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Tavakkoli M, Runderkamp B, de Buck M, Strijkers G, Noseworthy M, Nederveen A, Caan M, van der Zwaag W. Compressed Sensing-Accelerated Free-Breathing Liver MRI at 7 T. NMR IN BIOMEDICINE 2025; 38:e70047. [PMID: 40296289 PMCID: PMC12038085 DOI: 10.1002/nbm.70047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 03/08/2025] [Accepted: 04/13/2025] [Indexed: 04/30/2025]
Abstract
Ultra-high field MRI facilitates imaging at high spatial resolutions, which may become important for detailed anatomical and pathological assessment of the human liver. Therefore, we aimed to advance structural liver imaging at 7 T by implementing a high-resolution, phase-shimmed, free-breathing liver scan. Six healthy participants underwent liver MRI scans at 7 T, utilizing an eight-channel parallel transmission system for phase shimming. B0 mapping and Fourier phase-encoded dual refocusing echo acquisition mode (PE-DREAM) multichannel B1 + mapping were performed during breath-holds at expiration. Prospectively undersampled golden-angle pseudo-spiral k-space data were acquired under free breathing, enabling retrospective respiratory binning using self-gating. Post-binning, the simultaneous autocalibrating and k-space estimation (SAKE) algorithm was employed for interpolation of a center of k-space area, prior to estimation of receive coil sensitivity maps. Image reconstruction was performed on expiration-phase data using compressed sensing, optimizing image quality by evaluating various regularization factors and numbers of respiratory bins. Finally, N4BiasFieldCorrection was applied to the resulting images. Expiration-phase image reconstruction using four bins and regularization factor values of 10-2.5 (1.50 mm) and 10-2.33 (1.35 mm) were found to optimize the tradeoff between sharpness, SNR, and artifacts. The optimized protocol facilitated clear visualization of the liver, blood vessels, and surrounding structures at isotropic resolutions of 1.50 and 1.35 mm in 3.5 min, without B1 + inhomogeneity effects in the shimmed liver region. A comparison between low-resolution fully sampled free-breathing (3.5 min) and breath-hold (19 s) acquisitions demonstrated comparable sharpness and SNR. To compare the 7 T data with 3 T MRI, 3 T scans were performed for two participants. 3 T reconstructions were done similarly to 7 T, excluding N4BiasFieldCorrection. Scan-specific regularization optimization was performed for fair comparison. Compared to 3 T, 7 T showed superior vascular contrast with inflow effects not observed at 3 T. Fold-over artifacts were present in 3 T scans but were minor at 7 T. 3 T and 7 T provided comparable results, with a much higher RF channel count at 3 T. In conclusion, high-resolution expiration-phase liver imaging at 7 T with homogeneous signal can be successfully achieved using a phase-shimmed, free-breathing protocol with a golden-angle pseudo-spiral sampling pattern technique and respiratory self-gating. This approach allows detailed anatomical depiction without the limitations of breath-holding, representing a significant advancement in ultra-high field abdominal MRI.
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Affiliation(s)
- Mitra Tavakkoli
- Department of Electrical and Computer EngineeringMcMaster UniversityHamiltonOntarioCanada
- Imaging Research CentreSt. Joseph's Healthcare HamiltonHamiltonOntarioCanada
| | - Bobby A. Runderkamp
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Matthijs H. S. de Buck
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
- Spinoza Centre for NeuroimagingRoyal Netherlands Academy for Arts and Sciences (KNAW)Amsterdamthe Netherlands
- Computational and Cognitive Neuroscience and NeuroimagingNetherlands Institute for Neuroscience, KNAWAmsterdamthe Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical CenterUniversity of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Michael D. Noseworthy
- Department of Electrical and Computer EngineeringMcMaster UniversityHamiltonOntarioCanada
- Imaging Research CentreSt. Joseph's Healthcare HamiltonHamiltonOntarioCanada
- Department of Medical ImagingMcMaster UniversityHamiltonOntarioCanada
- School of Biomedical EngineeringMcMaster UniversityHamiltonOntarioCanada
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical CenterUniversity of AmsterdamAmsterdamthe Netherlands
| | - Matthan W. A. Caan
- Department of Biomedical Engineering and Physics, Amsterdam University Medical CenterUniversity of Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Wietske van der Zwaag
- Spinoza Centre for NeuroimagingRoyal Netherlands Academy for Arts and Sciences (KNAW)Amsterdamthe Netherlands
- Computational and Cognitive Neuroscience and NeuroimagingNetherlands Institute for Neuroscience, KNAWAmsterdamthe Netherlands
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Yang J, Zhang J, An J, Dong F, Huang S, Guo W, Zhang W, Bao Y, Zhang J. Hepatic Portal Venous Perfusion Imaging Using Vessel-Labeling Super-Resolution Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2025; 51:951-960. [PMID: 40140336 DOI: 10.1016/j.ultrasmedbio.2025.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 01/14/2025] [Accepted: 01/26/2025] [Indexed: 03/28/2025]
Abstract
OBJECTIVE Blood flow imaging and perfusion assessment of the hepatic portal vein are critical for the diagnosis of several liver diseases, including cirrhosis, primary and metastatic liver tumors. However, perfusion imaging of the portal vein is challenging due to the unique dual blood supply system of the liver. METHODS We developed a novel method for specific perfusion imaging of the portal vein and downstream vessels, which was validated on healthy mice (n = 4). The right lobe of the liver in healthy mice was sequentially imaged using ultrafast plane-wave Doppler imaging and vascular labeling. In each experiment, mice were first injected with phase-change nanodroplets (PCNDs), followed immediately by ultrafast Doppler imaging to determine the imaging section and locate portal vein branches. Through an interactive process, portal vein branches were selected by mouse click for data acquisition of vessel-labeling ultrasound (VLUS) based on PCNDs. Subsequent arrival time calculations and super-resolution ultrasound (SRUS) imaging were performed offline. To demonstrate the specificity of the proposed method for vascular imaging, one mouse was injected with Sonovue microbubbles for plane-wave ultrasound data acquisition and microbubble-based VLUS data acquisition. All imaging experiments were conducted on the Verasonics (Kirkland, WA, USA) Vantage 256 ultrasound system using an L22-8v linear array transducer with a center frequency of 15.625 MHz. The multi-angle coherent compounding plane-wave acquisition frame rate was 500 Hz. RESULTS Imaging results from healthy mice (n = 4) demonstrated that VLUS was able to label different branches of the hepatic portal vein and specifically image downstream vessels. Analysis of the in vivo results at different spatial scales showed that the brightness of the downstream perfusion area was significantly enhanced after labeling started, while there was no significant difference in image brightness before the labeling started and after it ended. By analyzing the acoustic field distribution at the focal point, the full width at half maximum in the x1 and z1 directions were 98.56 μm and 526.68 μm, respectively. Along the propagation path of the focused beam (outside the labeling area), no significant activation of the PCNDs was observed (p < 0.0001). Combined with SRUS technology, the resolution of the VLUS portal vein imaging results was further enhanced. The time-intensity curves of the downstream regions of interest indicated that VLUS provided a step input signal to the downstream vessels. Based on the arrival time of the step point in the time-intensity curves, the arrival time distribution map of the downstream vessels relative to the labeling point could be calculated. CONCLUSION We propose a novel method for hepatic portal vein perfusion imaging based on VLUS. In vivo experiments, simulation results and statistical analysis demonstrate that this method is able to accurately label portal vein vessels with millimeter-level precision, enabling specific high-resolution imaging and precise, non-invasive measurement of the downstream perfusion area. By combining VLUS with SRUS technology, the resolution of the portal vein imaging results can be further enhanced.
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Affiliation(s)
- Jinyu Yang
- College of Engineering, Peking University, Beijing, China
| | - Jiabin Zhang
- College of Future Technology, Peking University, Beijing, China
| | - Jian An
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Feihong Dong
- College of Future Technology, Peking University, Beijing, China
| | - Shuo Huang
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Wenyu Guo
- Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
| | - Wenli Zhang
- College of Future Technology, Peking University, Beijing, China
| | - Yunlong Bao
- College of Engineering, Peking University, Beijing, China
| | - Jue Zhang
- College of Engineering, Peking University, Beijing, China; Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
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Goris LC, Zaid Al-Kaylani AHA, Schuurmann RCL, Greuter MJW, Bokkers RPH, Manohar S. Development of a cerebral CT perfusion phantom: A structured approach. Phys Med 2025; 131:104944. [PMID: 39985960 DOI: 10.1016/j.ejmp.2025.104944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 01/14/2025] [Accepted: 02/18/2025] [Indexed: 02/24/2025] Open
Abstract
INTRODUCTION Computed tomography perfusion (CTP) imaging is crucial in diagnosing and managing vascular diseases, e.g, stroke. Differences in scanners and protocols may lead to different results, affecting clinical decision-making. Objective validation and evaluation of CTP imaging are therefore important. Perfusion phantoms are essential test objects to facilitate the validation and evaluation of perfusion imaging. Therefore, this study aimed to develop, validate and evaluate a brain perfusion phantom for the evaluation of cerebral CTP. METHODS A cerebral perfusion phantom was developed to evaluate CTP imaging of the brain using a workflow based on the Design Science Research Methodology. The reliability and repeatability of the phantom's perfusion parameters derived from the time-density curves (TDCs) in CTP were evaluated. RESULTS A 3D-printed modular perfusion phantom was developed, filled with sodium alginate beads, and connected to a pumping system to mimic microvasculature and flow dynamics. The phantom consisted of three compartments that simulated different states of perfusion. The phantom showed reliable TDCs, with a relative standard deviation of <6.6 % for peak intensity and time-to-peak (TTP) over two sets of five repeated experiments for all compartments, and repeatable TTP and mean transit time values with a repeatability coefficient of <2.3 s compared to the mean. CONCLUSIONS The developed perfusion phantom demonstrated high reliability and could be employed for investigating CTP imaging under various flow speeds. The presented workflow promotes transparency in the development, validation, and application of CTP phantoms, and facilitates cross-study comparisons through structured iterative development and unified evaluation metrics.
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Affiliation(s)
- Liselot C Goris
- Multi-Modality Medical Imaging Group, Techmed Center, University of Twente, Enschede, the Netherlands.
| | - Abdallah H A Zaid Al-Kaylani
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Richte C L Schuurmann
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, Groningen, the Netherlands.
| | - Marcel J W Greuter
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, Groningen, the Netherlands.
| | - Reinoud P H Bokkers
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, Groningen, the Netherlands.
| | - Srirang Manohar
- Multi-Modality Medical Imaging Group, Techmed Center, University of Twente, Enschede, the Netherlands.
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Pat Fong W, Li ZJ, Ren C, Guan WL, Zuo MX, Zhang TQ, Li BK, Zheng Y, Wu XJ, Ding PR, Chen G, Pan ZZ, Yuan YF, Tan Q, Wang ZQ, Li YH, Wang DS. Percutaneous hepatic artery infusion chemotherapy with oxaliplatin and fluoropyrimidines in treatment-resistant colorectal cancer patients with unresectable liver metastases: a retrospective cohort study. HPB (Oxford) 2025; 27:289-298. [PMID: 39668070 DOI: 10.1016/j.hpb.2024.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 11/19/2024] [Accepted: 11/25/2024] [Indexed: 12/14/2024]
Abstract
BACKGROUND Subsequent lines of therapy for chemotherapy-resistant metastatic colorectal cancer (CRC) have shown limited efficacy. Herein, we retrospectively investigated the efficacy and safety of hepatic artery infusion chemotherapy (HAIC) using oxaliplatin plus 5-FU/FUDR in patients with unresectable colorectal liver metastases (CRLM) who progressed following standard chemotherapy regimens. METHODS From March 2017 to April 2023, CRC patients with unresectable CRLM who progressed following standard chemotherapy and subsequently received HAIC oxaliplatin plus 5-FU/FUDR were evaluated. Objective response rate (ORR), disease control rate (DCR), median depth of tumor response (DpR), no evidence of disease (NED) rate, progression-free survival (PFS), overall survival (OS), and safety were assessed. RESULTS A total of 21 patients who progressed after a median of two (range: 1-4) lines of standard systemic chemotherapy were included. The ORR and DCR were 28.6 % and 95.2 %, respectively, with six patients reaching partial response. Additionally, the median DpR was 10.6 %, and seven patients underwent successful conversion surgery. Stratification revealed significantly better PFS in patients with liver-limited metastases compared to those with concurrent hepatic and extrahepatic metastases (P = 0.0003). CONCLUSION HAIC oxaliplatin plus 5-FU/FUDR is a robust regimen for treatment-resistant CRC patients with unresectable CRLM, particularly those with liver-limited disease.
