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Ibrahim A, Guha S, Lu L, Geng P, Wu Q, Chou Y, Yang H, Wang D, Schwartz LH, Xie CM, Zhao B. The reproducibility and predictivity of radiomic features extracted from dynamic contrast-enhanced computed tomography of hepatocellular carcinoma. PLoS One 2024; 19:e0310486. [PMID: 39269960 PMCID: PMC11398651 DOI: 10.1371/journal.pone.0310486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
PURPOSE To assess the reproducibility of radiomic features (RFs) extracted from dynamic contrast-enhanced computed tomography (DCE-CT) scans of patients diagnosed with hepatocellular carcinoma (HCC) with regards to inter-observer variability and acquisition timing after contrast injection. The predictive ability of reproducible RFs for differentiating between the degrees of HCC differentiation is also investigated. METHODS We analyzed a set of DCE-CT scans of 39 patients diagnosed with HCC. Two radiologists independently segmented the scans, and RFs were extracted from each sequence of the DCE-CT scans. The same lesion was segmented across the DCE-CT sequences of each patient's scan. From each lesion, 127 commonly used RFs were extracted. The reproducibility of RFs was assessed with regard to (i) inter-observer variability, by evaluating the reproducibility of RFs between the two radiologists; and (ii) timing of acquisition following contrast injection (inter- and intra-imaging phase). The reproducibility of RFs was assessed using the concordance correlation coefficient (CCC), with a cut-off value of 0.90. Reproducible RFs were used for building XGBoost classification models for the differentiation of HCC differentiation. RESULTS Inter-observer analyses across the different contrast-enhancement phases showed that the number of reproducible RFs was 29 (22.8%), 52 (40.9%), and 36 (28.3%) for the non-contrast enhanced, late arterial, and portal venous phases, respectively. Intra- and inter-sequence analyses revealed that the number of reproducible RFs ranged between 1 (0.8%) and 47 (37%), inversely related with time interval between the sequences. XGBoost algorithms built using reproducible RFs in each phase were found to be high predictive ability of the degree of HCC tumor differentiation. CONCLUSIONS The reproducibility of many RFs was significantly impacted by inter-observer variability, and a larger number of RFs were impacted by the difference in the time of acquisition after contrast injection. Our findings highlight the need for quality assessment to ensure that scans are analyzed in the same physiologic imaging phase in quantitative imaging studies, or that phase-wide reproducible RFs are selected. Overall, the study emphasizes the importance of reproducibility and quality control when using RFs as biomarkers for clinical applications.
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Affiliation(s)
- Abdalla Ibrahim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Siddharth Guha
- Department of Radiology, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Lin Lu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Pengfei Geng
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Qian Wu
- First Affiliated Hospital of Nanjing Medical University, Jiangsu, China
| | - Yen Chou
- Department of Medical Imaging, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Hao Yang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Delin Wang
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lawrence H. Schwartz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Chuan-miao Xie
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Binsheng Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
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Guha S, Ibrahim A, Wu Q, Geng P, Chou Y, Yang H, Ma J, Lu L, Wang D, Schwartz LH, Xie CM, Zhao B. Machine learning-based identification of contrast-enhancement phase of computed tomography scans. PLoS One 2024; 19:e0294581. [PMID: 38306329 PMCID: PMC10836663 DOI: 10.1371/journal.pone.0294581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/04/2023] [Indexed: 02/04/2024] Open
Abstract
Contrast-enhanced computed tomography scans (CECT) are routinely used in the evaluation of different clinical scenarios, including the detection and characterization of hepatocellular carcinoma (HCC). Quantitative medical image analysis has been an exponentially growing scientific field. A number of studies reported on the effects of variations in the contrast enhancement phase on the reproducibility of quantitative imaging features extracted from CT scans. The identification and labeling of phase enhancement is a time-consuming task, with a current need for an accurate automated labeling algorithm to identify the enhancement phase of CT scans. In this study, we investigated the ability of machine learning algorithms to label the phases in a dataset of 59 HCC patients scanned with a dynamic contrast-enhanced CT protocol. The ground truth labels were provided by expert radiologists. Regions of interest were defined within the aorta, the portal vein, and the liver. Mean density values were extracted from those regions of interest and used for machine learning modeling. Models were evaluated using accuracy, the area under the curve (AUC), and Matthew's correlation coefficient (MCC). We tested the algorithms on an external dataset (76 patients). Our results indicate that several supervised learning algorithms (logistic regression, random forest, etc.) performed similarly, and our developed algorithms can accurately classify the phase of contrast enhancement.
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Affiliation(s)
- Siddharth Guha
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Abdalla Ibrahim
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Qian Wu
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Pengfei Geng
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Yen Chou
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Hao Yang
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Jingchen Ma
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Lin Lu
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Delin Wang
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lawrence H. Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
| | | | - Binsheng Zhao
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, United States of America
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Yamaguchi H, Ichikawa T, Morisaka H, Akai H, Izuka K, Ueno T, Abe O, Tsushima Y. Early detection of hypervascularization in hepatocellular carcinoma (≤2 cm) on hepatic arterial phase with virtual monochromatic imaging: Comparison with low-tube voltage CT. Medicine (Baltimore) 2023; 102:e34774. [PMID: 37773820 PMCID: PMC10545275 DOI: 10.1097/md.0000000000034774] [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: 04/25/2023] [Accepted: 07/25/2023] [Indexed: 10/01/2023] Open
Abstract
This study aims to assess the diagnostic value of virtual monochromatic image (VMI) at low keV energy for early detection of small hepatocellular carcinoma (HCC) in hepatic arterial phase compared with low-tube voltage (80 kVp) CT generated from dual-energy CT (DE-CT). A total of 107 patients with 114 hypervascular HCCs (≤2 cm) underwent DE-CT, 140 kVp, blended 120 kVp, and 80 kVp images were generated, as well as 40 and 50 keV. CT numbers of HCCs and the standard deviation as image noise on psoas muscle were measured. The contrast-to-noise ratios (CNR) of HCC were compared among all techniques. Overall image quality and sensitivity for detecting HCC hypervascularity were qualitatively assessed by three readers. The mean CT numbers, CNR, and image noise were highest at 40 keV followed by 50 keV, 80 kVp, blended 120 kVp, and 140 kVp. Significant differences were found in all evaluating endpoints except for mean image noise of 50 keV and 80 kVp. Image quality of 40 keV was the lowest, but still it was considered acceptable for diagnostic purposes. The mean sensitivity for detecting lesion hypervascularity with 40 keV (92%) and 50 keV (84%) was higher than those with 80 kVp (56%). Low keV energy images were superior to 80 kVp in detecting hypervascularization of early HCC.
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Affiliation(s)
- Haruomi Yamaguchi
- Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- Diagnostic Radiology and Nuclear Medicine Department, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tomoaki Ichikawa
- Diagnostic Radiology and Nuclear Medicine Department, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Hiroyuki Akai
- Department of Radiology, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Keisuke Izuka
- Department of Gastroenterology, Isesazaki Municipal Hospital, Gunma, Japan
| | - Takashi Ueno
- Department of Gastroenterology, Isesazaki Municipal Hospital, Gunma, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshito Tsushima
- Diagnostic Radiology and Nuclear Medicine Department, Gunma University Graduate School of Medicine, Gunma, Japan
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Lee HJ, Kim JS, Lee JK, Lee HA, Pak S. Ultra-low-dose hepatic multiphase CT using deep learning-based image reconstruction algorithm focused on arterial phase in chronic liver disease: A non-inferiority study. Eur J Radiol 2023; 159:110659. [PMID: 36584563 DOI: 10.1016/j.ejrad.2022.110659] [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: 10/04/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study determined whether image quality and detectability of ultralow-dose hepatic multiphase CT (ULDCT, 33.3% dose) using a vendor-agnostic deep learning model(DLM) are noninferior to those of standard-dose CT (SDCT, 100% dose) using model-based iterative reconstruction(MBIR) in patients with chronic liver disease focusing on arterial phase. METHODS Sixty-seven patients underwent hepatic multiphase CT using a dual-source scanner to obtain two different radiation dose CT scans (100%, SDCT and 33.3%, ULDCT). ULDCT using DLM and SDCT using MBIR were compared. A margin of -0.5 for the difference between the two protocols was pre-defined as noninferiority of the overall image quality of the arterial phase image. Quantitative image analysis (signal to noise ratio[SNR] and contrast to noise ratio[CNR]) was also conducted. The detectability of hepatic arterial focal lesions was compared using the Jackknife free-response receiver operating characteristic analysis. Non-inferiority was satisfied if the margin of the lower limit of 95%CI of the difference in figure-of-merit was less than -0.1. RESULTS Mean overall arterial phase image quality scores with ULDCT using DLM and SDCT using MBIR were 4.35 ± 0.57 and 4.08 ± 0.58, showing noninferiority (difference: -0.269; 95 %CI, -0.374 to -0.164). ULDCT using DLM showed a significantly superior contrast-to-noise ratio of arterial enhancing lesion (p < 0.05). Figure-of-merit for detectability of arterial hepatic focal lesion was 0.986 for ULDCT using DLM and 0.963 for SDCT using MBIR, showing noninferiority (difference: -0.023, 95 %CI: -0.016 to 0.063). CONCLUSION ULDCT using DLM with 66.7% dose reduction showed non-inferior overall image quality and detectability of arterial focal hepatic lesion compared to SDCT using MBIR.
