine concentration in spring water was significantly lower than that in other sources (p<0.001). There was no association between the mean TSH levels of children and the altitudes at which they lived (p>0.05). There was no significant association between TSH levels of children and iodine concentration in drinking water (p>0.05). Conclusions: The main potable water source available to the population in the Ratnapura District was spring water (84%). The mean iodine concentration of spring water was significantly lower as compared to other water sources. There was no significant association between serum TSH levels in children 5 to 9 years of age and iodine concentration in drinking water.

Seaweed supplementation to prevent iodine deficiency.

Iodine is considered as one of the essential elements for the proper functioning of the hormones of human and animal thyroid glands. In many parts of the world iodine deficiency disorders develop because of deficiency of iodine in water and food supply. An iodine deficient goitrous mother may give birth to a cretinous baby because the fetus requires an adequate secretion of thyroxine during the later stages of pregnancy. Seaweed has such a large proportion of iodine compared to dietary minimum requirements, that it is primarily known as a source of this nutrient. A trial study on supplementation of iodine rich seaweed Caulerpa racemosa availed from Gujarat coast was conducted on iodine-deficient or thyroid-insufficient (n=10) pregnant women. They were supplemented daily with 0.17 g of algae in 20 g wheat flour ladoo for one month so as to provide 50μg/day of iodine and 0.343 mg/day of iron. A slight non-significant increase (104.75 to 121.05 μg/L) in median urinary iodine concentration (UIC) was observed after one month of supplementation. No significant effect of supplementation was observed on thyroid function parameters of the subjects. They also showed slight increase in hemoglobin level. Prolonged supplementation needs to be carried out further to opine on the impact of algae.