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Affiliation(s)
- William Pat Fong
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zi-Jing Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chao Ren
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wen-Long Guan
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Meng-Xuan Zuo
- Department of Minimally Invasive & Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tian-Qi Zhang
- Department of Minimally Invasive & Interventional Therapy, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bin-Kui Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yun Zheng
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-Jun Wu
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Pei-Rong Ding
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Gong Chen
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Zhong Pan
- Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yun-Fei Yuan
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qiong Tan
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-Qiang Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yu-Hong Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
| | - De-Shen Wang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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Zhang K, Triphan SMF, Wielpütz MO, Ziener CH, Ladd ME, Schlemmer HP, Kauczor HU, Sedlaczek O, Kurz FT. Non-contrast free-breathing liver perfusion imaging using velocity selective ASL combined with prospective motion compensation. Z Med Phys 2025; 35:87-97. [PMID: 38960810 PMCID: PMC11910247 DOI: 10.1016/j.zemedi.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/28/2024] [Accepted: 06/11/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE To apply velocity selective arterial spin labeling (VSASL) combined with a navigator-based (NAV) prospective motion compensation method for a free-breathing liver perfusion measurement without contrast agent. METHODS Sinc-modulated Velocity Selective Inversion (sinc-VSI) pulses were applied as labeling and control pulses. In order to account for respiratory motion, a navigator was employed in the form of a single gradient-echo projection readout, located at the diaphragm along the inferior-superior direction. Prior to each transverse imaging slice of the spin-echo EPI based readouts, navigator and fat suppression were incorporated. Motion data was obtained from the navigator and transmitted back to the sequence, allowing real-time adjustments to slice positioning. The sinc-VSI without velocity-selective gradients during the control condition but with velocity-selective gradients along all three directions during labeling was chosen for the VSASL. The VSASL was compared with pseudo-continuous ASL (pCASL) methods, which selectively tagged the moving spins using a tagging plane placed at the portal vein and hepatic artery. RESULTS The motion caused by respiratory activity was effectively computed using the navigator signal. The coefficients of variation (CoV) of average liver voxel in NAV were significantly decreased when compared to breath-hold (BH), with an average reduction of 29.4 ± 18.44% for control images, and 29.89 ± 20.83% for label images (p < 0.001). The resulting maps of normalized ASL signal (normalized to M0) showed significantly higher perfusion weightings in the NAV-compensated VSASL, when compared to the NAV-compensated pCASL techniques. CONCLUSIONS This study demonstrates the feasibility of using a navigator-based prospective motion compensation technique in conjunction with VSASL for the measurement of liver perfusion without the use of contrast agents while allowing for free-breathing.
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Affiliation(s)
- Ke Zhang
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic & Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Divison of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Simon M F Triphan
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic & Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Mark O Wielpütz
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic & Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Christian H Ziener
- Divison of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Mark E Ladd
- Divison of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany; Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany; Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | | | - Hans-Ulrich Kauczor
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany; Department of Diagnostic & Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Sedlaczek
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Diagnostic & Interventional Radiology with Nuclear Medicine, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany; Divison of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Felix T Kurz
- Divison of Radiology, German Cancer Research Center, Heidelberg, Germany; Division of Neuroradiology, Geneva University Hospitals, Geneva, Switzerland.
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Faccenda V, Panizza D, Niespolo RM, Colciago RR, Rossano G, De Sanctis L, Gandola D, Ippolito D, Arcangeli S, De Ponti E. Synchronized Contrast-Enhanced 4DCT Simulation for Target Volume Delineation in Abdominal SBRT. Cancers (Basel) 2024; 16:4066. [PMID: 39682252 DOI: 10.3390/cancers16234066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 11/29/2024] [Accepted: 12/03/2024] [Indexed: 12/18/2024] Open
Abstract
Background/Objectives: To present the technical aspects of contrast-enhanced 4DCT (ce4DCT) simulation for abdominal SBRT. Methods: Twenty-two patients underwent two sequential 4DCT scans: one baseline and one contrast-enhanced with personalized delay time (tdelay) calculated to capture the tumor in the desired contrast phase, based on diagnostic triple-phase CT. The internal target volume (ITV) was delineated on ten contrast phases, and a panel of three experts qualitatively evaluated tumor visibility. Aortic HU values were measured to refine the tdelay for subsequent patients. The commonly used approach of combining triple-phase CT with unenhanced 4DCT was simulated, and differences in target delineation were evaluated by volume, centroid shift, Dice and Jaccard indices, and mean distance agreement (MDA). The margins required to account for motion were calculated. Results: The ce4DCT acquisitions substantially improved tumor visibility over the entire breathing cycle in 20 patients, according to the experts' unanimous evaluation. The median contrast peak time was 54.5 s, and the washout plateau was observed at 70.3 s, with mean peak and plateau HU values of 292 ± 59 and 169 ± 25. The volumes from the commonly used procedure (ITV2) were significantly smaller than the ce4DCT volumes (ITV1) (p = 0.045). The median centroid shift was 4.7 mm. The ITV1-ITV2 overlap was 69% (Dice index), 53% (Jaccard index), and 2.89 mm (MDA), with the liver volumes showing significantly lower indices compared to the pancreatic volumes (p ≤ 0.011). The margins required to better encompass ITV1 were highly variable, with mean values ≥ 4 mm in all directions except for the left-right axis. Conclusions: The ce4DCT simulation was feasible, resulting in optimal tumor enhancement with minimal resource investment, while significantly mitigating uncertainties in SBRT planning by addressing poor visibility and respiratory motion. Triple-phase 3DCT with unenhanced 4DCT led to high variability in target delineation, making the isotropic margins ineffective.
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Affiliation(s)
- Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Denis Panizza
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Rita Marina Niespolo
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | | | - Giulia Rossano
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Lorenzo De Sanctis
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Davide Gandola
- Diagnostic Radiology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Davide Ippolito
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Diagnostic Radiology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Elena De Ponti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
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Tunissen SAM, Smit EJ, Mikerov M, Prokop M, Sechopoulos I. Performance evaluation of a 4D similarity filter for dynamic CT angiography imaging of the liver. Med Phys 2024; 51:8814-8827. [PMID: 39264288 DOI: 10.1002/mp.17394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Dynamic computed tomography (CT) angiography of the abdomen provides perfusion information and characteristics of the tissues present in the abdomen. This information could potentially help characterize liver metastases. However, radiation dose has to be relatively low for the patient, causing the images to have very high noise content. Denoising methods are needed to increase image quality. PURPOSE The purpose of this study was to investigate the performance, limitations, and behavior of a new 4D filtering method, called the 4D Similarity Filter (4DSF), to reduce image noise in temporal CT data. METHODS The 4DSF averages voxels with similar time-intensity curves (TICs). Each phase is filtered individually using the information of all phases except for the one being filtered. This approach minimizes the bias toward the noise initially present in this phase. Since the 4DSF does not base similarity on spatial proximity, loss of spatial resolution is avoided. The 4DSF was evaluated on a 12-phase liver dynamic CT angiography acquisition of 52 digital anthropomorphic phantoms, each containing one hypervascular 1 cm lesion with a small necrotic core. The metrics used for evaluation were noise reduction, lesion contrast-to-noise ratio (CNR), CT number accuracy using peak-time and peak-intensity of the TICs, and resolution loss. The results were compared to those obtained by the time-intensity profile similarity (TIPS) filter, which uses the whole TIC for determining similarity, and the combination 4DSF followed by TIPS filter (4DSF + TIPS). RESULTS The 4DSF alone resulted in a median noise reduction by a factor of 6.8, which is lower than that obtained by the TIPS filter at 8.1, and 4DSF + TIPS at 12.2. The 4DSF increased the median CNR from 0. 44 to 1.85, which is less than the TIPS filter at 2.59 and 4DSF + TIPS at 3.12. However, the peak-intensity accuracy in the TICs was superior for the 4DSF, with a median intensity decrease of -34 HU compared to -88 and -50 HU for the hepatic artery when using the TIPS filter and 4DSF + TIPS, respectively. The median peak-time accuracy was inferior for the 4DSF filter and 4DSF + TIPS, with a time shift of -1 phases for the portal vein TIC compared to no shift in time when using the TIPS. The analysis of the full-width-at-half-maximum (FWHM) of a small artery showed significantly less spatial resolution loss for the 4DSF at 3.2 pixels, compared to the TIPS filter at 4.3 pixels, and 3.4 pixels for the 4DSF + TIPS. CONCLUSION The 4DSF can reduce noise with almost no resolution loss, making the filter very suitable for denoising 4D CT data for detection tasks, even in very low dose, i.e., very high noise level, situations. In combination with the TIPS filter, the noise reduction can be increased even further.
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Affiliation(s)
- Sjoerd A M Tunissen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewoud J Smit
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mikhail Mikerov
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening (LRCB), Nijmegen, The Netherlands
- Technical Medicine Centre, University of Twente, Enschede, The Netherlands
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Chen Z, Yuan Z, Cheng J, Liu J, Liu F, Chen Z. An adaptive parameter decoupling algorithm-based image reconstruction model (ADAIR) for rapid golden-angle radial DCE-MRI. Phys Med Biol 2024; 69:215012. [PMID: 39383887 DOI: 10.1088/1361-6560/ad8545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/09/2024] [Indexed: 10/11/2024]
Abstract
Objective. The acceleration of magnetic resonance imaging (MRI) acquisition is crucial for both clinical and research applications, particularly in dynamic MRI. Existing compressed sensing (CS) methods, despite being effective for fast imaging, face limitations such as the need for incoherent sampling and residual noise, which restrict their practical use for rapid MRI.Approach. To overcome these challenges, we propose a novel image reconstruction framework that integrates the MRI physical model with a flexible, self-adjusting, decoupling data-driven model. We validated this method through experiments using both simulated andin vivodynamic contrast-enhanced MRI datasets.Main results. The experimental results demonstrate that the proposed framework achieves high spatial and temporal resolution reconstructions. Additionally, when compared to state-of-the-art image reconstruction approaches, our method significantly enhances acceleration capabilities, enabling sparse and rapid imaging with high resolution.Significance. Our proposed framework offers a promising solution for real-time imaging and image-guided radiation therapy applications by providing superior performance in achieving high spatial and temporal resolution reconstructions, thus addressing the limitations of existing CS schemes.
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Affiliation(s)
- Zhifeng Chen
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Department of Data Science & AI, Faculty of IT, Monash University, Clayton, VIC, Australia
| | - Zhenguo Yuan
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
- Department of Radiology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Junying Cheng
- Department of MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jinhai Liu
- College of Information Science and Engineering, Northeastern University, Shenyang, People's Republic of China
| | - Feng Liu
- School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, QLD, Australia
| | - Zhaolin Chen
- Monash Biomedical Imaging, Monash University, Clayton, VIC, Australia
- Department of Data Science & AI, Faculty of IT, Monash University, Clayton, VIC, Australia
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9
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Kale SR, Karande G, Gudur A, Garud A, Patil MS, Patil S. Recent Trends in Liver Cancer: Epidemiology, Risk Factors, and Diagnostic Techniques. Cureus 2024; 16:e72239. [PMID: 39583507 PMCID: PMC11584332 DOI: 10.7759/cureus.72239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 10/23/2024] [Indexed: 11/26/2024] Open
Abstract
Liver cancer, particularly hepatocellular carcinoma (HCC), poses a significant global health challenge due to its high mortality rate. Hepatocellular carcinoma and intrahepatic cholangiocarcinoma (ICC) are the two main types of primary liver cancer (PLC), each with its own set of complexities. Secondary or metastatic liver cancer is more common than PLC. It is frequently observed in malignancies such as colorectal, pancreatic, melanoma, lung, and breast cancer. Liver cancer is often diagnosed at an advanced stage, making it difficult to treat. This highlights the need for focused research on early detection and effective treatment strategies. This review explores the epidemiology, risk factors, and diagnostic techniques for HCC. The development of HCC involves various risk factors, including chronic liver diseases, hepatitis B and C infections, alcohol consumption, obesity, smoking, and genetic predispositions. Various invasive and non-invasive diagnostic techniques, such as biopsy, liquid biopsy, and imaging modalities like ultrasonography, computed tomography scans (CT scans), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans, are utilized for HCC detection and monitoring. Advances in imaging technology and biomarker research have led to more accurate and sensitive methods for early HCC detection. We also reviewed advanced research on emerging techniques, including next-generation sequencing, metabolomics, epigenetic biomarkers, and microbiome analysis, which show great potential for advancing early diagnosis and personalized treatment strategies. This literature review provides insights into the current state of liver cancer diagnosis and promising future advancements. Ongoing research and innovation in these areas are essential for improving early diagnosis and reducing the global burden of liver cancer.
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Affiliation(s)
- Shivani R Kale
- Molecular Biology and Genetics, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Geeta Karande
- Microbiology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Anand Gudur
- Oncology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Aishwarya Garud
- Molecular Biology and Genetics, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Monika S Patil
- Molecular Biology and Genetics, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
| | - Satish Patil
- Microbiology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, IND
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10
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Keenan KE, Jordanova KV, Ogier SE, Tamada D, Bruhwiler N, Starekova J, Riek J, McCracken PJ, Hernando D. Phantoms for Quantitative Body MRI: a review and discussion of the phantom value. MAGMA (NEW YORK, N.Y.) 2024; 37:535-549. [PMID: 38896407 PMCID: PMC11417080 DOI: 10.1007/s10334-024-01181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/18/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
In this paper, we review the value of phantoms for body MRI in the context of their uses for quantitative MRI methods research, clinical trials, and clinical imaging. Certain uses of phantoms are common throughout the body MRI community, including measuring bias, assessing reproducibility, and training. In addition to these uses, phantoms in body MRI methods research are used for novel methods development and the design of motion compensation and mitigation techniques. For clinical trials, phantoms are an essential part of quality management strategies, facilitating the conduct of ethically sound, reliable, and regulatorily compliant clinical research of both novel MRI methods and therapeutic agents. In the clinic, phantoms are used for development of protocols, mitigation of cost, quality control, and radiotherapy. We briefly review phantoms developed for quantitative body MRI, and finally, we review open questions regarding the most effective use of a phantom for body MRI.