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Affiliation(s)
- Hyun Joo Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jin Sil Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Seongyong Pak
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology,Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Vidili G, Arru M, Solinas G, Calvisi DF, Meloni P, Sauchella A, Turilli D, Fabio C, Cossu A, Madeddu G, Babudieri S, Zocco MA, Iannetti G, Di Lembo E, Delitala AP, Manetti R. Contrast-enhanced ultrasound Liver Imaging Reporting and Data System: Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis. World J Gastroenterol 2022; 28:3488-3502. [PMID: 36158272 PMCID: PMC9346460 DOI: 10.3748/wjg.v28.i27.3488] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/10/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is considered a secondary examination compared to computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of hepatocellular carcinoma (HCC), due to the risk of misdiagnosing intrahepatic cholangiocarcinoma (ICC). The introduction of CEUS Liver Imaging Reporting and Data System (CEUS LI-RADS) might overcome this limitation. Even though data from the literature seems promising, its reliability in real-life context has not been well-established yet.
AIM To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in cirrhosis.
METHODS CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver cirrhosis. The diagnostic standard for all nodules was either biopsy (102 nodules) or CT/MRI (409 nodules). Common diagnostic accuracy indexes such as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for the following associations: CEUS LR-5 and HCC; CEUS LR-4 and 5 merged class and HCC; CEUS LR-M and ICC; and CEUS LR-3 and malignancy. The frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also determined. Inter-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was evaluated.
RESULTS CEUS LR-5 predicted HCC with a 67.6% sensitivity, 97.7% specificity, and 99.3% PPV (P < 0.001). The merging of LR-4 and 5 offered an improved 93.9% sensitivity in HCC diagnosis with a 94.3% specificity and 98.8% PPV (P < 0.001). CEUS LR-M predicted ICC with a 91.3% sensitivity, 96.7% specificity, and 99.6% NPV (P < 0.001). CEUS LR-3 predominantly included benign lesions (only 28.8% of malignancies). In this class, the hypo-hypo pattern showed a much higher rate of malignant lesions (73.3%) than the iso-iso pattern (2.6%). Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect (n = 511, k = 0.94, P < 0.001), while the agreement among raters from separate centres was substantial (n = 50, k = 0.67, P < 0.001). Agreement was stronger for arterial phase hyperenhancement (internal k = 0.86, P < 2.7 × 10-214; external k = 0.8, P < 0.001) than washout (internal k = 0.79, P < 1.6 × 10-202; external k = 0.71, P < 0.001).
CONCLUSION CEUS LI-RADS is effective but can be improved by merging LR-4 and 5 to diagnose HCC and by splitting LR-3 into two subgroups to differentiate iso-iso nodules from other patterns.
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Affiliation(s)
- Gianpaolo Vidili
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Marco Arru
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Giuliana Solinas
- Department of Biomedical Sciences, Public Health-Laboratory of Biostatistics, University of Sassari, Sassari 07100, Italy
| | - Diego Francesco Calvisi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Pierluigi Meloni
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Assunta Sauchella
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Davide Turilli
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Claudio Fabio
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Antonio Cossu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Giordano Madeddu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Sergio Babudieri
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
| | - Maria Assunta Zocco
- Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome 00168, Italy
| | | | - Enza Di Lembo
- Ultrasound Unit, Ospedale S. Spirito, Pescara 65123, Italy
| | | | - Roberto Manetti
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari 07100, Italy
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Nadarevic T, Giljaca V, Colli A, Fraquelli M, Casazza G, Miletic D, Štimac D. Computed tomography for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev 2021; 10:CD013362. [PMID: 34611889 PMCID: PMC8493329 DOI: 10.1002/14651858.cd013362.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and fourth in terms of cancer deaths. In clinical practice, computed tomography (CT) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-foetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study CT or magnetic resonance imaging (MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is valid to diagnose hepatocellular carcinoma. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma is, therefore, missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of CT may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of CT in people with chronic liver disease, who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. OBJECTIVES Primary: to assess the diagnostic accuracy of multidetector, multiphasic contrast-enhanced CT for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease, either in a surveillance programme or in a clinical setting. Secondary: to assess the diagnostic accuracy of CT for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease. SEARCH METHODS We searched the Cochrane Hepato-Biliary Trials Register, Cochrane Hepato-Biliary Diagnostic-Test-Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index - Science until 4 May 2021. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of CT for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. DATA COLLECTION AND ANALYSIS At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 21 studies, with a total of 3101 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time-interval between the index test and the reference standard was rarely defined. Regarding applicability in the patient selection domain, we judged 14% (3/21) of studies to be at low concern and 86% (18/21) of studies to be at high concern owing to characteristics of the participants who were on waiting lists for orthotopic liver transplantation. CT for hepatocellular carcinoma of any size and stage: sensitivity 77.5% (95% CI 70.9% to 82.9%) and specificity 91.3% (95% CI 86.5% to 94.5%) (21 studies, 3101 participants; low-certainty evidence). CT for resectable hepatocellular carcinoma: sensitivity 71.4% (95% CI 60.3% to 80.4%) and specificity 92.0% (95% CI 86.3% to 95.5%) (10 studies, 1854 participants; low-certainty evidence). In the three studies at low concern for applicability (861 participants), we found sensitivity 76.9% (95% CI 50.8% to 91.5%) and specificity 89.2% (95% CI 57.0% to 98.1%). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. AUTHORS' CONCLUSIONS In the clinical pathway for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, CT has roles as a confirmatory test for hepatocellular carcinoma lesions, and for staging assessment. We found that using CT in detecting hepatocellular carcinoma of any size and stage, 22.5% of people with hepatocellular carcinoma would be missed, and 8.7% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 28.6% of people with resectable hepatocellular carcinoma would improperly not be resected, while 8% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results.
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Affiliation(s)
- Tin Nadarevic
- Department of Radiology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Vanja Giljaca
- Department of Gastroenterology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Damir Miletic
- Department of Radiology , Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | - Davor Štimac
- Department of Gastroenterology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
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Zhao Y, Hernandez AM, Boone JM, Molloi S. Quantification of Airway Dimensions using a High-Resolution CT Scanner: A Phantom Study. Med Phys 2021; 48:5874-5883. [PMID: 34287955 DOI: 10.1002/mp.15103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Small airways with inner diameters less than 2 mm are sites of major airflow limitations in patients with chronic obstructive pulmonary disease (COPD) and asthma. The purpose of this study is to investigate the limitations for accurate assessment of small airway dimensions using both high-resolution CT (HRCT) and conventional normal-resolution CT at low dose levels. METHODS To model the normal human airways from the 3rd to 20th generations, a cylindrical polyurethane phantom with 14 airway tubes of inner diameters (ID) ranging from 0.3 to 3.4 mm and wall thicknesses (WT) ranging from 0.15 to 1.6 mm was placed within an Anthropomorphic QRM-Thorax phantom. The Aquilion Precision (Canon Medical Systems Corporation) HRCT scanner was used to acquire images at 80, 100 and 120 kV using high resolution mode (HR, 0.25 mm x 160 detector configuration) and normal resolution mode (NR, 0.5 mm x 80 detector configuration). The HR data were reconstructed using 1024 x 1024 matrix (0.22 x 0.22 x 0.25 mm voxel size) and the NR data were reconstructed using a 512 x 512 matrix (0.43 x 0.43 x 0.50 mm). Two reconstruction algorithms (filtered back projection; FBP and an adaptive iterative dose reduction 3D algorithm; AIDR 3D) and three reconstruction kernels (FC30, FC52 and FC56) were investigated. The CTDIvol dose values ranged from 0.2 to 6.2 mGy. A refined automated full-width half-maximum (FWHM) method was used for the measurement of airway dimensions, where the density profiles were computed by radial oversampling using a polar coordinate system. Both ID and WT were compared to the known dimensions using a regression model, and the root-mean-squared-error (RMSE) and average error were computed across all 14 airway tubes. RESULTS The results indicate that the ID can be measured within a 15% error down to approximately 0.8 mm and 2.0 mm using the HR and NR modes, respectively. The overall RMSE (and average error) of ID measurements for HR and NR were 0.10 mm (-0.70%) and 0.31 mm (-2.63%), respectively. The RMSE (and average error) of WT measurements using HR and NR were 0.10 mm (23.27%) and 0.27 mm (53.56%), respectively. The WT measurement using HR yielded a factor of two improvement in accuracy as compared to NR. CONCLUSIONS High-resolution CT can provide more accurate measurements of airway dimensions as compared with normal resolution CT, potentially improving quantitative assessment of pathologies such as COPD and asthma. The high resolution mode acquired and reconstructed with AIDR3D and the FC52 kernel provides most accurate measurement of airway dimensions. Low-dose high resolution measurements at dose level above 0.9 mGy can provide improved accuracy on both inner diameters and wall thicknesses compared to full dose normal resolution airway phantom measurements.
