Peripheral iodine uptake on DECT predicts systemic, not lesion-level, progression in ICI-treated metastatic melanoma

In 73 metastatic melanoma patients on immunotherapy, baseline peripheral rim iodine concentration on DECT independently predicted shorter progression-free survival and greater new-lesion burden, but not individual lesion progression. Organ-specific effects were heterogeneous.

• Peripheral rim iodine concentration independently associated with shorter PFS after adjusting for lesion count and tumor volume.
• Organ-specific heterogeneity: positive association in splenic, soft tissue, and hepatic metastases; inverse association in lymph node metastases.
• Higher peripheral iodine concentration predicted greater new-lesion burden through first two follow-ups, but not progression of individual baseline lesions.

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