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Affiliation(s)
- Kathryn E Keenan
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA.
| | - Kalina V Jordanova
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA
| | - Stephen E Ogier
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA
- Department of Physics, University of Colorado Boulder, Boulder, CO, USA
| | | | - Natalie Bruhwiler
- Physical Measurement Laboratory, National Institute of Standards and Technology, NIST, 325 Broadway, Boulder, CO, 80305, USA
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11
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Zhu Y, Feng B, Wang P, Wang B, Cai W, Wang S, Meng X, Wang S, Zhao X, Ma X. Bi-regional dynamic contrast-enhanced MRI for prediction of microvascular invasion in solitary BCLC stage A hepatocellular carcinoma. Insights Imaging 2024; 15:149. [PMID: 38886267 PMCID: PMC11183021 DOI: 10.1186/s13244-024-01720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/23/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To construct a combined model based on bi-regional quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), as well as clinical-radiological (CR) features for predicting microvascular invasion (MVI) in solitary Barcelona Clinic Liver Cancer (BCLC) stage A hepatocellular carcinoma (HCC), and to assess its ability for stratifying the risk of recurrence after hepatectomy. METHODS Patients with solitary BCLC stage A HCC were prospective collected and randomly divided into training and validation sets. DCE perfusion parameters were obtained both in intra-tumoral region (ITR) and peritumoral region (PTR). Combined DCE perfusion parameters (CDCE) were constructed to predict MVI. The combined model incorporating CDCE and CR features was developed and evaluated. Kaplan-Meier method was used to investigate the prognostic significance of the model and the survival benefits of different hepatectomy approaches. RESULTS A total of 133 patients were included. Total blood flow in ITR and arterial fraction in PTR exhibited the best predictive performance for MVI with areas under the curve (AUCs) of 0.790 and 0.792, respectively. CDCE achieved AUCs of 0.868 (training set) and 0.857 (validation set). A combined model integrated with the α-fetoprotein, corona enhancement, two-trait predictor of venous invasion, and CDCE could improve the discrimination ability to AUCs of 0.966 (training set) and 0.937 (validation set). The combined model could stratify the prognosis of HCC patients. Anatomical resection was associated with a better prognosis in the high-risk group (p < 0.05). CONCLUSION The combined model integrating DCE perfusion parameters and CR features could be used for MVI prediction in HCC patients and assist clinical decision-making. CRITICAL RELEVANCE STATEMENT The combined model incorporating bi-regional DCE-MRI perfusion parameters and CR features predicted MVI preoperatively, which could stratify the risk of recurrence and aid in optimizing treatment strategies. KEY POINTS Microvascular invasion (MVI) is a significant predictor of prognosis for hepatocellular carcinoma (HCC). Quantitative DCE-MRI could predict MVI in solitary BCLC stage A HCC; the combined model improved performance. The combined model could help stratify the risk of recurrence and aid treatment planning.
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Affiliation(s)
- Yongjian Zhu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bing Feng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Peng Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Cai
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Shuang Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xuan Meng
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Sicong Wang
- Magnetic Resonance Imaging Research, General Electric Healthcare (China), Beijing, 100176, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaohong Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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12
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Ramachandran A, Hussain H, Seiberlich N, Gulani V. Perfusion MR Imaging of Liver: Principles and Clinical Applications. Magn Reson Imaging Clin N Am 2024; 32:151-160. [PMID: 38007277 DOI: 10.1016/j.mric.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Perfusion imaging techniques provide quantitative characterization of tissue microvasculature. Perfusion MR of liver is particularly challenging because of dual afferent flow, need for large organ high-resolution coverage, and significant movement with respiration. The most common MR technique used for quantifying liver perfusion is dynamic contrast-enhanced MR imaging. Here, the authors describe the various perfusion MR models of the liver, the basic concepts behind implementing a perfusion acquisition, and clinical results that have been obtained using these models.
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Affiliation(s)
- Anupama Ramachandran
- Brigham and Women's Hospital, Harvard University, Boston, MA, USA; Department of Radiology, University of Michigan, AnnArbor, MI, USA
| | - Hero Hussain
- Department of Radiology, University of Michigan, AnnArbor, MI, USA
| | | | - Vikas Gulani
- Department of Radiology, University of Michigan, AnnArbor, MI, USA.
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13
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Bonde A, Fung AW, Mayo SC, Li P, Walker BS, Jaganathan S, Mallak N, Korngold EK. Imaging of the hepatic arterial infusion pump: Primer for radiologists. Clin Imaging 2024; 105:110022. [PMID: 37992624 DOI: 10.1016/j.clinimag.2023.110022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023]
Abstract
Hepatic arterial infusion (HAI) pumps are used to deliver liver-directed therapy by allowing the administration of selective chemotherapy to the liver via a catheter implanted most commonly into the gastroduodenal artery connected to a subcutaneous pump. This selective administration helps maximize the chemotherapeutic effect within the hepatic tumors while minimizing systemic toxicity. While HAI therapy has primarily been used to treat liver-only metastatic colorectal cancer, the indications have expanded to other malignancies, including intrahepatic cholangiocarcinoma. Radiologists play an important role in pre-operative planning, assessment of treatment response, and evaluation for potential complications using various imaging studies, including computed tomography angiography, magnetic resonance imaging, and perfusion scintigraphy. This article describes the radiologist's role as part of a multi-disciplinary oncology team to help maximize the success of HAI therapy and also helps radiologists familiarize themselves with various aspects of HAI pumps.
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Affiliation(s)
- Apurva Bonde
- Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States of America.
| | - Alice W Fung
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Skye C Mayo
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Peter Li
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Brett S Walker
- Department of Surgical Oncology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Sriram Jaganathan
- Department of Radiology, University of Arkansas for Medical Sciences, 4301 W Markham St, AR 72205, United States of America
| | - Nadine Mallak
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
| | - Elena K Korngold
- Department of Radiology, Oregon Health & Science University, Knight Cancer Institute, 3181 Sam Jackson Park Road, Mail Code: L340, Portland, OR 97239, United States of America
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14
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Lakshmipriya B, Pottakkat B, Ramkumar G. Deep learning techniques in liver tumour diagnosis using CT and MR imaging - A systematic review. Artif Intell Med 2023; 141:102557. [PMID: 37295904 DOI: 10.1016/j.artmed.2023.102557] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 06/12/2023]
Abstract
Deep learning has become a thriving force in the computer aided diagnosis of liver cancer, as it solves extremely complicated challenges with high accuracy over time and facilitates medical experts in their diagnostic and treatment procedures. This paper presents a comprehensive systematic review on deep learning techniques applied for various applications pertaining to liver images, challenges faced by the clinicians in liver tumour diagnosis and how deep learning bridges the gap between clinical practice and technological solutions with an in-depth summary of 113 articles. Since, deep learning is an emerging revolutionary technology, recent state-of-the-art research implemented on liver images are reviewed with more focus on classification, segmentation and clinical applications in the management of liver diseases. Additionally, similar review articles in literature are reviewed and compared. The review is concluded by presenting the contemporary trends and unaddressed research issues in the field of liver tumour diagnosis, offering directions for future research in this field.
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Affiliation(s)
- B Lakshmipriya
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
| | - G Ramkumar
- Department of Radio Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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15
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Hu W, Cao G, Ye S, Xu J, Chen J, Shao G. Quantitative analysis with multiphase contrast-enhanced computed tomography to evaluate residual tumor activity of hepatocellular carcinoma after DEB-TACE. Medicine (Baltimore) 2023; 102:e34054. [PMID: 37327303 PMCID: PMC10270488 DOI: 10.1097/md.0000000000034054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Most hepatocellular carcinomas (HCC) treated by transcatheter arterial chemoembolization with drug-eluting beads (DEB-TACE) are characterized by coagulation necrosis; therefore, it is often difficult to distinguish enhancement in the arterial phase that would lead to false negative evaluation. This study aimed to evaluate the specificity and sensitivity of the difference value of multiphase contrast-enhanced computed tomography (CECT) in predicting residual tumor activity in HCC lesions after DEB-TACE. This retrospective diagnostic study analyzed CECT images of 73 HCC lesions in 57 patients 20 to 40 days (average 28 days) after DEB-TACE treatment at our Hospital from January to December 2019. Postoperative pathology or digital subtraction angiography images were used as references. Residual tumor activity after the first intervention was determined based on the presence of tumor staining in digital subtraction angiography or the postoperative pathological discovery of HCC tumor cells. A significant difference was observed between the active and inactive residual groups in ∆ HU difference between CT values of arterial phase and non-contrast scans (AN, P = .000), difference between CT values of venous phase and non-contrast scans (VN, P = .000), difference between CT values of delay phase and non-contrast scans (DN, P = .000), (difference between CT values of venous and arterial phase scans, P = .001), and (difference between CT values of delay and arterial phase scans, P = .005). No statistically significant difference was observed between the delayed and venous phases (difference between CT values of delay and venous phase scans, P = .361). The area under the curve (AUC) of the ROC curve showed that the diagnostic efficacies in difference in CT value of AN (AUC = 0.976), VN (AUC = 0.927), and DN (AUC = 0.924) were higher, and their cutoff values were 4.86, 12.065, 20.19 HU with their sensitivities of 93.3%, 84.4%, 77.8% and specificities of 100%, 96.4%, and 100%, respectively. difference in CT value values of AN, VN, DN, difference between CT values of venous and arterial phase scans and difference between CT values of delay and arterial phase scans can sensitively detect residual tumor activity 20-40 days after DEB-TACE. Thus, more sensitive active residual foci were detected using all 3 enhanced phases rather than only the arterial phase. Quantitative analysis of multiphase CECT can detect residual tumor activity in an early and noninvasive manner, which can provide time for patients to receive early follow-up treatment.
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Affiliation(s)
- Wenchao Hu
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Radiology, Shulan Hangzhou Hospital, Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Guohong Cao
- Department of Radiology, Shulan Hangzhou Hospital, Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Shengli Ye
- Department of Radiology, Shulan Hangzhou Hospital, Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Jianfeng Xu
- Department of Radiology, Shulan Hangzhou Hospital, Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Jing Chen
- Department of Radiology, Shulan Hangzhou Hospital, Affiliated to Shulan International Medical College, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Guoliang Shao
- Department of Interventional Treatment, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
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Dong J, Zhang Y, Wu YF, Yue ZD, Fan ZH, Zhang CY, Liu FQ, Wang L. Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient. World J Gastrointest Surg 2023; 15:664-673. [PMID: 37206083 PMCID: PMC10190718 DOI: 10.4240/wjgs.v15.i4.664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/11/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension (PH), invasiveness and potential risks in the process of measurement limited its widespread use.
AIM To investigate the correlation of computed tomography (CT) perfusion parameters with HVPG in PH, and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt (TIPS).
METHODS Twenty-four PH related gastrointestinal bleeding patients were recruited in this study, and all patients were performed perfusion CT before and after TIPS surgery within 2 wk. Quantitative parameters of CT perfusion, including liver blood volume (LBV), liver blood flow (LBF), hepatic arterial fraction (HAF), spleen blood volume (SBV) and spleen blood flow (SBF), were measured and compared before and after TIPS, and the quantitative parameters between clinically significant PH (CSPH) and non-CSPH (NCSPH) group were also compared. Then the correlation of CT perfusion parameters with HVPG were analyzed, with statistical significance as P < 0.05.
RESULTS For all 24 PH patients after TIPS, CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared with NCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAF before TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation was found in other CT perfusion parameters with HVPG and Child-Pugh scores.
CONCLUSION HAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH than NCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found after TIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.
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Affiliation(s)
- Jian Dong
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yu Zhang
- Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yi-Fan Wu
- Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zhen-Dong Yue
- Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zhen-Hua Fan
- Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Chun-Yan Zhang
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Fu-Quan Liu
- Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Lei Wang
- Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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17
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Wang L, Zhang Y, Wu YF, Yue ZD, Fan ZH, Zhang CY, Liu FQ, Dong J. Computed tomography perfusion in liver and spleen for hepatitis B virus-related portal hypertension: A correlation study with hepatic venous pressure gradient. World J Gastroenterol 2022; 28:6068-6077. [PMID: 36405387 PMCID: PMC9669822 DOI: 10.3748/wjg.v28.i42.6068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/14/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension (PH). However, its use can be limited because it is an invasive procedure. Therefore, it is necessary to explore a non-invasive method to assess PH. AIM To investigate the correlation of computed tomography (CT) perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus (HBV)-related PH. METHODS Twenty-eight patients (4 female, 24 male) with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our study. All patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt (TIPS) therapy. Quantitative parameters of CT perfusion of the liver, including liver blood flow (LBF), liver blood volume (LBV), hepatic artery fraction, splenic blood flow and splenic blood volume were measured. HVPG was recorded during TIPS therapy. Correlation of liver perfusion with Child-Pugh score and HVPG were analyzed, and the receiver operating characteristic curve was analyzed. Based on HVPG (> 12 mmHg vs ≤ 12 mmHg), patients were divided into moderate and severe groups, and all parameters were compared. RESULTS Based on HVPG, 18 patients were classified into the moderate group and 10 patients were classified into the severe group. The Child-Pugh score, HVPG, LBF and LBV were significantly higher in the moderate group compared to the severe group (all P < 0.05). LBF and LBV were negatively associated with HVPG (r = -0.473, P < 0.05 and r = -0.503, P < 0.01, respectively), whereas splenic blood flow was positively associated with hepatic artery fraction (r = 0.434, P < 0.05). LBV was negatively correlated with Child-Pugh score. Child-Pugh score was not related to HVPG. Using a cutoff value of 17.85 mL/min/100 g for LBV, the sensitivity and specificity of HVPG ≥ 12 mmHg for diagnosis were 80% and 89%, respectively. CONCLUSION LBV and LBF were negatively correlated with HVPG and Child-Pugh scores. CT perfusion imaging is a potential non-invasive quantitative predictor for PH in HBV-related liver cirrhosis.