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Affiliation(s)
- Yixiao Zhao
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
| | - Andrew M Hernandez
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - John M Boone
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,Department of Biomedical Engineering, University of California Davis, Davis, CA, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, USA
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8
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Tang Y, Gao R, Lee HH, Chen Y, Gao D, Bermudez C, Bao S, Huo Y, Savoie BV, Landman BA. Phase identification for dynamic CT enhancements with generative adversarial network. Med Phys 2021; 48:1276-1285. [PMID: 33410167 DOI: 10.1002/mp.14706] [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: 05/11/2020] [Revised: 12/02/2020] [Accepted: 12/18/2020] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Dynamic contrast-enhanced computed tomography (CT) is widely used to provide dynamic tissue contrast for diagnostic investigation and vascular identification. However, the phase information of contrast injection is typically recorded manually by technicians, which introduces missing or mislabeling. Hence, imaging-based contrast phase identification is appealing, but challenging, due to large variations among different contrast protocols, vascular dynamics, and metabolism, especially for clinically acquired CT scans. The purpose of this study is to perform imaging-based phase identification for dynamic abdominal CT using a proposed adversarial learning framework across five representative contrast phases. METHODS A generative adversarial network (GAN) is proposed as a disentangled representation learning model. To explicitly model different contrast phases, a low dimensional common representation and a class specific code are fused in the hidden layer. Then, the low dimensional features are reconstructed following a discriminator and classifier. 36 350 slices of CT scans from 400 subjects are used to evaluate the proposed method with fivefold cross-validation with splits on subjects. Then, 2216 slices images from 20 independent subjects are employed as independent testing data, which are evaluated using multiclass normalized confusion matrix. RESULTS The proposed network significantly improved correspondence (0.93) over VGG, ResNet50, StarGAN, and 3DSE with accuracy scores 0.59, 0.62, 0.72, and 0.90, respectively (P < 0.001 Stuart-Maxwell test for normalized multiclass confusion matrix). CONCLUSION We show that adversarial learning for discriminator can be benefit for capturing contrast information among phases. The proposed discriminator from the disentangled network achieves promising results.
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Affiliation(s)
- Yucheng Tang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | - Riqiang Gao
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | - Ho Hin Lee
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | | | - Dashan Gao
- 12 Sigma Technologies, San Diego, CA, 92130, USA
| | - Camilo Bermudez
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA
| | - Shunxing Bao
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | - Yuankai Huo
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA
| | - Brent V Savoie
- Vanderbilt University Medical Center, Nashville, TN, 37235, USA
| | - Bennett A Landman
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, 37235, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, 37235, USA.,Vanderbilt University Medical Center, Nashville, TN, 37235, USA
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9
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DiMaso LD, Miller JR, Lawless MJ, Bassetti MF, DeWerd LA, Huang J. Investigating split-filter dual-energy CT for improving liver tumor visibility for radiation therapy. J Appl Clin Med Phys 2020; 21:249-255. [PMID: 32410336 PMCID: PMC7484851 DOI: 10.1002/acm2.12904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/20/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Accurate liver tumor delineation is crucial for radiation therapy, but liver tumor volumes are difficult to visualize with conventional single‐energy CT. This work investigates the use of split‐filter dual‐energy CT (DECT) for liver tumor visibility by quantifying contrast and contrast‐to‐noise ratio (CNR). Methods Split‐filter DECT contrast‐enhanced scans of 20 liver tumors including cholangiocarcinomas, hepatocellular carcinomas, and liver metastases were acquired. Analysis was performed on the arterial and venous phases of mixed 120 kVp‐equivalent images and VMIs at 57 keV and 40 keV gross target volume (GTV) contrast and CNR were calculated. Results For the arterial phase, liver GTV contrast was 12.1 ± 10.0 HU and 43.1 ± 32.3 HU (P < 0.001) for the mixed images and 40 keV VMIs. Image noise increased on average by 116% for the 40 keV VMIs compared to the mixed images. The average CNR did not change significantly (1.6 ± 1.5, 1.7 ± 1.4, 2.4 ± 1.7 for the mixed, 57 keV and 40 keV VMIs (P > 0.141)). For individual cases, however, CNR increases of up to 607% were measured for the 40 keV VMIs compared to the mixed image. Venous phase 40 keV VMIs demonstrated an average increase of 35.4 HU in GTV contrast and 121% increase in image noise. Average CNR values were also not statistically different, but for individual cases CNR increases of up to 554% were measured for the 40 keV VMIs compared to the mixed image. Conclusions Liver tumor contrast was significantly improved using split‐filter DECT 40 keV VMIs compared to mixed images. On average, there was no statistical difference in CNR between the mixed images and VMIs, but for individual cases, CNR was greatly increased for the 57 keV and 40 keV VMIs. Therefore, although not universally successful for our patient cohort, split‐filter DECT VMIs may provide substantial gains in tumor visibility of certain liver cases for radiation therapy treatment planning.
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Affiliation(s)
- Lianna D. DiMaso
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Jessica R. Miller
- Department of Human OncologyUniversity of Wisconsin‐MadisonMadisonWIUSA
| | | | | | - Larry A. DeWerd
- Department of Medical PhysicsUniversity of Wisconsin‐MadisonMadisonWIUSA
| | - Jessie Huang
- Department of Human OncologyUniversity of Wisconsin‐MadisonMadisonWIUSA
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10
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Zhou X, Wang J, Tang M, Huang M, Xu L, Peng Z, Li ZP, Feng ST. Hepatocellular carcinoma with hilar bile duct tumor thrombus versus hilar Cholangiocarcinoma on enhanced computed tomography: a diagnostic challenge. BMC Cancer 2020; 20:54. [PMID: 31969123 PMCID: PMC6977349 DOI: 10.1186/s12885-020-6539-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with hilar bile duct tumor thrombus (HBDTT) often mimic hilar cholangiocarcinoma (hilar CC). The purpose of this study is to analyze the Computed Tomography (CT) characteristics of HCC with HBDTT and to identify imaging features to aid its differentiation from hilar CC on enhanced CT. METHODS We retrospectively identified 58 cases with pathologically proved HCC with HBDTT between 2011 and 2018. Seventy-seven cases of pathologically proven hilar CCs were selected during the same period. The clinical features and CT findings of the two groups were reviewed and compared. RESULTS HCC with HBDTTs are more commonly found in men (87.9% vs 63.6%, p = 0.001) with lower age of onset (49.84 vs 58.61 years; p < 0.001) in comparison to hilar CCs. Positive correlation were identified between HCC with HBDTTs and chronic HBV infection (72.4% vs 11.7%; p < 0.001), increased serum AFP (67.2% vs 1.3%; p < 0.001), CA19-9 level (58.6% vs 85.7%; p < 0.001) and CEA level (3.4% vs 29.9%; p = 0.001), parenchymal lesion with intraductal lesion (100% vs 18.2%; p < 0.001), washout during the portal venous phase (84.5% vs 6.5%; p < 0.001), thickened bile duct wall (8.6% vs 93.5%; p < 0.001), intrahepatic vascular embolus (44.8% vs 7.8%; p < 0.001), splenomegaly (34.5% vs 2.6%, p < 0.001). A scoring system consisting of the five parameters obtained from characteristics mentioned above was trialed. The sensitivity and specificity for diagnosing HCC with HBDTT were 96.39, 100 and 92.5% respectively when the total score was 2 or more. CONCLUSIONS HCC with HBDTTs are often distinguishable from hilar CCs based on washout during portal venous phase without thickened bile duct wall. HBV infection and serum AFP level facilitate the differentiation.
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Affiliation(s)
- Xiaoqi Zhou
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jifei Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Mimi Tang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Mengqi Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, Australia
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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11
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Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 2018; 43:56-74. [PMID: 28940042 DOI: 10.1007/s00261-017-1325-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate detection and characterization of liver observations to enable HCC diagnosis and staging using LI-RADS requires a technically adequate imaging exam. To help achieve this objective, LI-RADS has proposed technical requirements for CT, MR, and contrast-enhanced ultrasound of liver. This article reviews the technical requirements for liver imaging, including the description of minimum acceptable technical standards, such as the scanner hardware requirements, recommended dynamic imaging phases, and common technical challenges of liver imaging.
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Affiliation(s)
- Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Keane FK, Hong TS. Role and Future Directions of External Beam Radiotherapy for Primary Liver Cancer. Cancer Control 2017; 24:1073274817729242. [PMID: 28975835 PMCID: PMC5937246 DOI: 10.1177/1073274817729242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 02/28/2017] [Indexed: 12/13/2022] Open
Abstract
The incidence of primary liver cancers continues to increase in the United States and worldwide. The majority of patients with primary liver cancer are not candidates for curative therapies such as surgical resection or orthotopic liver transplantation due to tumor size, vascular invasion, or underlying comorbidities. Therefore, while primary liver cancer is the sixth-most common cancer diagnosis worldwide, it represents the second leading cause of cancer-related deaths. Radiotherapy traditionally played a limited role in the treatment of primary liver cancer due to concerns over hepatic tolerance and the inability to deliver a tumoricidal dose of radiotherapy while still sparing normal hepatic parenchyma. However, the development of modern radiotherapy techniques has made liver-directed radiotherapy a safe and effective treatment option for both hepatocellular carcinoma and intrahepatic cholangiocarcinoma. An increasing body of literature has demonstrated the excellent local control and survival rates associated with liver-directed radiotherapy. These data include multiple radiotherapy techniques and modalities, including stereotactic body radiotherapy (SBRT), intensity modulated radiotherapy (IMRT), and charged particle therapy, including proton therapy. In this review, we discuss the development of liver-directed radiotherapy and evidence in support of its use, particularly in patients who are not candidates for resection or orthotopic liver transplantation. We also discuss future directions for its role in the management of primary liver cancers.
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Affiliation(s)
- Florence K. Keane
- Department of Radiation Oncology, Massachusetts General Hospital,
Boston, MA, USA
| | - Theodore S. Hong
- Department of Radiation Oncology, Massachusetts General Hospital,
Boston, MA, USA
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13
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Kiyokawa H, Yasuda H, Oikawa R, Okuse C, Matsumoto N, Ikeda H, Watanabe T, Yamamoto H, Itoh F, Otsubo T, Yoshimura T, Yoshida E, Nakagawa M, Koshikawa N, Seiki M. Serum monomeric laminin-γ2 as a novel biomarker for hepatocellular carcinoma. Cancer Sci 2017; 108:1432-1439. [PMID: 28418226 PMCID: PMC5497925 DOI: 10.1111/cas.13261] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 02/04/2023] Open
Abstract
The diagnosis of hepatocellular carcinoma (HCC) in the early stages is important for successful clinical management. Laminin (Ln)-γ2 expression has been reported in various types of malignant carcinomas. We recently developed a highly sensitive method to measure serum monomeric Ln-γ2 levels using a fully automated chemiluminescent immunoassay (CLIA). Using our CLIA, we evaluated its diagnostic value in sera from patients with chronic liver disease (CLD) and patients with hepatocellular carcinoma (HCC). Serum alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) were also examined in these subjects. Median levels of Ln-γ2 were significantly higher in patients with HCC (173.2 pg/mL; range: 39.5-986 pg/mL) compared with patients with CLD (76.7 pg/mL; range: 38.7-215.9 pg/mL) and with healthy volunteers (41.1 pg/mL; range: 10.9-79.0 pg/mL). The optimal cutoff value for Ln-γ2 that allowed us to distinguish between HCC and nonmalignant CLD was 116.6 pg/mL. Elevated Ln-γ2 levels were observed in 0% of healthy volunteers, 17% of patients with CLD, and 63% of patients with HCC. The positivity rate in patients with HCC for the combination of Ln-γ2 and DCP was 89.5%, which was better than that for either of the two markers alone (63% and 68%, respectively). Among patients with early-stage HCC (T1 or T2), the positivity rates for monomeric Ln-γ2, AFP and DCP were 61%, 39% and 57%, respectively. Serum Ln-γ2 may be a potential biomarker for HCC surveillance. The combination of Ln-γ2 and DCP may be more sensitive for laboratory diagnosis of HCC than the combination of AFP and DCP.
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Affiliation(s)
- Hirofumi Kiyokawa
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroshi Yasuda
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ritsuko Oikawa
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Chiaki Okuse
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nobuyuki Matsumoto
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroki Ikeda
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Yamamoto
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takehito Otsubo
- Department of Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toru Yoshimura
- Diagnostics Division, Abbott Japan Co. Ltd., Chiba, Japan
| | - Eisaku Yoshida
- Diagnostics Division, Abbott Japan Co. Ltd., Chiba, Japan
| | | | - Naohiko Koshikawa
- Division of Cancer Cell Research, Kanagawa Cancer Center Research Institute, Yokohama, Japan.,Division of Cancer Cell Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Motoharu Seiki
- Division of Cancer Cell Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
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Ünal E, İdilman İS, Akata D, Özmen MN, Karçaaltıncaba M. Microvascular invasion in hepatocellular carcinoma. Diagn Interv Radiol 2017; 22:125-32. [PMID: 26782155 DOI: 10.5152/dir.2015.15125] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microvascular invasion is a crucial histopathologic prognostic factor for hepatocellular carcinoma. We reviewed the literature and aimed to draw attention to clinicopathologic and imaging findings that may predict the presence of microvascular invasion in hepatocellular carcinoma. Imaging findings suggesting microvascular invasion are disruption of capsule, irregular tumor margin, peritumoral enhancement, multifocal tumor, increased tumor size, and increased glucose metabolism on positron emission tomography-computed tomography. In the presence of typical findings, microvascular invasion may be predicted.
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Affiliation(s)
- Emre Ünal
- Department of Radiology, Hacettepe University School of Medicine Ankara, Turkey; Department of Radiology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
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15
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Yao Y, Ng JM, Megibow AJ, Pelc NJ. Image quality comparison between single energy and dual energy CT protocols for hepatic imaging. Med Phys 2016; 43:4877. [DOI: 10.1118/1.4959554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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16
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Abstract
BACKGROUND The incidence of hepatocellular carcinoma (HCC) continues to increase world-wide. Many patients present with advanced disease with extensive local tumor or vascular invasion and are not candidates for traditionally curative therapies such as orthotopic liver transplantation (OLT) or resection. Radiotherapy (RT) was historically limited by its inability to deliver a tumoricidal dose; however, modern RT techniques have prompted renewed interest in the use of liver-directed RT to treat patients with primary hepatic malignancies. SUMMARY The aim of this review was to discuss the use of external beam RT in the treatment of HCC, with particular focus on the use of stereotactic body radiotherapy (SBRT). We review the intricacies of SBRT treatment planning and delivery. Liver-directed RT involves accurate target identification, precise and reproducible patient immobilization, and assessment of target and organ motion. We also summarize the published data on liver-directed RT, and demonstrate that it is associated with excellent local control and survival rates, particularly in patients who are not candidates for OLT or resection. KEY MESSAGES Modern liver-directed RT is safe and effective for the treatment of HCC, particularly in patients who are not candidates for OLT or resection. Liver-directed RT, including SBRT, depends on accurate target identification, precise and reproducible patient immobilization, and assessment of target and organ motion. Further prospective studies are needed to fully delineate the role of liver-directed RT in the treatment of HCC.
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Affiliation(s)
- Florence K. Keane
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Mass., USA
| | - Jennifer Y. Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Mass., USA
| | - Andrew X. Zhu
- Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Mass., USA
| | - Theodore S. Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Mass., USA,*Theodore S. Hong, MD, Department of Radiation Oncology, Massachusetts General Hospital, 32 Fruit St, Yawkey 7, Boston, MA 02114 (USA), Tel. +1 617 726 6050, E-Mail
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17
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Jones ID, Lamb CR, Drees R, Priestnall SL, Mantis P. ASSOCIATIONS BETWEEN DUAL-PHASE COMPUTED TOMOGRAPHY FEATURES AND HISTOPATHOLOGIC DIAGNOSES IN 52 DOGS WITH HEPATIC OR SPLENIC MASSES. Vet Radiol Ultrasound 2016; 57:144-53. [PMID: 26763951 DOI: 10.1111/vru.12336] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/30/2015] [Accepted: 10/04/2015] [Indexed: 12/14/2022] Open
Abstract
Ability to noninvasively differentiate malignant from nonmalignant abdominal masses would aid clinical decision making. The aim of this retrospective, cross-sectional study was to identify features in dual-phase computed tomographic (CT) studies that could be used to distinguish malignant from nonmalignant hepatic and splenic masses in dogs. Medical records were searched for dogs that had an abdominal dual-phase CT examination, a hepatic or splenic mass, and subsequent histopathologic diagnosis. Computed tomographic images for all included dogs were acquired prior to and <30 s (early phase) and >60 s (delayed phase) after intravenous contrast administration. Fifty-two dogs with 55 masses were studied: 24 hepatic, including 14 (58%) malignant and 10 (42%) non-malignant; 31 splenic, including 18 (58%) malignant and 13 (42%) nonmalignant. There was substantial overlap in the pre- and postcontrast CT features of malignant and nonmalignant hepatic and splenic masses. Regardless of histologic diagnosis, hepatic masses most frequently showed marked, generalized enhancement in early phase images that persisted in the delayed phase. Splenic hemangiosarcoma and nodular hyperplastic lesions most frequently showed marked, generalized enhancement in early phase images that persisted in delayed images whereas most splenic hematomas had slight enhancement in early phase images. All splenic hematomas and 77% of the hemangiosarcomas had contrast accumulation compatible with active hemorrhage. There were no other significant differences in quantitative or categorical CT data between malignant and nonmalignant hepatic or splenic masses. Dual-phase CT of dogs with hepatic or splenic masses provides limited specific diagnostic information.