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Affiliation(s)
- Lei Wang
- Department of Intervention Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yu Zhang
- Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yi-Fan Wu
- Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zhen-Dong Yue
- Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Zhen-Hua Fan
- Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Chun-Yan Zhang
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Fu-Quan Liu
- Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Jian Dong
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
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Sharma A, Cressman E, Attaluri A, Kraitchman DL, Ivkov R. Current Challenges in Image-Guided Magnetic Hyperthermia Therapy for Liver Cancer. NANOMATERIALS (BASEL, SWITZERLAND) 2022; 12:2768. [PMID: 36014633 PMCID: PMC9414548 DOI: 10.3390/nano12162768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 05/09/2023]
Abstract
For patients diagnosed with advanced and unresectable hepatocellular carcinoma (HCC), liver transplantation remains the best option to extend life. Challenges with organ supply often preclude liver transplantation, making palliative non-surgical options the default front-line treatments for many patients. Even with imaging guidance, success following treatment remains inconsistent and below expectations, so new approaches are needed. Imaging-guided thermal therapy interventions have emerged as attractive procedures that offer individualized tumor targeting with the potential for the selective targeting of tumor nodules without impairing liver function. Furthermore, imaging-guided thermal therapy with added standard-of-care chemotherapies targeted to the liver tumor can directly reduce the overall dose and limit toxicities commonly seen with systemic administration. Effectiveness of non-ablative thermal therapy (hyperthermia) depends on the achieved thermal dose, defined as time-at-temperature, and leads to molecular dysfunction, cellular disruption, and eventual tissue destruction with vascular collapse. Hyperthermia therapy requires controlled heat transfer to the target either by in situ generation of the energy or its on-target conversion from an external radiative source. Magnetic hyperthermia (MHT) is a nanotechnology-based thermal therapy that exploits energy dissipation (heat) from the forced magnetic hysteresis of a magnetic colloid. MHT with magnetic nanoparticles (MNPs) and alternating magnetic fields (AMFs) requires the targeted deposition of MNPs into the tumor, followed by exposure of the region to an AMF. Emerging modalities such as magnetic particle imaging (MPI) offer additional prospects to develop fully integrated (theranostic) systems that are capable of providing diagnostic imaging, treatment planning, therapy execution, and post-treatment follow-up on a single platform. In this review, we focus on recent advances in image-guided MHT applications specific to liver cancer.
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Affiliation(s)
- Anirudh Sharma
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Erik Cressman
- Department of Interventional Radiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anilchandra Attaluri
- Department of Mechanical Engineering, School of Science, Engineering, and Technology, The Pennsylvania State University, Middletown, PA 17057, USA
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
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Arterial enhancement fraction in evaluating the therapeutic effect and survival for hepatocellular carcinoma patients treated with DEB-TACE. Cancer Imaging 2022; 22:38. [PMID: 35908071 PMCID: PMC9338623 DOI: 10.1186/s40644-022-00477-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Arterial enhancement fraction (AEF), derived from triphasic CT scans, is considered to indirectly reflect the ratio of hepatic arterial perfusion to total perfusion. The purpose of this study was to retrospectively investigate the relationship between AEF and treatment response and survival in hepatocellular carcinoma (HCC) patients treated with drug-eluting bead (DEB) TACE. METHODS AEF of primary lesion (AEFpre) and residual tumor (AEFpost) in 158 HCC patients were obtained from triphasic liver CT examinations pre- and post-treatment. Wilcoxon-signed rank test was used to compare the AEFpre and AEFpost for different response groups. Survival curves for overall survival (OS) in patients with different AEF were created by using Kaplan-Meier method. Cox regression analyses were used to determine the association between AEF and OS. RESULTS There was no correlation between AEFpre and treatment response. After DEB-TACE, AEFpost was significantly lower than AEFpre either in the partial response group (38.9% vs. 52.7%, p < 0.001) or in the stable disease group (49.3% vs. 52.1%, p = 0.029). In the progression disease group, AEFpost was numerically higher than AEFpre (55.5% vs. 53.0%, p = 0.604). Cox regression analyses showed that risk of death increased in patients with AEFpre > 57.95% (HR = 1.66, p = 0.019) or AEFpost > 54.85% (HR = 2.47, p < 0.001), and the risk reduced in patients with any reduction in tumor AEF (decrease ratio ≥ 0) and with increased AEF but not exceeding the ratio of 0.102 (increase ratio < 0.102) (HR = 0.32, p < 0.001). CONCLUSIONS The change in AEF of viable tumor is correlated with response of HCC to DEB-TACE. In addition, the AEF could be a helpful predictor in future studies on the embolization treatment for HCC.
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Palaniyappan N, Fallowfield JA. Emerging Non-invasive Markers: Imaging, Blood, and Liver Clearance Tests. PORTAL HYPERTENSION VII 2022:135-151. [DOI: 10.1007/978-3-031-08552-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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21
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Oxygen-Challenge Blood Oxygen Level-Dependent Magnetic Resonance Imaging for Evaluation of Early Change of Hepatocellular Carcinoma to Chemoembolization: A Feasibility Study. Acad Radiol 2021; 28 Suppl 1:S13-S19. [PMID: 32747180 DOI: 10.1016/j.acra.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 01/20/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of oxygen-challenge blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) at 3T for evaluating the early change of blood oxygenation before and after transcatheter arterial embolization (TACE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Thirty HCC patients with cirrhosis (HCC group, n = 30) and 30 healthy volunteers (control group, n = 30) were included in this study. Patients in the HCC group underwent BOLD before and 1 month after TACE. Oxygen was administered via a mask. Differences between pre- and post-O2 T2* values were evaluated using a pairwise t-test. Analysis of variance was performed to assess the statistical differences in the T2* values measured in HCC group pre-TACE and post-TACE and in healthy volunteers. RESULTS In the HCC group, the pre- and post-O2 T2* values of the cancerous area before TACE were 26.03 ± 3.30 and 26.84 ± 3.42 msec, respectively, and both decreased significantly to 8.67 ± 1.76 and 8.82 ± 1.80 msec, respectively, at 1 month after TACE (p < 0.001). The respective pre- and post-O2 T2* values of the noncancerous area increased significantly from 14.96 ± 2.32 and 15.33 ± 2.28 msec at baseline to 16.38 ± 2.22 and 16.89 ± 2.24 msec at 1 month after TACE (p < 0.001). No significant response to BOLD was observed in the control group (p = 0.059). CONCLUSION Oxygen-challenge BOLD MRI is feasible to assess post-TACE changes in HCC patients.
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22
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Rahmanuddin S, Korn R, Cridebring D, Borazanci E, Brase J, Boswell W, Jamil A, Cai W, Sabir A, Motarjem P, Koay E, Mitra A, Goel A, Ho J, Chung V, Von Hoff DD. Role of 3D Volumetric and Perfusion Imaging for Detecting Early Changes in Pancreatic Adenocarcinoma. Front Oncol 2021; 11:678617. [PMID: 34568010 PMCID: PMC8456995 DOI: 10.3389/fonc.2021.678617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/13/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose There is a major shortage of reliable early detection methods for pancreatic cancer in high-risk groups. The focus of this preliminary study was to use Time Intensity-Density Curve (TIDC) and Marley Equation analyses, in conjunction with 3D volumetric and perfusion imaging to demonstrate their potential as imaging biomarkers to assist in the early detection of Pancreatic Ductal Adenocarcinoma (PDAC). Experimental Designs A quantitative retrospective and prospective study was done by analyzing multi-phase Computed Tomography (CT) images of 28 patients undergoing treatment at different stages of pancreatic adenocarcinoma using advanced 3D imaging software to identify the perfusion and radio density of tumors. Results TIDC and the Marley Equation proved useful in quantifying tumor aggressiveness. Perfusion delays in the venous phase can be linked to Vascular Endothelial Growth Factor (VEGF)-related activity which represents the active part of the tumor. 3D volume analysis of the multiphase CT scan of the patient showed clear changes in arterial and venous perfusion indicating the aggressive state of the tumor. Conclusion TIDC and 3D volumetric analysis can play a significant role in defining the response of the tumor to treatment and identifying early-stage aggressiveness.
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Affiliation(s)
- Syed Rahmanuddin
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Ronald Korn
- Virginia G Piper Cancer Center, Honor Health, Scottsdale, AZ, United States
| | - Derek Cridebring
- Molecular Medicine Division, Translational Genomics Research Institute (TGEN), Phoenix, AZ, United States
| | - Erkut Borazanci
- Virginia G Piper Cancer Center, Honor Health, Scottsdale, AZ, United States
| | - Jordyn Brase
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - William Boswell
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Asma Jamil
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Wenli Cai
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Aqsa Sabir
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Pejman Motarjem
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Eugene Koay
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Anirban Mitra
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ajay Goel
- Molecular Diagnostic and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Monrovia, CA, United States
| | - Joyce Ho
- Molecular Diagnostic and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Monrovia, CA, United States
| | - Vincent Chung
- Molecular Diagnostic and Experimental Therapeutics, City of Hope Comprehensive Cancer Center, Monrovia, CA, United States
| | - Daniel D Von Hoff
- National Medical Center & Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States.,Virginia G Piper Cancer Center, Honor Health, Scottsdale, AZ, United States.,Molecular Medicine Division, Translational Genomics Research Institute (TGEN), Phoenix, AZ, United States
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Chang NW, Wang HK, Liu CS, Loong CC, Lai YC, Chiou HJ, Chou YH. First-Pass Arrival Interval of Ultrasound Contrast Medium in the Hepatic Artery and Portal Vein as a Marker for Assessment of Liver Transplant Recipients. Transplant Proc 2021; 53:2329-2334. [PMID: 34446308 DOI: 10.1016/j.transproceed.2021.07.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study measures the first-pass arrival times in the hepatic artery and portal vein of the transplanted liver using contrast-enhanced ultrasound (CEUS) and assess its correlation with graft performance in the early posttransplant period. METHODS This study evaluated 35 liver transplant recipients who underwent CEUS examination within 1 month of transplant surgery. CEUS under contrast-specific harmonic imaging mode were recorded for 60 seconds immediately after intravenous administration of microbubble ultrasound contrast medium (Sonazoid, GE Healthcare, Oslo, Norway). The recorded video clips were reviewed by 2 readers to determine the first-pass arrival times in the hepatic artery and portal vein, and the difference between the 2 was defined as the arterial-portal arrival interval (APAI). Laboratory data on the same date of CEUS examination were collected as indicators to correlate with APAI. RESULTS The intra- and inter-rater reliability for APAI measurement were excellent, with intraclass correlation coefficients > .95. The mean APAI was 4.5 ± 1.8 seconds (range, 2.0-10.5 seconds). The APAI was positively correlated with the serum total bilirubin level (r = 0.357, P = .035) and negatively correlated with the platelet count (r = -0.354, P = .037). At the 5 second cutoff point, a total serum bilirubin of >8 mg/dL was reported in 5 of 11 patients (45.4%) with APAI of >5 seconds and in only 3 of 24 patients (12.5%) with APAI of <5 seconds (P < .05). CONCLUSIONS The APAI is a quantitative marker that links the hemodynamics and the clinical status of the liver graft.
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Affiliation(s)
- Nai-Wen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Kai Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Chin-Su Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Che-Chuan Loong
- Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hong-Jen Chiou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu, Taiwan; Department of Radiology, Yee Zen General Hospital, Taoyuan, Taiwan
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Yoon JH, Lee JM, Yu MH, Hur BY, Grimm R, Sourbron S, Chandarana H, Son Y, Basak S, Lee KB, Yi NJ, Lee KW, Suh KS. Simultaneous evaluation of perfusion and morphology using GRASP MRI in hepatic fibrosis. Eur Radiol 2021; 32:34-45. [PMID: 34120229 DOI: 10.1007/s00330-021-08087-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/11/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine if golden-angle radial sparse parallel (GRASP) dynamic contrast-enhanced (DCE)-MRI allows simultaneous evaluation of perfusion and morphology in liver fibrosis. METHODS Participants who were scheduled for liver biopsy or resection were enrolled (NCT02480972). Images were reconstructed at 12-s temporal resolution for morphologic assessment and at 3.3-s temporal resolution for quantitative evaluation. The image quality of the morphologic images was assessed on a four-point scale, and the Liver Imaging Reporting and Data System score was recorded for hepatic observations. Comparisons were made between quantitative parameters of DCE-MRI for the different fibrosis stages, and for hepatocellular carcinoma (HCCs) with different LR features. RESULTS DCE-MRI of 64 participants (male = 48) were analyzed. The overall image quality consistently stood at 3.5 ± 0.4 to 3.7 ± 0.4 throughout the exam. Portal blood flow significantly decreased in participants with F2-F3 (n = 18, 175 ± 110 mL/100 mL/min) and F4 (n = 12, 98 ± 47 mL/100 mL/min) compared with those in participants with F0-F1 (n = 34, 283 ± 178 mL/100 mL/min, p < 0.05 for all). In participants with F4, the arterial fraction and extracellular volume were significantly higher than those in participants with F0-F1 and F2-F3 (p < 0.05). Compared with HCCs showing non-LR-M features (n = 16), HCCs with LR-M (n = 5) had a significantly prolonged mean transit time and lower arterial blood flow (p < 0.05). CONCLUSIONS Liver MRI using GRASP obtains both sufficient spatial resolution for confident diagnosis and high temporal resolution for pharmacokinetic modeling. Significant differences were found between the MRI-derived portal blood flow at different hepatic fibrosis stages. KEY POINTS A single MRI examination is able to provide both images with sufficient spatial resolution for anatomic evaluation and those with high temporal resolution for pharmacokinetic modeling. Portal blood flow was significantly lower in clinically significant hepatic fibrosis and mean transit time and extracellular volume increased in cirrhosis, compared with those in no or mild hepatic fibrosis. HCCs with different LR features showed different quantitative parameters of DCE-MRI: longer mean transit time and lower arterial flow were observed in HCCs with LR-M features.
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Affiliation(s)
- Jeong Hee Yoon
- Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jeong Min Lee
- Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea.
| | - Mi Hye Yu
- Radiology, Konkuk University School of Medicine, Seoul, 05080, Republic of Korea
| | - Bo Yun Hur
- Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 06236, Republic of Korea
| | | | - Steven Sourbron
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), New York, NY, USA.,Department of Radiology, New York University Grossman School of Medicine, New York, NY, 10016, USA
| | - Yohan Son
- Siemens Healthcare Korea, Seoul, 03737, Republic of Korea
| | - Susmita Basak
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Kyoung-Bun Lee
- Pathology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Nam-Joon Yi
- Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Kwang-Woong Lee
- Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Kyung-Suk Suh
- Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
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Shao CC, Zhao F, Yu YF, Zhu LL, Pang GD. Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma. Chin Med J (Engl) 2021; 134:1181-1190. [PMID: 34018996 PMCID: PMC8143758 DOI: 10.1097/cm9.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pre-operative non-invasive histological evaluation of hepatocellular carcinoma (HCC) remains a challenge. Tumor perfusion is significantly associated with the development and aggressiveness of HCC. The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography (CT) scans in predicting histological grade of HCC. METHODS Totally, 52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging. The blood perfusion parameters were derived from triple-phase CT scans. The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade. RESULTS The variance of arterial enhancement fraction (AEF) was significantly higher in HCCs without poorly differentiated components (NP-HCCs) than in HCCs with poorly differentiated components (P-HCCs). The difference in hepatic blood flow (HF) between total tumor and total liver flow (ΔHF = HFtumor - HFliver) and relative flow (rHF = ΔHF/HFliver) were significantly higher in NP-HCCs than in P-HCCs. The difference in portal vein blood supply perfusion (PVP) between tumor and liver tissue (ΔPVP) and the ΔPVP/liver PVP ratio (rPVP) were significantly higher in patients with NP-HCCs than in patients with P-HCCs. The area under ROC (AUC) of ΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2% and specificity of only 56.2%. The ΔHF and rHF had a higher specificity of 87.5% with an AUC of 0.681 and 0.673, respectively. The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9% and specificity of 93.8%. The combined parameter of ΔHF and rPVP, rHF and rPVP had the highest positive predictive value of 0.903, and that of rPVP and ΔPVP had the highest negative predictive value of 0.781. CONCLUSION Liver perfusion parameters and corresponding histogram parameters (including ΔHF, rHF, ΔPVP, rPVP, and AEFvariance) in patients with HCC derived from traditional triphasic CT scans may be helpful to non-invasively and pre-operatively predict the degree of the differentiation of HCC.
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Affiliation(s)
- Chun-Chun Shao
- Department of Evidence-Based Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, China
| | - Fang Zhao
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Yi-Fan Yu
- Healthcare Big Data Institute of Shandong University, Jinan, Shandong 250000, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong 250000, China
| | - Lin-Lin Zhu
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, China
| | - Guo-Dong Pang
- Department of Radiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250033, China
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Colagrande S, Calistri L, Campani C, Dragoni G, Lorini C, Nardi C, Castellani A, Marra F. CT volume of enhancement of disease (VED) can predict the early response to treatment and overall survival in patients with advanced HCC treated with sorafenib. Eur Radiol 2021; 31:1608-1619. [PMID: 32827266 PMCID: PMC7880966 DOI: 10.1007/s00330-020-07171-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/22/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To analyse the predictive value of the volume of enhancement of disease (VED), based on the CT arterial enhancement coefficient (ΔArt%), in the evaluation of the sorafenib response in patients with advanced hepatocellular carcinoma (HCC). METHODS Patients with sorafenib-treated advanced HCC, who underwent a multiphase contrast-enhanced CT before (T0) and after 60-70 days of starting therapy (T1), were included. The same target lesions utilised for the response evaluation according to modified Response Evaluation Criteria in Solid Tumors criteria were retrospectively used for the ΔArt% calculation ([(HUarterial phase - HUunenhanced phase) / HUunenhanced phase] × 100). ΔArt% was weighted for the lesion volume to obtain the VED. We compared VEDT0 and VEDT1 values in patients with clinical benefit (CB) or progressive disease (PD). The impact of VED, ancillary imaging findings, and blood chemistries on survival probability was evaluated. RESULTS Thirty-two patients (25 men, mean age 65.8 years) analysed between 2012 and 2016 were selected. At T1, 8 patients had CB and 24 had PD. VEDT0 was > 70% in 8/8 CB patients compared with 12/24 PD patients (p = 0.011). Patients with VEDT0 > 70% showed a significantly higher median survival than those with lower VEDT0 (451.5 days vs. 209.5 days, p = 0.032). Patients with VEDT0 > 70% and alpha-fetoproteinT0 ≤ 400 ng/ml had significantly longer survival than all other three combinations. In multivariate analysis, VEDT0 > 70% emerged as the only factor independently associated with survival (p = 0.037). CONCLUSION In patients with advanced HCC treated with sorafenib, VED is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to sorafenib, and with a longer survival. KEY POINTS • To achieve the best results of treatment with sorafenib in advanced HCC, a strict selection of patients is needed. • New radiologic parameters predictive of the response to sorafenib would be essential. • Volume of enhancement of disease (VED) is a novel radiologic parameter obtained by contrast-enhanced CT, which could be helpful in selecting patients who are more likely to respond to therapy, and with a longer survival.
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Affiliation(s)
- S Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - L Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - C Campani
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - G Dragoni
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - C Lorini
- Department of Health Science, University of Florence, Viale Morgagni 48, 50134, Florence, Italy
| | - C Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - A Castellani
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - F Marra
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
- Research Centre Denothe, University of Florence, Florence, Italy
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Abstract
Perfusion imaging allows for the quantitative extraction of physiological perfusion parameters of the liver microcirculation at levels far below the spatial the resolution of CT and MR imaging. Because of its peculiar structure and architecture, perfusion imaging is more challenging in the liver than in other organs. Indeed, the liver is a mobile organ and significantly deforms with respiratory motion. Moreover, it has a dual vascular supply and the sinusoidal capillaries are fenestrated in the normal liver. Using extracellular contrast agents, perfusion imaging has shown its ability to discriminate patients with various stages of liver fibrosis. The recent introduction of hepatobiliary contrast agents enables quantification of both the liver perfusion and the hepatocyte transport function using advanced perfusion models. The purpose of this review article is to describe the characteristics of liver perfusion imaging to assess chronic liver disease, with a special focus on CT and MR imaging.
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Zhou IY, Catalano OA, Caravan P. Advances in functional and molecular MRI technologies in chronic liver diseases. J Hepatol 2020; 73:1241-1254. [PMID: 32585160 PMCID: PMC7572718 DOI: 10.1016/j.jhep.2020.06.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
MRI has emerged as the most comprehensive non-invasive diagnostic tool for liver diseases. In recent years, the value of MRI in hepatology has been significantly enhanced by a wide range of contrast agents, both clinically available and under development, that add functional information to anatomically detailed morphological images, or increase the distinction between normal and pathological tissues by targeting molecular and cellular events. Several classes of contrast agents are available for contrast-enhanced hepatic MRI, including i) conventional non-specific extracellular fluid contrast agents for assessing tissue perfusion; ii) hepatobiliary-specific contrast agents that are taken up by functioning hepatocytes and excreted through the biliary system for evaluating hepatobiliary function; iii) superparamagnetic iron oxide particles that accumulate in Kupffer cells; and iv) novel molecular contrast agents that are biochemically targeted to specific molecular/cellular processes for staging liver diseases or detecting treatment responses. The use of different functional and molecular MRI methods enables the non-invasive assessment of disease burden, progression, and treatment response in a variety of liver diseases. A high diagnostic performance can be achieved with MRI by combining imaging biomarkers.
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Affiliation(s)
- Iris Y Zhou
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA
| | - Onofrio A Catalano
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States; Harvard Medical School, Boston, MA, USA; Institute for Innovation in Imaging (i(3)), Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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Roberts NT, Hinshaw LA, Colgan TJ, Ii T, Hernando D, Reeder SB. B 0 and B 1 inhomogeneities in the liver at 1.5 T and 3.0 T. Magn Reson Med 2020; 85:2212-2220. [PMID: 33107109 DOI: 10.1002/mrm.28549] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this work is to characterize the magnitude and variability of B0 and B1 inhomogeneities in the liver in large cohorts of patients at both 1.5 T and 3.0 T. METHODS Volumetric B0 and B1 maps were acquired over the liver of patients presenting for routine abdominal MRI. Regions of interest were drawn in the nine Couinaud segments of the liver, and the average value was recorded. Magnitude and variation of measured averages in each segment were reported across all patients. RESULTS A total of 316 B0 maps and 314 B1 maps, acquired at 1.5 T and 3.0 T on a variety of GE Healthcare MRI systems in 630 unique exams, were identified, analyzed, and, in the interest of reproducible research, de-identified and made public. Measured B0 inhomogeneities ranged (5th-95th percentiles) from -31.7 Hz to 164.0 Hz for 3.0 T (-14.5 Hz to 81.3 Hz at 1.5 T), while measured B1 inhomogeneities (ratio of actual over prescribed flip angle) ranged from 0.59 to 1.13 for 3.0 T (0.83 to 1.11 at 1.5 T). CONCLUSION This study provides robust characterization of B0 and B1 inhomogeneities in the liver to guide the development of imaging applications and protocols. Field strength, bore diameter, and sex were determined to be statistically significant effects for both B0 and B1 uniformity. Typical clinical liver imaging at 3.0 T should expect B0 inhomogeneities ranging from approximately -100 Hz to 250 Hz (-50 Hz to 150 Hz at 1.5 T) and B1 inhomogeneities ranging from approximately 0.4 to 1.3 (0.7 to 1.2 at 1.5 T).
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Affiliation(s)
- Nathan T Roberts
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Louis A Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy J Colgan
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Takanori Ii
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Abstract
PURPOSE The aim of this study was to demonstrate the feasibility of hepatic perfusion imaging using dynamic contrast-enhanced (DCE) golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) for characterizing liver parenchyma and hepatocellular carcinoma (HCC) before and after transarterial chemoembolization (TACE) as a potential alternative to volume perfusion computed tomography (VPCT). METHODS AND MATERIALS Between November 2017 and September 2018, 10 patients (male = 8; mean age, 66.5 ± 8.6 years) with HCC were included in this prospective, institutional review board-approved study. All patients underwent DCE GRASP MRI with high spatiotemporal resolution after injection of liver-specific MR contrast agent before and after TACE. In addition, VPCT was acquired before TACE serving as standard of reference. From the dynamic imaging data of DCE MRI and VPCT, perfusion maps (arterial liver perfusion [mL/100 mL/min], portal liver perfusion [mL/100 mL/min], hepatic perfusion index [%]) were calculated using a dual-input maximum slope model and compared with assess perfusion measures, lesion characteristics, and treatment response using Wilcoxon signed-rank test. To evaluate interreader agreement for measurement repeatability, the interclass correlation coefficient (ICC) was calculated. RESULTS Perfusion maps could be successfully generated from all DCE MRI and VPCT data. The ICC was excellent for all perfusion maps (ICC ≥ 0.88; P ≤ 0.001). Image analyses revealed perfusion parameters for DCE MRI and VPCT within the same absolute range for tumor and liver tissue. Dynamic contrast-enhanced MRI further enabled quantitative assessment of treatment response showing a significant decrease (P ≤ 0.01) of arterial liver perfusion and hepatic perfusion index in the target lesion after TACE. CONCLUSIONS Dynamic contrast-enhanced GRASP MRI allows for a reliable and robust assessment of hepatic perfusion parameters providing quantitative results comparable to VPCT and enables characterization of HCC before and after TACE, thus posing the potential to serve as an alternative to VPCT.