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Affiliation(s)
- Ian D Jones
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
| | - Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
| | - Randi Drees
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
| | - Simon L Priestnall
- Department of Pathology and Pathogen Biology, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
| | - Panagiotis Mantis
- Department of Clinical Sciences and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, AL9 7TA, UK
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18
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CT Appearance of Hepatocellular Carcinoma after Locoregional Treatments: A Comprehensive Review. Gastroenterol Res Pract 2015; 2015:670965. [PMID: 26798332 PMCID: PMC4700180 DOI: 10.1155/2015/670965] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide, affecting more than 600,000 new patients per year. Curative treatments are available in a small percentage of patients, while most of them present in stages requiring locoregional treatments such as thermoablation, transarterial chemoembolization, and/or radioembolization. These therapies
result in specific imaging features that the general radiologist has to be aware of in order to assess the response to treatment and to correctly manage the follow-up of treated patients. Multiphasic helical computed tomography has become a popular imaging modality for detecting hypervascular tumors and characterizing liver lesions. On this basis, many staging and diagnostic systems have been proposed for evaluating response to all different existing strategies. Radiofrequencies and microwaves generate thermoablation of tumors, and transarterial chemoembolization exploits the double effect of the locoregional administration of drugs and embolizing particles. Eventually radioembolization uses a beta-emitting isotope to induce necrosis. Therefore, the aim of this comprehensive review is to analyze and compare CT imaging appearance of HCC after various locoregional treatments, with regard to specific indications for all possible procedures.
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19
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Niska JR, Keane FK, Wolfgang JA, Hahn PF, Wo JY, Zhu AX, Hong TS. Impact of intravenous contrast enhancement phase on target definition for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC): Observations from patients enrolled on a prospective phase 2 trial. Pract Radiat Oncol 2015; 6:e9-16. [PMID: 26598907 DOI: 10.1016/j.prro.2015.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/17/2015] [Accepted: 08/22/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety and efficacy of radiation therapy for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) depend on accurate definition of gross tumor volume (GTV), but GTV often varies between phases of multiphasic computed tomography (CT) imaging. METHODS We contoured GTVs on arterial, portal venous, and delayed phases of multiphasic CT scans for 32 patients treated on an institutional review board-approved prospective trial of proton therapy for primary liver tumors and determined which phase provided optimal GTV visualization. We assessed agreement between individual phase GTVs to determine if GTV for each phase was encompassed in a 5-mm expansion of either the smallest or the best-visualized GTV. RESULTS There were 19 HCC lesions and 14 IHC lesions. HCC lesions were best identified on the arterial phase in 42% (n = 8), portal venous phase in 32% (n = 6), and delayed phase in 26% (n = 5). IHC lesions were best identified on portal venous phase in 64% (n = 9) and the arterial phase in 29% (n = 4), with 1 case equally visualized on arterial and portal venous phases. In all 33 lesions, a 5-mm expansion around the smallest GTV failed to cover GTVs defined on other available phases. A 5-mm expansion around the best-visualized GTV provided satisfactory coverage of all available phases' GTVs in 6/18 HCC cases and 2/9 IHC cases. CONCLUSIONS Variability between GTVs on multiphasic CT scans could not be overcome with a 5-mm expansion of either the smallest GTV or the best-visualized GTV. Assessment of all available intravenous contrast phases is essential to accurately define the GTV.
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Affiliation(s)
- Joshua R Niska
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - John A Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew X Zhu
- Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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Abstract
Different imaging modalities including ultrasonography, computed tomography (CT), and MR imaging may be used in the liver depending on the clinical situation. The ability of dedicated contrast-enhanced liver MR imaging or CT to definitively characterize lesions as benign is crucial in avoiding unnecessary biopsy. Liver imaging surveillance in patients with cirrhosis may allow for detection of hepatocellular carcinoma at an earlier stage, and therefore may improve outcome. This article reviews the different imaging modalities used to evaluate the liver and focal benign and malignant hepatic lesions, and the basic surveillance strategy for patients at increased risk for hepatocellular carcinoma.
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Affiliation(s)
- Erin K O'Neill
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Jonathan R Cogley
- Department of Radiology, VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, USA
| | - Frank H Miller
- Body Imaging Section, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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21
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Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology 2015; 273:S45-74. [PMID: 25340438 DOI: 10.1148/radiol.14141356] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Computed tomography (CT) has had a profound effect on the practice of medicine. Both the spectrum of clinical applications and the role that CT has played in enhancing the depth of our understanding of disease have been profound. Although almost 90 000 articles on CT have been published in peer-reviewed journals over the past 40 years, fewer than 5% of these have been published in Radiology. Nevertheless, these almost 4000 articles have provided a basis for many important medical advances. By enabling a deepened understanding of anatomy, physiology, and pathology, CT has facilitated key advances in the detection and management of disease. This article celebrates this breadth of scientific discovery and development by examining the impact that CT has had on the diagnosis, characterization, and management of a sampling of major health challenges, including stroke, vascular diseases, cancer, trauma, acute abdominal pain, and diffuse lung diseases, as related to key technical advances in CT and manifested in Radiology.
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Affiliation(s)
- Geoffrey D Rubin
- From the Duke Clinical Research Institute and Department of Radiology, Duke University School of Medicine, PO Box 17969, 2400 Pratt St, Durham, NC 27715
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Abstract
Hepatocellular carcinoma (HCC) is an epithelial tumor derived from hepatocytes; it accounts for 80% of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related deaths. HCC treatment is a multidisciplinary and a multimodal task, with surgery in the form of liver resection and liver transplantation (LT) representing the only potentially curative modality. However, there are variable opinions and discussions about applying these surgical options and using other supporting treatments. This article is a narrative review that includes articles published from 1984 to 2013 located by searching scientific databases such as PubMed, SCOPUS, and Elsevier, with the main keyword of hepatocellular carcinoma in addition to other keywords such as liver transplantation, liver resection, transarterial chemoembolization, portal vein embolization, bridging therapy, and downstaging. In this review, we focus mainly on the surgical treatment options offered for HCC, in order to illustrate the current relevant data available in the literature to help in applying these surgical options and to use other supporting treatment modalities when appropriate.
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Affiliation(s)
- Ahmad A. Madkhali
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Section of Hepatopancreatobilairy and Transplant, Transplant, McGill University, Montreal, Canada
| | - Zahir T. Fadel
- Section of Hepatopancreatobilairy and Transplant, Transplant, McGill University, Montreal, Canada,Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Murad M. Aljiffry
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mazen M. Hassanain
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Oncology, McGill University, Montreal, Canada,Address for correspondence: Dr. Mazen Hassanain, Assistant Professor of Surgery and Consultant HPB and Transplant Surgery, Department of Surgery, College of Medicine, Scientific Director Liver Disease Research Centre, King Saud University, P.O.Box 25179, Riyadh, 11466, Saudi Arabia. E-mail:
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Hong TS, Bosch WR, Krishnan S, Kim TK, Mamon HJ, Shyn P, Ben-Josef E, Seong J, Haddock MG, Cheng JC, Feng MU, Stephans KL, Roberge D, Crane C, Dawson LA. Interobserver variability in target definition for hepatocellular carcinoma with and without portal vein thrombus: radiation therapy oncology group consensus guidelines. Int J Radiat Oncol Biol Phys 2014; 89:804-13. [PMID: 24969794 DOI: 10.1016/j.ijrobp.2014.03.041] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Defining hepatocellular carcinoma (HCC) gross tumor volume (GTV) requires multimodal imaging, acquired in different perfusion phases. The purposes of this study were to evaluate the variability in contouring and to establish guidelines and educational recommendations for reproducible HCC contouring for treatment planning. METHODS AND MATERIALS Anonymous, multiphasic planning computed tomography scans obtained from 3 patients with HCC were identified and distributed to a panel of 11 gastrointestinal radiation oncologists. Panelists were asked the number of HCC cases they treated in the past year. Case 1 had no vascular involvement, case 2 had extensive portal vein involvement, and case 3 had minor branched portal vein involvement. The agreement between the contoured total GTVs (primary + vascular GTV) was assessed using the generalized kappa statistic. Agreement interpretation was evaluated using Landis and Koch's interpretation of strength of agreement. The S95 contour, defined using the simultaneous truth and performance level estimation (STAPLE) algorithm consensus at the 95% confidence level, was created for each case. RESULTS Of the 11 panelists, 3 had treated >25 cases in the past year, 2 had treated 10 to 25 cases, 2 had treated 5 to 10 cases, 2 had treated 1 to 5 cases, 1 had treated 0 cases, and 1 did not respond. Near perfect agreement was seen for case 1, and substantial agreement was seen for cases 2 and 3. For case 2, there was significant heterogeneity in the volume identified as tumor thrombus (range 0.58-40.45 cc). For case 3, 2 panelists did not include the branched portal vein thrombus, and 7 panelists contoured thrombus separately from the primary tumor, also showing significant heterogeneity in volume of tumor thrombus (range 4.52-34.27 cc). CONCLUSIONS In a group of experts, excellent agreement was seen in contouring total GTV. Heterogeneity exists in the definition of portal vein thrombus that may impact treatment planning, especially if differential dosing is contemplated. Guidelines for HCC GTV contouring are recommended.
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Affiliation(s)
- Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Walter R Bosch
- Department of Radiation Oncology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Sunil Krishnan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tae K Kim
- Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harvey J Mamon
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul Shyn
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University Medical College, Seoul, Korea
| | | | - Jason C Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mary U Feng
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, Michigan
| | - Kevin L Stephans
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - David Roberge
- Department of Radiation Oncology, Montreal General Hospital/McGill University Health Centre, Montreal, Quebec, Canada
| | - Christopher Crane
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura A Dawson
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada
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Dynamic multidetector computed tomography findings of hepatocellular carcinoma of hepatitis B virus-positive and -negative patients. Cancer Imaging 2014; 14:9. [PMID: 25608603 PMCID: PMC4331841 DOI: 10.1186/1470-7330-14-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 12/21/2022] Open
Abstract
Background The objective of this study was to retrospectively investigate and compare multidetector computed tomography findings of hepatocellular carcinoma (HCC) in hepatitis B virus (HBV)-positive and -negative patients. Methods Triphasic (arterial, portal venous, and delayed phases) dynamic multidetector computed tomography (CT) was performed in 83 patients with HCC, 48 of whom were HBV-positive. The diagnosis of HCC was established with typical CT imaging findings (68 patients) or histopathological evaluation (15 patients). Distribution of solitary, multiple, and diffuse HCC, portal/hepatic vein thrombosis, metastasis, and patients with high alpha-fetoprotein levels in the HBV-positive and -negative groups were compared using the Kolmogorov–Smirnov test. Lesion size, alpha-fetoprotein levels, arterial, portal, delayed enhancement, and washout of lesions were compared using the Student’s t-test. Results Hypervascular tumors were observed in 72 (87%) patients, and hypovascular tumors were found in 11 (13%) patients. The mean alpha-fetoprotein value of HBV-positive patients with HCC was significantly higher than the mean alpha-fetoprotein value of HBV-negative patients (P < 0.05). Portal/hepatic vein thrombosis and metastasis were more frequently observed in HBV-positive patients (P < 0.05). The frequencies of solitary, multiple, and diffuse lesions in HBV-positive and -negative patients were not significantly different (P > 0.05). The mean diameters, arterial, portal, and delayed phase attenuations, and washout of HCC were not significantly different (P > 0.05). Conclusions Multidetector CT imaging findings of HCC in HBV-positive and -negative patients are alike. Portal/hepatic vein thrombosis and metastasis are more frequently observed in HBV-positive patients. Alpha-fetoprotein levels are higher in HBV-positive patients.
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The usefulness of the sum of relative enhancement ratio in making a differential diagnosis of hepatocellular carcinoma from cirrhosis-related nodules. Clin Imaging 2014; 38:154-9. [DOI: 10.1016/j.clinimag.2013.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 10/24/2013] [Accepted: 10/29/2013] [Indexed: 11/23/2022]
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Exploratory Use of Cardiovascular Magnetic Resonance Imaging in Liver Transplantation. Transplantation 2013; 96:827-33. [DOI: 10.1097/tp.0b013e3182a078e9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Characterization of 1-to 2-cm liver nodules detected on hcc surveillance ultrasound according to the criteria of the American Association for the Study of Liver Disease: is quadriphasic CT necessary? AJR Am J Roentgenol 2013; 201:314-21. [PMID: 23883211 DOI: 10.2214/ajr.12.9341] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the essential number of phases from multiphasic CT for 1- to 2-cm hepatocellular carcinoma (HCC) on surveillance ultrasound and to compare the results with the American Association for the Study of Liver Disease (AASLD) standard (arterial phase hypervascularity and portal venous phase [PVP] or delayed phase hypovascularity). MATERIALS AND METHODS The study included 110 newly detected nodules (1-2 cm; 36 HCC, 74 benign) in 96 patients detected in an HCC surveillance program. Three radiologists prospectively evaluated the attenuation of each nodule relative to the liver on each phase of quadriphasic CT. Univariate and multivariate logistic regression analyses were used to identify parameters associated with HCC. Multiple combinations of phases were compared with the AASLD standard. RESULTS Only arterial phase hypervascularity and delayed phase hypovascularity were significantly associated with HCC both on univariate (odds ratio, arterial phase 7.51 [95% CI, 2.79-20.20]; delayed phase, 2.80 [1.14-6.90]) and multivariate analyses (arterial phase, 11.30 [4.30-29.68]; delayed phase, 4.39 [1.20-16.13]). The combination of arterial phase and delayed phase yielded the highest specificity (99%) and sensitivity (57%). There was no significant difference between AASLD standard (sensitivity, 57%; specificity, 98%) versus biphasic (arterial phase hypervascularity and delayed phase hypovascularity: sensitivity, 57%; p = 1 and specificity, 99%; p = 0.32), triphasic (arterial phase hypervascularity and unenhanced or PVP hypovascularity: sensitivity, 53%; p = 0.325 and specificity, 97%; p = 0.32), or quadriphasic combination (arterial phase hypervascularity and unenhanced, PVP or delayed phase hypovascularity: sensitivity, 57%; specificity, 97%), whereas the sensitivity of biphasic arterial phase and PVP was significantly lower (39% vs 57%, p = 0.022). CONCLUSION For diagnosing 1- to 2-cm HCC detected on surveillance ultrasound, arterial phase and delayed phase are two essential phases, providing higher sensitivity than the combination of arterial phase and PVP, and equal performance with triphasic and quadriphasic combinations. The biphasic combination of arterial phase and delayed phase may replace quadriphasic CT recommended by AASLD.
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Ichikawa T, Okada M, Kondo H, Sou H, Murakami T, Kanematsu M, Yoshikawa S, Shiosakai K, Hayakawa A, Awai K, Yoshimitsu K, Yamashita Y. Recommended iodine dose for multiphasic contrast-enhanced mutidetector-row computed tomography imaging of liver for assessing hypervascular hepatocellular carcinoma: multicenter prospective study in 77 general hospitals in Japan. Acad Radiol 2013; 20:1130-6. [PMID: 23931427 DOI: 10.1016/j.acra.2013.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/02/2013] [Accepted: 05/07/2013] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the recommended iodine dose of contrast material (CM) for hepatic arterial-dominant phase (HAP) and hepatic parenchymal phase (HPP) imaging to assess hypervascular hepatocellular carcinoma (HCC). MATERIALS AND METHODS This was a prospective study including 348 patients with hypervascular HCC in 77 hospitals as a postmarketing surveillance to investigate the effects of body weight-tailored dose of CM (300 mgI/mL of iohexol) for hepatic multiphasic contrast-enhanced multidetector-row computed tomography imaging. Informed consent was obtained from all patients who were enrolled. The tumor-to-liver contrast (TLC) of HAP images was assessed qualitatively (QL-TLC) and quantitatively (QT-TLC [HU]; computed tomography [CT] value of tumor-CT value of hepatic parenchyma). Minimal and sufficient QT-TLC were defined as CT values corresponding to the median and 75% of QL-TLC assigned with "good," respectively. The recommended iodine dose was estimated by the relationship between iodine dose (mgI/kg) and QT-TLC. RESULTS There was a good correlation between QL-TLC and QT-TLC. The recommended iodine dose of CM for HAP imaging was considered to be in the range of 567-647 mgI/kg based on minimal (33.7 HU) and sufficient QT-TLC (40.9 HU). Meanwhile, the recommended dose of CM for HPP imaging was 572 mgI/kg as a dose that gives hepatic enhancement more than 50 HU during HPP imaging. CONCLUSIONS The recommended iodine dose of CM for HAP and HPP imaging may be different, being 567-647 mgI/kg and 572 mgI/kg, respectively, in assessing hypervascular HCC.
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Affiliation(s)
- Tomoaki Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan.