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Shen B, Yan J, Wang S, Zhou F, Zhao Y, Hu R, Qu J, Liu L. Label-free whole-colony imaging and metabolic analysis of metastatic pancreatic cancer by an autoregulating flexible optical system. Am J Cancer Res 2020; 10:1849-1860. [PMID: 32042340 PMCID: PMC6993220 DOI: 10.7150/thno.40869] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Cancer metastasis is a Gordian knot for tumor diagnosis and therapy. Many studies have demonstrated that metastatic processes are inevitably affected by the tumor microenvironment. Histopathology is used universally as the gold standard for cancer diagnosis despite the lengthy preparation process and invasiveness. Methods: Here, we introduced a supercontinuum and super-wide-tuning integrated multimodal platform, which combines the confocal, nonlinear and fluorescence lifetime microscopy with autoregulations, for label-free evaluation of fresh tissue and pathological sections. Based on various automated tunable lasers, synchronized and self-adjusting components and eight fast switching detection channels, the system features fast, large-field and subcellular-scale imaging of exogenous and endogenous fluorophores, nonlinear coherent scattering and lifetime contrast. Results: With such an integrated multi-dimensional system, we searched the metastatic region by two-photon and three-photon excited autofluorescence, analyzed the cancer invasion by second harmonic generation and revealed the affected cellular metabolism by phasor-lifetime. We demonstrated the flexible measurement of multiple nonlinear modalities at NIR I and II excitation with a pre-compensation for group delay dispersion of ~7,000 fs2 and low power of <40 mW, and of dual autofluorescence lifetime decays for phasor approach to decompose cancer-associated and disassociated components. This significantly revealed the metastatic and metabolic optical signatures of the whole colony of pancreatic cancers. Conclusion: The synergistic effect of the system demonstrates the great potential to translate this technique into routine clinical applications, particularly for large-scale and quantitative studies of metastatic colonization.
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Abstract
Non-invasive magnetic resonance imaging (MRI) techniques are increasingly applied in the clinic with a fast growing body of evidence regarding its value for clinical decision making. In contrast to biochemical or histological markers, the key advantages of imaging biomarkers are the non-invasive nature and the spatial and temporal resolution of these approaches. The following chapter focuses on clinical applications of novel MR biomarkers in humans with a strong focus on oncologic diseases. These include both clinically established biomarkers (part 1-4) and novel MRI techniques that recently demonstrated high potential for clinical utility (part 5-7).
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Affiliation(s)
- Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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Ring HL, Gao Z, Sharma A, Han Z, Lee C, Brockbank KGM, Greene ED, Helke KL, Chen Z, Campbell LH, Weegman B, Davis M, Taylor M, Giwa S, Fahy GM, Wowk B, Pagotan R, Bischof JC, Garwood M. Imaging the distribution of iron oxide nanoparticles in hypothermic perfused tissues. Magn Reson Med 2019; 83:1750-1759. [PMID: 31815324 DOI: 10.1002/mrm.28123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/01/2019] [Accepted: 11/20/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE Herein, we evaluate the use of MRI as a tool for assessing iron oxide nanoparticle (IONP) distribution within IONP perfused organs and vascularized composite allografts (VCAs) (i.e., hindlimbs) prepared for cryopreservation. METHODS Magnetic resonance imaging was performed on room-temperature organs and VCAs perfused with IONPs and were assessed at 9.4 T. Quantitative T1 mapping and T 2 ∗ -weighted images were acquired using sweep imaging with Fourier transformation and gradient-echo sequences, respectively. Verification of IONP localization was performed through histological assessment and microcomputer tomography. RESULTS Quantitative imaging was achieved for organs and VCAs perfused with up to 642 mMFe (36 mgFe /mL), which is above previous demonstrations of upper limit detection in agarose (35.7mMFe [2 mgFe /mL]). The stability of IONPs in the perfusate had an effect on the quality of distribution and imaging within organs or VCA. Finally, MRI provided more accurate IONP localization than Prussian blue histological staining in this system, wherein IONPs remain primarily in the vasculature. CONCLUSION Using MRI, we were able to assess the distribution of IONPs throughout organs and VCAs varying in complexity. Additional studies are necessary to better understand this system and validate the calibration between T1 measurements and IONP concentration.
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Affiliation(s)
- Hattie L Ring
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Zhe Gao
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Anirudh Sharma
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Zonghu Han
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Charles Lee
- Department of Mechanical Engineering and Engineering Science, University of North Carolina, Charlotte, North Carolina
| | - Kelvin G M Brockbank
- Tissue Testing Technologies LLC, North Charleston.,Department of Bioengineering, Clemson University, Charleston, South Carolina.,Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | | | - Kristi L Helke
- Department of Comparative Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Zhen Chen
- Tissue Testing Technologies LLC, North Charleston
| | | | | | - Monica Davis
- Sylvatica Biotech, Inc., North Charleston, South Carolina
| | - Michael Taylor
- Sylvatica Biotech, Inc., North Charleston, South Carolina
| | - Sebastian Giwa
- Sylvatica Biotech, Inc., North Charleston, South Carolina
| | | | - Brian Wowk
- 21st Century Medicine, Inc., Fontana, California
| | | | - John C Bischof
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, Minnesota
| | - Michael Garwood
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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Ippolito D, Pecorelli A, Querques G, Drago SG, Maino C, Franzesi CT, Hatzidakis A, Sironi S. Dynamic Computed Tomography Perfusion Imaging: Complementary Diagnostic Tool in Hepatocellular Carcinoma Assessment From Diagnosis to Treatment Follow-up. Acad Radiol 2019; 26:1675-1685. [PMID: 30852079 DOI: 10.1016/j.acra.2019.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 02/05/2023]
Abstract
Early diagnosis of HCC is of paramount importance in order to enable the application of curative treatments. Among these, radiofrequency ablation (RFA) is actually considered the most effective ablative therapy for early stage hepatocellular carcinoma (HCC) not suitable for surgery. On the other hand, transarterial chemoembolization (TACE) represents the standard of care for intermediate stage HCC and compensated liver function. Finally, sorafenib, an oral antiangiogenic targeted drug, is the only approved systemic therapy for advanced HCC with vascular invasion, extrahepatic spread, and well-preserved liver function. Beside traditional radiological techniques, new functional imaging tools have been introduced in order to provide not only morphological information but also quantitative functional data. In this review, we analyze perfusion-CT (pCT) from a technical point of view, describing the main different mathematical analytical models for the quantification of tissue perfusion from acquired CT raw data, the most commonly acquired perfusion parameters, and the technical parameters required to perform a standard pCT examination. Moreover, a systematic review of the literature was performed to assess the role of pCT as an emerging imaging biomarker for HCC diagnosis, response evaluation to RFA, TACE, and sorafenib, and we examine its challenges in HCC management.
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Affiliation(s)
- Davide Ippolito
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Anna Pecorelli
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy.
| | - Giulia Querques
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Silvia Girolama Drago
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Cesare Maino
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Cammillo Talei Franzesi
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, San Gerardo Hospital, Via Pergolesi 33 - 20900 Monza, Italy
| | - Adam Hatzidakis
- Department of Medical Imaging, University Hospital of Heraklion, Greece
| | - Sandro Sironi
- University of Milano-Bicocca, Milan, Italy; Department of Diagnostic Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Can Disturbed Liver Perfusion Revealed in p-CT on the First Day of Acute Pancreatitis Provide Information about the Expected Severity of the Disease? Gastroenterol Res Pract 2019; 2019:6590729. [PMID: 31485219 PMCID: PMC6710743 DOI: 10.1155/2019/6590729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 04/24/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
Background The aim of the study was to evaluate the prognostic properties of perfusion parameters of liver parenchyma based on computed tomography (CT) of patients with acute pancreatitis (AP) made on the first day of onset of symptoms, to assess their usefulness in identifying patients with increased risk of the development of severe AP. Methods 79 patients with clinical symptoms and biochemical criteria indicative of AP underwent perfusion computed tomography (p-CT) within 24 hours after onset of the symptoms. Perfusion parameters in 41 people who developed a severe form of AP were compared with parameters in 38 patients in whom the course of AP was mild. Results Statistical differences in the liver perfusion parameters between the group of patients with mild and severe AP were shown. The permeability-surface area product was significantly lower, and the hepatic arterial fraction was significantly higher in the group of patients with progression of AP. Conclusions Based on the results, it seems that p-CT performed on the first day from the onset of AP is a method that, by revealing disturbances in hepatic perfusion, can help in identifying patients with increased risk of the development of severe AP.
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Weight-adapted ultra-low-dose pancreatic perfusion CT: radiation dose, image quality, and perfusion parameters. Abdom Radiol (NY) 2019; 44:2196-2204. [PMID: 30790008 DOI: 10.1007/s00261-019-01938-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We evaluate the reliability and feasibility of weight-adapted ultra-low-dose pancreatic perfusion CT. METHODS A total of 100 (47 men, 53 women) patients were enrolled prospectively and were assigned to five groups (A, B, C, D, and E) with different combination of tube voltage and tube current according to their body weight. Radiation dose parameters including volume CT dose index (CTDI) and dose-length product (DLP) were recorded. Image quality was evaluated both subjectively and objectively (noise, signal-to-noise ratio, contrast-to-noise ratio). Perfusion parameters including blood flow (BF), blood volume (BV), and permeability (PMB) were measured. The dose, image quality measurements, and perfusion parameters were compared between the five groups using one-way analysis of variance (ANOVA). RESULTS Radiation dose reached 8.7 mSv in patients under 50 kg and was 18.9 mSv in patients above 80 kg. The mean subjective image quality score was above 4.45 on a 5-point scale with good agreement between two radiologists. Groups A-D had equivalent performance on objective image quality (P > 0.05), while Group E performed even better (P < 0.05). No significant differences emerged in comparison with perfusion parameters (BF, BV, PMB) of normal pancreas parenchyma between the five groups. CONCLUSION Weight-adapted ultra-low-dose pancreatic perfusion CT can effectively reduce radiation dose without prejudice to image quality, and the perfusion parameters of normal parenchyma are accurate and reliable.
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Influence of Gadolinium-Based Contrast Agents on Tissue Sodium Quantification in Sodium Magnetic Resonance Imaging. Invest Radiol 2018; 53:555-562. [DOI: 10.1097/rli.0000000000000487] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Dynamic Contrast-Enhanced Magnetic Resonance Imaging of Advanced Cervical Carcinoma: The Advantage of Perfusion Parameters From the Peripheral Region in Predicting the Early Response to Radiotherapy. Int J Gynecol Cancer 2018; 28:1342-1349. [DOI: 10.1097/igc.0000000000001308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThis study aimed to investigate the importance of perfusion parameters from the peripheral region in predicting the early response to radiotherapy for advanced cervical carcinoma by using dynamic contrast-enhanced (DCE) perfusion magnetic resonance imaging (MRI).MethodsOne hundred eight patients with advanced cervical carcinoma were enrolled into this study. Dynamic contrast-enhanced perfusion MR examinations were performed for all the patients before radiotherapy. Perfusion parameters were obtained from the central region and the peripheral region of tumor respectively. After radiotherapy, the patients were classified into responders and nonresponders according to tumor shrinkage on the basis of follow-up MRI examination. The mean follow-up time lasted 12 months. The perfusion parameters were compared between the 2 groups. The relationship between perfusion parameters from 2 different regions of tumor and treatment effect was analyzed.ResultsThe mean value of volume transfer constant (Ktrans), rate constant (Kep) or extravascular extracellular volume fraction (Ve) from the peripheral region was higher than that from the central region of tumor, respectively (P = 0.01, 004, 0.03). Responders had higher Ktransperipheral (Ktrans from the peripheral region) and Ktranscentral (Ktrans from the central region) values than nonresponders (P = 0.04, 0.01). Responders had higher Kepperipheral (Kep from the peripheral region) than nonresponders (P = 0.03). Responders had lower Veperipheral (Ve from the peripheral region) than nonresponders (P = 0.04). At logistic regression analysis, the perfusion parameters that had predicting value were Ktransperipheral, Veperipheral, Kepperipheral and Ktranscentral according to diagnostic potency.ConclusionsCompared with perfusion parameters from the central region of tumor, perfusion parameters from the peripheral region are more valuable in predicting the early response to radiotherapy for advanced cervical carcinoma.
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Coolens C, Mohseni H, Dhodi S, Ma S, Keller H, Jaffray DA. Quantification accuracy for dynamic contrast enhanced (DCE) CT imaging: phantom and quality assurance framework. Eur J Radiol 2018; 106:192-198. [PMID: 30150044 DOI: 10.1016/j.ejrad.2018.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/05/2018] [Indexed: 01/01/2023]
Abstract
PURPOSE Standardization and protocol optimization is essential for quantification of Dynamic Contrast Enhanced CT as an imaging biomarker. Currently, no commercially available quality assurance (QA) phantoms can provide for testing a complete set of imaging parameters pertaining to routine quality control for contrast-enhanced (CE) CT, as well as spatiotemporal accuracy. The purpose of this work was, therefore: (a) developing a solid calibration phantom for routine CE CT quality assurance; (b) investigating the sensitivity of CECT to organ motion, and (c) characterizing a volumetric CT scanner for CECT. METHODS CECT calibration phantom consisting of an acrylic uniform cylinder containing multiple capsules of varying diameters and orientations was designed and built. The capsules contain different solid density materials mimicking iodine contrast enhancement. Sensitivity and accuracy of CECT measurements on all capsules was performed using a 320-slice CT scanner for a range of scan parameters both with and without phantom motion along the transaxial axis of the scanner. RESULTS Routine commissioning tests such as uniformity, spatial resolution and image noise were successfully determined using the CECT phantom. Partial volume effect and motion blurring both contribute to a general decrease in contrast enhancement and this was further dependent on capsule orientation (least pronounced for the transaxial orientation). Scanning with a rotation time of less than 0.5 s, the effect of blurring is less than 3% for all orientations and phantom speeds. CONCLUSION A new robust contrast calibration phantom was developed and used to evaluate the performance of a 320-slice volumetric CT scanner for DCE-CT.