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MDCT Imaging Findings of Liver Cirrhosis: Spectrum of Hepatic and Extrahepatic Abdominal Complications. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2013; 2013:129396. [PMID: 23986608 PMCID: PMC3748773 DOI: 10.1155/2013/129396] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 07/02/2013] [Accepted: 07/17/2013] [Indexed: 01/14/2023]
Abstract
Hepatic cirrhosis is the clinical and pathologic result of a multifactorial chronic liver injury. It is well known that cirrhosis is the origin of multiple extrahepatic abdominal complications and a markedly increased risk of hepatocellular carcinoma (HCC). This tumor is the sixth most common malignancy worldwide and the third most common cause of cancer related death. With the rising incidence of HCC worldwide, awareness of the evolution of cirrhotic nodules into malignancy is critical for an early detection and treatment. Adequate imaging protocol selection with dynamic multiphase Multidetector Computed Tomography (MDCT) and reformatted images is crucial to differentiate and categorize the hepatic nodular dysplasia. Knowledge of the typical and less common extrahepatic abdominal manifestations is essential for accurately assessing patients with known or suspected hepatic disease. The objective of this paper is to illustrate the imaging spectrum of intra- and extrahepatic abdominal manifestations of hepatic cirrhosis seen on MDCT.
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Imaging Assessment of Hepatocellular Carcinoma Response to Locoregional and Systemic Therapy. AJR Am J Roentgenol 2013; 201:80-96. [DOI: 10.2214/ajr.13.10706] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Ichikawa T, Motosugi U, Morisaka H, Sano K, Ali M, Araki T. Volumetric low-tube-voltage CT imaging for evaluating hypervascular hepatocellular carcinoma; effects on radiation exposure, image quality, and diagnostic performance. Jpn J Radiol 2013; 31:521-9. [PMID: 23793776 DOI: 10.1007/s11604-013-0217-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/10/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess the value of hepatic arterial-phase (HAP) imaging with a low tube voltage (80 kVp), using non-helical, volumetric acquisition with a 320-detector-rows area-detector CT (ADCT) scanner for evaluating hypervascular hepatocellular carcinoma (HCC) compared with routine 120-kVp HAP imaging. METHODS This study enrolled 128 patients with 148 HCCs. Seventy-six patients with 79 HCCs underwent HAP imaging with 80 kVp obtained using a 320-detector-rows ADCT scanner. The remaining 52 patients with 69 HCCs underwent routine HAP imaging with 120 kVp obtained by 64-slice helical acquisition. Image noise and tumor to liver contrast-to-noise ratio (CNR) of the two sets of images were compared. Three radiologists evaluated both sets of images using receiver operating characteristic analyses. RESULTS Although there was a two-fold increase in the mean image noise with 80 kVp over that with 120 kVp (p < 0.001), no significant differences were observed in CNR among the two sets. The mean area under the curve (Az value) and the sensitivity for detecting HCC with 80 kVp (0.980, 78/79, respectively) were higher than that of 120 kVp (0.892, 55/69, respectively). CONCLUSIONS HAP imaging with 80 kVp obtained by an ADCT scanner significantly improves the diagnostic performance for evaluating hypervascular HCC.
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Affiliation(s)
- Tomoaki Ichikawa
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, Japan.
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Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy, and usually develops in the setting of liver cirrhosis. The early diagnosis of HCC is essential as curative treatment (including surgical resection and liver transplantation) improves survival. While screening and surveillance are traditionally performed with ultrasound, reported accuracies of ultrasound vary greatly, and poor sensitivity for small nodules is a uniformly recognized concern. Advances in computed tomography (CT) and magnetic resonance imaging (MRI), including multidetector technology and fast breath hold sequences now allow dynamic multiphasic enhanced imaging of the liver with excellent spatial and temporal resolution, holding much promise for improved HCC detection.
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Schmid-Tannwald C, Herrmann K, Oto A, Panteleon A, Reiser M, Zech C. Optimization of the dynamic, Gd-EOB-DTPA-enhanced MRI of the liver: the effect of the injection rate. Acta Radiol 2012; 53:961-5. [PMID: 23024179 DOI: 10.1258/ar.2012.120186] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Tissue-specific gadolinium-based contrast agents such as Gd-BOPTA, Gd-EOB-DTPA are increasingly used for liver imaging. Despite the added value of the hepatobiliary phase a proper arterial phase is still critical, especially in patients with chronic liver diseases. So far, there are limited data in the literature about the effect of the injection speed of Gd-EOB-DTPA in liver and vessel enhancement. PURPOSE To evaluate the effect of injection rate on the enhancement of liver parenchyma and vasculature in Gd-EOB-DTPA-enhanced liver MRI. MATERIAL AND METHODS Eighty patients who underwent Gd-EOB-DTPA-enhanced liver MRI (1.5T multi-channel MR-system) were retrospectively evaluated. We used a Care Bolus technique with an injection rate of 2 mL/s in group 1 (n = 40) and a Care Bolus technique with an injection rate of 1 mL/s in group 2 (n = 40) to determine the start of the arterial-dominant phase. Signal intensities were measured in vascular structures and liver parenchyma. Signal-to-noise-ratio (SNR), SNR increase (SNRi), and percentage enhancement (PE) were calculated and compared by a students t-test. RESULTS The SNR, SNRi, and PE of the aorta in the arterial phase were significantly higher in group 2 in comparison to group 1 (P = 0.007, P = 0.0043, and P < 0.001, respectively). There were no significant differences concerning the SNR, SNRi, or PE of the portal vein and the normal liver parenchyma between both groups at all time points. CONCLUSION The study shows that a lower injection rate of 1 mL/s enables a higher enhancement in the aorta in the arterial phase compared with Gd-EOB-DTPA-enhanced MRI with the more commonly used injection rate of 2 mL/s.
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Affiliation(s)
| | - Karin Herrmann
- Ludwig-Maximilian-University, Institute for Clinical Radiology, Munich, Germany
| | - Aytekin Oto
- University of Chicago, Department of Radiology, Chicago, USA
| | - Alexandra Panteleon
- Ludwig-Maximilian-University, Institute for Clinical Radiology, Munich, Germany
| | - Maximilian Reiser
- Ludwig-Maximilian-University, Institute for Clinical Radiology, Munich, Germany
| | - Christoph Zech
- Ludwig-Maximilian-University, Institute for Clinical Radiology, Munich, Germany
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Nakaura T, Nakamura S, Maruyama N, Funama Y, Awai K, Harada K, Uemura S, Yamashita Y. Low contrast agent and radiation dose protocol for hepatic dynamic CT of thin adults at 256-detector row CT: effect of low tube voltage and hybrid iterative reconstruction algorithm on image quality. Radiology 2012; 264:445-54. [PMID: 22627597 DOI: 10.1148/radiol.12111082] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the effect on image quality of a low contrast agent dose and radiation dose protocol at abdominal dynamic computed tomography (CT) with a low tube voltage, hybrid iterative reconstruction algorithm, and a 256- detector row scanner. MATERIALS AND METHODS This prospective study received institutional review board approval, and prior informed written consent was obtained from all patients. Seventy-four patients undergoing hepatic dynamic CT were randomly assigned to one of two protocols: Thirty-nine patients underwent scanning with the conventional 120-kVp protocol and the other 35 patients underwent scanning with an 80-kVp tube voltage and a 40% reduction in contrast agent dose. The 80-kVp images were also postprocessed with a hybrid iterative reconstruction algorithm. The estimated effective radiation dose of each protocol was compared and the image noise and contrast-to-noise-ratio (CNR) of the 120-kVp, 80-kVp, and hybrid iterative reconstructed 80-kVp images were evaluated by using the Student t test. RESULTS The effective radiation dose was 51% lower during the hepatic arterial phase (HAP) and 48% lower during the portal venous phase (PVP) with the 80-kVp protocol than with the 120-kVp protocol (HAP: 5.6 mSv ± 1.0 [standard deviation] vs 11.6 mSv ± 3.3; PVP: 5.8 mSv ± 0.7 vs 11.2 mSv ± 3.2, respectively). The hybrid iterative reconstruction decreased image noise by 23% during the HAP (9.2 ± 1.9 vs 12.0 ± 2.6) and by 24% during the PVP (9.4 ± 1.8 vs 12.3 ± 2.6). There were no significant differences in the CNR of any of the regions of interest between 80-kVp with iterative reconstruction and 120-kVp protocols (P = .46-.85). CONCLUSION A low tube voltage and the hybrid iterative reconstruction algorithm can dramatically decrease radiation and contrast agent doses with adequate image quality at hepatic dynamic CT of thin adults with use of a 256-detector row scanner.
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Affiliation(s)
- Takeshi Nakaura
- Department of Diagnostic Radiology, Amakusa Medical Center, Amakusa, Kumamoto, Japan.