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Affiliation(s)
- C Coolens
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; TECHNA Institute, University Health Network, Toronto, Ontario, Canada.
| | - H Mohseni
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - S Dhodi
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - S Ma
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - H Keller
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - D A Jaffray
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; TECHNA Institute, University Health Network, Toronto, Ontario, Canada
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Enjilela E, Lee TY, Hsieh J, Murjoomdar A, Stewart E, Dekaban M, Su F, So A. Ultra-Low-Dose Sparse-View Quantitative CT Liver Perfusion Imaging. ACTA ACUST UNITED AC 2018; 3:175-179. [PMID: 30042980 PMCID: PMC6024390 DOI: 10.18383/j.tom.2017.00018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Radiation dose of computed tomography liver perfusion imaging can be reduced by collecting fewer x-ray projections in each gantry rotation, but the resulting aliasing artifacts could affect the hepatic perfusion measurement. We investigated the effect of projection undersampling on the assessment of hepatic arterial blood flow (HABF) in hepatocellular carcinoma (HCC) when dynamic contrast-enhanced (DCE) liver images were reconstructed with filtered backprojection (FBP) and compressed sensing (CS). DCE liver images of a patient with HCC acquired with a 64-row CT scanner were reconstructed from all the measured projections (984-view) with the standard FBP and from one-third (328-view) and one-fourth (246-view) of all available projections with FBP and CS. Each of the 5 sets of DCE liver images was analyzed with a model-based deconvolution algorithm from which HABF maps were generated and compared. Mean HABF in the tumor and normal tissue measured by the 328-view CS and FBP protocols was within 5% differences from that assessed by the reference full-view FBP protocol. In addition, the tumor size measured by using the 328-view CS and FBP average images was identical to that determined by using the full-view FBP average image. By contrast, both the 246-view CS and FBP protocols exhibited larger differences (>20%) in anatomical and functional assessments compared with the full-view FBP protocol. The preliminary results suggested that computed tomography perfusion imaging in HCC could be performed with 3 times less projection measurement than the current full-view protocol (67% reduction in radiation dose) when either FBP or CS was used for image reconstruction.
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Affiliation(s)
- Esmaeil Enjilela
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Ting-Yim Lee
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada.,Imaging Program, Lawson Health Research Institute, London, ON, Canada
| | | | - Amol Murjoomdar
- Department of Medical Imaging, Western University, London, ON, Canada; and
| | - Errol Stewart
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Mark Dekaban
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Feng Su
- Imaging Research Laboratories, Robarts Research Institute, London, ON, Canada
| | - Aaron So
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
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Pereira PL, Krüger K, Hohenstein E, Welke F, Sommer C, Meier F, Eigentler T, Garbe C. Intraprocedural 3D perfusion measurement during chemoembolisation with doxorubicin-eluting beads in liver metastases of malignant melanoma. Eur Radiol 2018; 28:1456-1464. [PMID: 29124381 DOI: 10.1007/s00330-017-5099-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 07/30/2017] [Accepted: 09/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To study feasibility and validity of a new software application for intraprocedural assessment of perfusion during chemoembolisation of melanoma metastases. METHODOLOGY In a prospective phase-II trial, ten melanoma patients with liver-only metastases underwent chemoembolisation with doxorubicin-eluting beads (DEBDOX-TACE). Tumour perfusion was evaluated immediately before and after treatment at cone beam computer tomography (CBCT) using a new software application. For control and comparison, patients underwent perfusion measurement via contrast-enhanced multidetector CT (MDCT) before and after treatment. RESULTS CBCT showed 94.7 % reduction in perfusion in metastases after DEBDOX-TACE, whereas MDCT showed 96.8 %. Reduction in perfusion after treatment was statistically significant (p < 0.01) for both methods. The additional time needed for data acquisition during treatment was 5 min per case or less; the post-processing data analysis was 10 min or less. Perfusion imaging was associated with additional contrast agent and patient exposure to radiation (dose-length product [DLP]): 18 ml and 394 mGy*cm in CBCT and 100 ml and 446 mGy*cm in MDCT, respectively. CONCLUSIONS Reduction in perfusion of melanoma metastases after DEBDOX-TACE can be reliably assessed during the intervention via perfusion software at CBCT. Data acquisition and analysis require additional time but can be easily performed during the treatment. KEY POINTS • Tumour perfusion of melanoma metastases can be assessed at cone beam CT. • The software shows a significant decrease of tumour perfusion after DEBDOX-TACE. • Data acquisition and analysis require an acceptable additional time during the procedure. • CBCT requires less radiation exposure and contrast for perfusion study than MSCT. • This software can monitor the course of DEBDOX-TACE in melanoma metastases.
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Affiliation(s)
- Philippe L Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclearmedicine, SLK-Kliniken GmbH, Heilbronn, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany.
| | - Kristina Krüger
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclearmedicine, SLK-Kliniken GmbH, Heilbronn, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany
| | - Ernst Hohenstein
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclearmedicine, SLK-Kliniken GmbH, Heilbronn, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany
| | - Florian Welke
- Institute for Diagnostic and Interventional Radiology, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Germany
| | - Christof Sommer
- Clinic for Diagnostic and Interventional Radiology, Ruprecht Karls University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Friedegund Meier
- Clinic for Dermato-Oncology, Universitätsklinikum Carl Gustav Carus, Fiedlerstraße 19, 01307, Dresden, Germany
| | - Thomas Eigentler
- Clinic für Dermato-Oncology, Eberhard-Karls University, Liebermeisterstraße 25, 72076, Tübingen, Germany
| | - Claus Garbe
- Clinic für Dermato-Oncology, Eberhard-Karls University, Liebermeisterstraße 25, 72076, Tübingen, Germany
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42
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Pahwa S, Liu H, Chen Y, Dastmalchian S, O'Connor G, Lu Z, Badve C, Yu A, Wright K, Chalian H, Rao S, Fu C, Vallines I, Griswold M, Seiberlich N, Zeng M, Gulani V. Quantitative perfusion imaging of neoplastic liver lesions: A multi-institution study. Sci Rep 2018; 8:4990. [PMID: 29563601 PMCID: PMC5862961 DOI: 10.1038/s41598-018-20726-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
We describe multi-institutional experience using free-breathing, 3D Spiral GRAPPA-based quantitative perfusion MRI in characterizing neoplastic liver masses. 45 patients (age: 48–72 years) were prospectively recruited at University Hospitals, Cleveland, USA on a 3 Tesla (T) MRI, and at Zhongshan Hospital, Shanghai, China on a 1.5 T MRI. Contrast-enhanced volumetric T1-weighted images were acquired and a dual-input single-compartment model used to derive arterial fraction (AF), distribution volume (DV) and mean transit time (MTT) for the lesions and normal parenchyma. The measurements were compared using two-tailed Student’s t-test, with Bonferroni correction applied for multiple-comparison testing. 28 hepatocellular carcinoma (HCC) and 17 metastatic lesions were evaluated. No significant difference was noted in perfusion parameters of normal liver parenchyma and neoplastic masses at two centers (p = 0.62 for AF, 0.015 for DV, 0.42 for MTT for HCC, p = 0.13 for AF, 0.97 for DV, 0.78 for MTT for metastases). There was statistically significant difference in AF, DV, and MTT of metastases and AF and DV of HCC compared to normal liver parenchyma (p < 0.5/9 = 0.0055). A statistically significant difference was noted in the MTT of metastases compared to hepatocellular carcinoma (p < 0.001*10-5). In conclusion, 3D Spiral-GRAPPA enabled quantitative free-breathing perfusion MRI exam provides robust perfusion parameters.
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Affiliation(s)
- Shivani Pahwa
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Hao Liu
- Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Chen
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Sara Dastmalchian
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Gregory O'Connor
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Ziang Lu
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Chaitra Badve
- Radiology, University Hospitals, Cleveland, OH, United States
| | - Alice Yu
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Katherine Wright
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Hamid Chalian
- Radiology, University Hospitals, Cleveland, OH, United States
| | - Shengxiang Rao
- Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | | | - Mark Griswold
- Radiology, Case Western Reserve University, Cleveland, OH, United States.,Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Nicole Seiberlich
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Mengsu Zeng
- Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Vikas Gulani
- Radiology, Case Western Reserve University, Cleveland, OH, United States. .,Radiology, University Hospitals, Cleveland, OH, United States.
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43
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Seyyedi S, Liapi E, Lasser T, Ivkov R, Hatwar R, Stayman JW. Low-Dose CT Perfusion of the Liver using Reconstruction of Difference. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018; 2:205-214. [PMID: 29785411 DOI: 10.1109/trpms.2018.2812360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Liver CT perfusion (CTP) is used in the detection, staging, and treatment response analysis of hepatic diseases. Unfortunately, CTP radiation exposures is significant, limiting more widespread use. Traditional CTP data processing reconstructs individual temporal samples, ignoring a large amount of shared anatomical information between temporal samples, suggesting opportunities for improved data processing. We adopt a prior-image-based reconstruction approach called Reconstruction of Difference (RoD) to enable low-exposure CTP acquisition. RoD differs from many algorithms by directly estimating the attenuation changes between the current patient state and a prior CT volume. We propose to use a high-fidelity unenhanced baseline CT image to integrate prior anatomical knowledge into subsequent data reconstructions. Using simulation studies based on a 4D digital anthropomorphic phantom with realistic time-attenuation curves, we compare RoD with conventional filtered-backprojection, penalized-likelihood estimation, and prior image penalized-likelihood estimation. We evaluate each method in comparisons of reconstructions at individual time points, accuracy of estimated time-attenuation curves, and in an analysis of common perfusion metric maps including hepatic arterial perfusion, hepatic portal perfusion, perfusion index, and time-to-peak. Results suggest that RoD enables significant exposure reductions, outperforming standard and more sophisticated model-based reconstruction, making RoD a potentially important tool to enable low-dose liver CTP.
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Affiliation(s)
- Saeed Seyyedi
- Computer Aided Medical Procedures and Chair of Biomedical Physics, Technical University of Munich, Munich, 85748 Germany
| | - Eleni Liapi
- Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Tobias Lasser
- Computer Aided Medical Procedures, Technical University of Munich, Munich, 85748 Germany
| | - Robert Ivkov
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD 21205 USA
| | - Rajeev Hatwar
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205 USA
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Sade R, Kantarci M, Genc B, Ogul H, Gundogdu B, Yilmaz O. Computed Tomography Perfusion Imaging for the Diagnosis of Hepatic Alveolar Echinococcosis. Eurasian J Med 2018; 50:1-5. [PMID: 29531482 PMCID: PMC5843444 DOI: 10.5152/eurasianjmed.2017.17321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/11/2017] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Alveolar echinococcosis (AE) is a rare life-threatening parasitic infection. Computed tomography perfusion (CTP) imaging has the potential to provide both quantitative and qualitative information about the tissue perfusion characteristics. The purpose of this study was the examination of the characteristic features and feasibility of CTP in AE liver lesions. MATERIAL AND METHODS CTP scanning was performed in 25 patients who had a total of 35 lesions identified as AE of the liver. Blood flow (BF), blood volume (BV), portal venous perfusion (PVP), arterial liver perfusion (ALP), and hepatic perfusion indexes (HPI) were computed for background liver parenchyma and each AE lesion. RESULTS Significant differences were detected between perfusion values of the AE lesions and background liver tissue. The BV, BF, ALP, and PVP values for all components of the AE liver lesions were significantly lower than the normal liver parenchyma (p<0.01). CONCLUSIONS We suggest that perfusion imaging can be used in AE of the liver. Thus, the quantitative knowledge of perfusion parameters are obtained via CT perfusion imaging.
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Affiliation(s)
- Recep Sade
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mecit Kantarci
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Berhan Genc
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
- Department of Radiology, Karataş Hospital, İzmir, Turkey
| | - Hayri Ogul
- Department of Radiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Betul Gundogdu
- Department of Pathology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Omer Yilmaz
- Department of Gastroenterology, Atatürk University School of Medicine, Erzurum, Turkey
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45
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Irastorza RM, Trujillo M, Berjano E. How coagulation zone size is underestimated in computer modeling of RF ablation by ignoring the cooling phase just after RF power is switched off. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33:e2869. [PMID: 28146314 DOI: 10.1002/cnm.2869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/29/2017] [Indexed: 06/06/2023]
Abstract
All the numerical models developed for radiofrequency ablation so far have ignored the possible effect of the cooling phase (just after radiofrequency power is switched off) on the dimensions of the coagulation zone. Our objective was thus to quantify the differences in the minor radius of the coagulation zone computed by including and ignoring the cooling phase. We built models of RF tumor ablation with 2 needle-like electrodes: a dry electrode (5 mm long and 17G in diameter) with a constant temperature protocol (70°C) and a cooled electrode (30 mm long and 17G in diameter) with a protocol of impedance control. We observed that the computed coagulation zone dimensions were always underestimated when the cooling phase was ignored. The mean values of the differences computed along the electrode axis were always lower than 0.15 mm for the dry electrode and 1.5 mm for the cooled electrode, which implied a value lower than 5% of the minor radius of the coagulation zone (which was 3 mm for the dry electrode and 30 mm for the cooled electrode). The underestimation was found to be dependent on the tissue characteristics: being more marked for higher values of specific heat and blood perfusion and less marked for higher values of thermal conductivity.
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Affiliation(s)
- Ramiro M Irastorza
- Instituto de Física de Líquidos y Sistemas Biológicos (CONICET), Calle 59 No 789, B1900BTE, La Plata, Argentina
- Instituto de Ingeniería y Agronomía, Universidad Nacional Arturo Jauretche, Avenida Calchaquí No 6200, 1888, Florencio Varela, Argentina
| | - Macarena Trujillo
- Instituto Universitario de Matemática Pura y Aplicada, Universitat Politècnica de València, Camí de Vera, 46022, València, Spain
| | - Enrique Berjano
- Biomedical Synergy, Electronic Engineering Department, Universitat Politècnica de València, Camí de Vera, 46022, València, Spain
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46
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Chouhan MD, Mookerjee RP, Bainbridge A, Punwani S, Jones H, Davies N, Walker-Samuel S, Patch D, Jalan R, Halligan S, Lythgoe MF, Taylor SA. Caval Subtraction 2D Phase-Contrast MRI to Measure Total Liver and Hepatic Arterial Blood Flow: Proof-of-Principle, Correlation With Portal Hypertension Severity and Validation in Patients With Chronic Liver Disease. Invest Radiol 2017; 52:170-176. [PMID: 27805917 DOI: 10.1097/rli.0000000000000328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Caval subtraction phase-contrast magnetic resonance imaging (PCMRI) noninvasive measurements of total liver blood flow (TLBF) and hepatic arterial (HA) flow have been validated in animal models and translated into normal volunteers, but not patients. This study aims to demonstrate its use in patients with liver cirrhosis, evaluate measurement consistency, correlate measurements with portal hypertension severity, and invasively validate TLBF measurements. MATERIALS AND METHODS Local research ethics committee approval was obtained. Twelve patients (mean, 50.8 ± 3.1 years; 10 men) with histologically confirmed cirrhosis were recruited prospectively, undergoing 2-dimensional PCMRI of the portal vein (PV) and the infrahepatic and suprahepatic inferior vena cava. Total liver blood flow and HA flow were estimated by subtracting infrahepatic from suprahepatic inferior vena cava flow and PV flow from estimated TLBF, respectively. Invasive hepatic venous pressure gradient (HVPG) and indocyanine green (ICG) clearance TLBF were measured within 7 days of PCMRI. Bland-Altman (BA) analysis of agreement, coefficients of variation, and Pearson correlation coefficients were calculated for comparisons with direct inflow PCMRI, HVPG, and ICG clearance. RESULTS The mean difference between caval subtraction TLBF and direct inflow PCMRI was 6.3 ± 4.2 mL/min/100 g (BA 95% limits of agreement, ±28.7 mL/min/100 g). Significant positive correlations were observed between HVPG and caval subtraction HA fraction (r = 0.780, P = 0.014), but not for HA flow (r = 0.625, P = 0.053), PV flow (r = 0.244, P = 0.469), or caval subtraction TLBF (r = 0.473, P = 0.141). Caval subtraction and ICG TLBF agreement was modest (mean difference, -32.6 ± 16.6 mL/min/100 g; BA 95% limits of agreement, ±79.7 mL/min/100 g), but coefficients of variation were not different (65.7% vs 48.1%, P = 0.28). CONCLUSIONS In this proof-of-principle study, caval subtraction PCMRI measurements are consistent with direct inflow PCMRI, correlate with portal hypertension severity, and demonstrate modest agreement with invasive TLBF measurements. Larger studies investigating the clinical role of TLBF and HA flow measurement in patients with liver disease are justified.
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Affiliation(s)
- Manil D Chouhan
- From the *Centre for Medical Imaging, Division of Medicine, and †Institute for Liver and Digestive Health, Division of Medicine, University College London; ‡Department of Medical Physics, University College London Hospitals NHS Trust; and §Centre for Advanced Biomedical Imaging, Division of Medicine, University College London, London, United Kingdom
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47
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Chouhan MD, Bainbridge A, Atkinson D, Punwani S, Mookerjee RP, Lythgoe MF, Taylor SA. Improved hepatic arterial fraction estimation using cardiac output correction of arterial input functions for liver DCE MRI. Phys Med Biol 2016; 62:1533-1546. [PMID: 28002045 PMCID: PMC5953239 DOI: 10.1088/1361-6560/aa553c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Liver dynamic contrast enhanced (DCE) MRI pharmacokinetic modelling could be useful in the assessment of diffuse liver disease and focal liver lesions, but is compromised by errors in arterial input function (AIF) sampling. In this study, we apply cardiac output correction to arterial input functions (AIFs) for liver DCE MRI and investigate the effect on dual-input single compartment hepatic perfusion parameter estimation and reproducibility. Thirteen healthy volunteers (28.7 ± 1.94 years, seven males) underwent liver DCE MRI and cardiac output measurement using aortic root phase contrast MRI (PCMRI), with reproducibility (n = 9) measured at 7 d. Cardiac output AIF correction was undertaken by constraining the first pass AIF enhancement curve using the indicator-dilution principle. Hepatic perfusion parameters with and without cardiac output AIF correction were compared and 7 d reproducibility assessed. Differences between cardiac output corrected and uncorrected liver DCE MRI portal venous (PV) perfusion (p = 0.066), total liver blood flow (TLBF) (p = 0.101), hepatic arterial (HA) fraction (p = 0.895), mean transit time (MTT) (p = 0.646), distribution volume (DV) (p = 0.890) were not significantly different. Seven day corrected HA fraction reproducibility was improved (mean difference 0.3%, Bland–Altman 95% limits-of-agreement (BA95%LoA) ±27.9%, coefficient of variation (CoV) 61.4% versus 9.3%, ±35.5%, 81.7% respectively without correction). Seven day uncorrected PV perfusion was also improved (mean difference 9.3 ml min−1/100 g, BA95%LoA ±506.1 ml min−1/100 g, CoV 64.1% versus 0.9 ml min−1/100 g, ±562.8 ml min−1/100 g, 65.1% respectively with correction) as was uncorrected TLBF (mean difference 43.8 ml min−1/100 g, BA95%LoA ±586.7 ml min−1/ 100 g, CoV 58.3% versus 13.3 ml min−1/100 g, ±661.5 ml min−1/100 g, 60.9% respectively with correction). Reproducibility of uncorrected MTT was similar (uncorrected mean difference 2.4 s, BA95%LoA ±26.7 s, CoV 60.8% uncorrected versus 3.7 s, ±27.8 s, 62.0% respectively with correction), as was and DV (uncorrected mean difference 14.1%, BA95%LoA ±48.2%, CoV 24.7% versus 10.3%, ±46.0%, 23.9% respectively with correction). Cardiac output AIF correction does not significantly affect the estimation of hepatic perfusion parameters but demonstrates improvements in normal volunteer 7 d HA fraction reproducibility, but deterioration in PV perfusion and TLBF reproducibility. Improved HA fraction reproducibility maybe important as arterialisation of liver perfusion is increased in chronic liver disease and within malignant liver lesions.
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Affiliation(s)
- Manil D Chouhan
- Division of Medicine, University College London (UCL) Centre for Medical Imaging, UCL, London, UK
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48
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Zhou L, Wang LY, Zhang XM, Zeng NL, Chen TW, Li R, Huang YC, Tang YL. Semi-quantitative assessment of the presence and Child-Pugh class of hepatitis B related cirrhosis by using liver lobe-based dynamic contrast-enhanced MRI. Clin Radiol 2016; 71:1289-1295. [PMID: 27633724 DOI: 10.1016/j.crad.2016.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022]
Abstract
AIM To determine whether liver lobe-based DCE-MRI can be used to detect the presence and Child-Pugh class of hepatitis B-related cirrhosis. MATERIALS AND METHODS Fifty-six cirrhotic patients with hepatitis B and 20 healthy participants underwent liver DCE-MRI, and the positive enhancement integral (PEI), time to peak (TTP), maximum slope of increase (MSI) and maximum slope of decrease (MSD) of the left lateral liver lobe (LLL), left medial liver lobe (LML), right liver lobe (RL), and caudate lobe (CL) were measured and analysed statistically to evaluate cirrhosis. RESULTS TTP values of the LLL, LML, RL and CL were positively correlated with the Child-Pugh class of cirrhosis (r=0.452 to 0.55, all p<0.05). PEI values of the LLL, LML, RL and CL, as well as the MSI of the CL and the MSD of the RL, were inversely correlated with the Child-Pugh class (r=-0.349 to -0.72, all p<0.05). PEI values of the LLL and CL, or TTP values of the RL had the most area under receiver operating characteristic curve (AUC) of 0.99 for identifying the presence of liver cirrhosis. The PEI of the RL had the largest AUC of 0.975 and 0.78 for distinguishing the Child-Pugh class A of cirrhosis from class B-C and class A-B of cirrhosis from class C, respectively. CONCLUSION Liver lobe-based DCE-MRI parameters are associated with the presence and Child-Pugh class of hepatitis B-related cirrhosis.
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Affiliation(s)
- L Zhou
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China; Department of Radiology, Affiliated Xi'an Gaoxin Hospital of Xi'an Jiaotong University, Xi'an 710075, Shanxi Province, China
| | - L-Y Wang
- Department of Imaging Centre, Central Hospital of Changsha, Changsha 430100, Hunan Province, China
| | - X-M Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China
| | - N-L Zeng
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China
| | - T-W Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China.
| | - R Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China
| | - Y-C Huang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China
| | - Y-L Tang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, 63(#) Wenhua Road, Shunqing District, Nanchong 637000, Sichuan Province, China
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Abstract
Stroke is the leading cause of long-term disability and the second leading cause of mortality in the world, and exerts an enormous burden on the public health. Computed Tomography (CT) remains one of the most widely used imaging modality for acute stroke diagnosis. However when coupled with CT perfusion, the excessive radiation exposure in repetitive imaging to assess treatment response and prognosis has raised significant public concerns regarding its potential hazards to both short- and long-term health outcomes. Tensor total variation has been proposed to reduce the necessary radiation dose in CT perfusion without comprising the image quality by fusing the information of the local anatomical structure with the temporal blood flow model. However the local search in the TTV framework fails to leverage the non-local information in the spatio-temporal data. In this paper, we propose TENDER, an efficient framework of non-local tensor deconvolution to maintain the accuracy of the hemodynamic parameters and the diagnostic reliability in low radiation dose CT perfusion. The tensor total variation is extended using non-local spatio-temporal cubics for regularization, and an efficient algorithm is proposed to reduce the time complexity with speedy similarity computation. Evaluations on clinical data of patients subjects with cerebrovascular disease and normal subjects demonstrate the advantage of non-local tensor deconvolution for reducing radiation dose in CT perfusion.
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50
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Chouhan MD, Bainbridge A, Atkinson D, Punwani S, Mookerjee RP, Lythgoe MF, Taylor SA. Estimation of contrast agent bolus arrival delays for improved reproducibility of liver DCE MRI. Phys Med Biol 2016; 61:6905-6918. [PMID: 27618594 PMCID: PMC5390945 DOI: 10.1088/0031-9155/61/19/6905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Delays between contrast agent (CA) arrival at the site of vascular input function (VIF) sampling and the tissue of interest affect dynamic contrast enhanced (DCE) MRI pharmacokinetic modelling. We investigate effects of altering VIF CA bolus arrival delays on liver DCE MRI perfusion parameters, propose an alternative approach to estimating delays and evaluate reproducibility. Thirteen healthy volunteers (28.7 ± 1.9 years, seven males) underwent liver DCE MRI using dual-input single compartment modelling, with reproducibility (n = 9) measured at 7 days. Effects of VIF CA bolus arrival delays were assessed for arterial and portal venous input functions. Delays were pre-estimated using linear regression, with restricted free modelling around the pre-estimated delay. Perfusion parameters and 7 days reproducibility were compared using this method, freely modelled delays and no delays using one-way ANOVA. Reproducibility was assessed using Bland–Altman analysis of agreement. Maximum percent change relative to parameters obtained using zero delays, were −31% for portal venous (PV) perfusion, +43% for total liver blood flow (TLBF), +3247% for hepatic arterial (HA) fraction, +150% for mean transit time and −10% for distribution volume. Differences were demonstrated between the 3 methods for PV perfusion (p = 0.0085) and HA fraction (p < 0.0001), but not other parameters. Improved mean differences and Bland–Altman 95% Limits-of-Agreement for reproducibility of PV perfusion (9.3 ml/min/100 g, ±506.1 ml/min/100 g) and TLBF (43.8 ml/min/100 g, ±586.7 ml/min/100 g) were demonstrated using pre-estimated delays with constrained free modelling. CA bolus arrival delays cause profound differences in liver DCE MRI quantification. Pre-estimation of delays with constrained free modelling improved 7 days reproducibility of perfusion parameters in volunteers.
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Affiliation(s)
- Manil D Chouhan
- University College London (UCL) Centre for Medical Imaging, Division of Medicine, UCL, London, UK
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