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Spectral CT in patients with small HCC: investigation of image quality and diagnostic accuracy. Eur Radiol 2012; 22:2117-24. [PMID: 22618521 DOI: 10.1007/s00330-012-2485-3] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/20/2012] [Accepted: 03/27/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess image quality and diagnostic accuracy of monochromatic imaging from spectral CT in patients with small HCC (≤3 cm). METHODS Twenty-seven patients with 31 HCC underwent spectral CT to generate conventional 140-kVp polychromatic images (group A) and monochromatic images with energy levels from 40 to 140 keV (group B) during the late arterial phase (LAP) and the portal venous phase (PVP). Two-sample t tests compared the tumour-to-liver contrast-to-noise ratio (CNR) and mean image noise. Lesion detection for LAP, reader confidence and readers' subjective evaluations of image quality were recorded. RESULTS Highest CNRs in group B were distributed at 40, 50 and 70 keV. Higher CNR values and lesion conspicuity scores (LCS) were obtained in group B than in group A (CNR 3.36 ± 2.07 vs. 1.47 ± 0.89 in LAP; 2.29 ± 2.26 vs. 1.58 ± 1.75 in PVP; LCS 2.82, 2.84, 2.63 and 2.53 at 40-70 keV, respectively, vs. 1.95) (P < 0.001). Lowest image noise for group B was at 70 keV, resulting in higher image quality than that in group A (4.70 vs. 4.07; P < 0.001). CONCLUSION Monochromatic energy levels of 40-70 keV can increase detectability in small HCC and this increase might not result in image quality degradation. KEY POINTS • Spectral computed tomography may help the detection of small hepatocellular carcinoma. • Monochromatic energy levels of 40-70 keV increase the sensitivity for detection. • Prospective study showed that monochromatic imaging provides greater diagnostic confidence. • Monochromatic energy level of 70 keV improves the overall image quality.
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Hwang J, Kim SH, Lee MW, Lee JY. Small (≤ 2 cm) hepatocellular carcinoma in patients with chronic liver disease: comparison of gadoxetic acid-enhanced 3.0 T MRI and multiphasic 64-multirow detector CT. Br J Radiol 2011; 85:e314-22. [PMID: 22167508 DOI: 10.1259/bjr/27727228] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To compare the diagnostic performance of gadoxetic acid-enhanced MRI using 3.0 T with that of multiphasic 64-multirow detector CT (MDCT) for the detection of small (≤2 cm) hepatocellular carcinoma (HCC) in patients with chronic liver disease. METHODS A total of 54 patients (44 men, 10 women; age range, 33-81 years) with 59 HCCs (≤2 cm in diameter) who underwent both multiphasic (arterial, portal venous, equilibrium) 64-MDCT and gadoxetic acid-enhanced 3.0 T MRI were enrolled in this study. Two observers independently and randomly reviewed the MR and CT images on a lesion-by-lesion basis. The diagnostic performance of these techniques for the detection of HCC was assessed by alternative free-response receiver operating characteristic (ROC) analysis, in addition to evaluating the sensitivity and positive predictive value. RESULTS For each observer, the areas under the ROC curve were 0.874 and 0.863 for MRI, respectively, as opposed to 0.660 and 0.687 for CT, respectively. The differences between the two techniques were statistically significant for each observer (p<0.001). The sensitivities (89.8% and 86.4%) of MRI for both observers were significantly higher than those (57.6% and 61.0% for each observer, respectively) of MDCT. No significant difference was seen between the positive predictive values for the two techniques (p>0.05). CONCLUSION Gadoxetic acid-enhanced 3.0 T MRI shows a better diagnostic performance than that of 64-MDCT for the detection of small (≤2 cm) HCCs in patients with chronic liver disease.
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Affiliation(s)
- J Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Baek CK, Choi JY, Kim KA, Park MS, Lim JS, Chung YE, Kim MJ, Kim KW. Hepatocellular carcinoma in patients with chronic liver disease: a comparison of gadoxetic acid-enhanced MRI and multiphasic MDCT. Clin Radiol 2011; 67:148-56. [PMID: 21920517 DOI: 10.1016/j.crad.2011.08.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/25/2011] [Accepted: 08/01/2011] [Indexed: 12/14/2022]
Abstract
AIM To compare the diagnostic performances of gadoxetic acid-enhanced magnetic resonance imaging (MRI) and multiphasic multidetector computed tomography (MDCT) in the detection of hepatocellular carcinoma (HCC) in patients with chronic liver disease. MATERIALS AND METHODS Institutional review board approval was obtained for this study and informed consent was obtained from all patients. Fifty-one patients (43 men, eight women; age range 32-80 years) with 73 HCCs underwent gadoxetic acid-enhanced MRI and multiphasic MDCT. Two readers independently analysed each image in three separate reading sessions. The alternative free-response receiver operating characteristic (AFROC) method was used to analyse the diagnostic accuracy. Positive and negative predictive values and sensitivity were evaluated. RESULTS A total of 73 HCCs were detected in 51 patients. Although not significant (p>0.05), the areas under the receiver operating characteristic curves were 0.877 and 0.850 for MDCT, 0.918 and 0.911 for dynamic MRI, and 0.905 and 0.918 for combined interpretation of dynamic and hepatobiliary phase MR images. Differences in sensitivity, specificity, and positive and negative predictive values between the readers were not statistically significant (p>0.05). Combined interpretation of dynamic and hepatobiliary phase MRI images was more useful than MDCT in the detection of HCC lesions ≤1cm in diameter for one reader (p=0.043). CONCLUSION Gadoxetic acid-enhanced MRI and MDCT show similar diagnostic performances for the detection of HCC in patients with chronic liver disease. However, the combined interpretation of dynamic and hepatobiliary phase MRI images may improve diagnostic accuracy in the detection of HCC lesions ≤1cm in diameter.
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Affiliation(s)
- C-K Baek
- Department of Radiology, Research Institute of Radiological Science, Yonsei University Health System, Seodaemungu, Seoul, Republic of Korea
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Nakaura T, Awai K, Maruyama N, Takata N, Yoshinaka I, Harada K, Uemura S, Yamashita Y. Abdominal dynamic CT in patients with renal dysfunction: contrast agent dose reduction with low tube voltage and high tube current-time product settings at 256-detector row CT. Radiology 2011; 261:467-76. [PMID: 21852567 DOI: 10.1148/radiol.11110021] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility of a low-contrast agent dose protocol at abdominal dynamic computed tomography (CT) with a low tube voltage high tube current-time product technique and a 256-detector row CT unit. MATERIALS AND METHODS This prospective study received institutional review board approval; written informed consent to participate was obtained from all patients. The study included 151 patients; 117 had an estimated glomerular filtration rate (eGFR) greater than or equal to 60 mL/min/1.73 m(2). These patients were examined with the conventional 120-kVp protocol. The other 34 patients underwent scanning with an 80-kVp tube voltage, a high tube current-time product, and a 40% reduction in contrast agent dose. Effective dose (ED), image noise, attenuation, contrast-to-noise ratio (CNR), and figure of merit of the aorta in the arterial phase and of the portal vein and hepatic parenchyma in the portal venous phase in the two groups were compared with the Student t test. RESULTS Estimated ED was about 20% lower with the 80-kVp protocol than with the 120-kVp protocol. There were no significant differences in CNR in any region of interest between the 80-kVp protocol and the 120-kVp protocol (abdominal aorta: 36.9 ± 9.7 [standard deviation] vs 36.1 ± 8.1, P = .63; portal vein: 13.4 ± 3.2 vs 13.1 ± 3.2, P = .65; hepatic parenchyma: 6.4 ± 2.6 vs 6.7 ± 2.3, P = .51). CONCLUSION Contrast dose at hepatic dynamic 256-detector row CT in patients with renal dysfunction can be decreased by 40% with this protocol by using the 80-kVp setting and a high tube current-time product.
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Affiliation(s)
- Takeshi Nakaura
- Department of Diagnostic Radiology, Amakusa Medical Center, Kameba 854-1, Amakusa, Kumamoto 863-0046, Japan.
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39
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Anis M, Irshad A. Imaging of hepatocellular carcinoma: practical guide to differential diagnosis. Clin Liver Dis 2011; 15:335-52, vii-x. [PMID: 21689617 DOI: 10.1016/j.cld.2011.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatocellular carcinoma (HCC) is most commonly seen in patients with cirrhosis. Criteria for diagnosis include arterial-phase enhancement, venous-phase washout, and a capsule on delayed sequences. Tiny HCC are best detected with magnetic resonance imaging using the new hepatocyte-specific gadolinium agents; otherwise, short-term follow up versus biopsy is considered. Diffuse HCC can be difficult to diagnose because of the inherent heterogeneous hepatic parenchyma in cirrhosis, however, portal vein expansion due to thrombosis is a helpful sign.
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Affiliation(s)
- Munazza Anis
- Department of Radiologic Sciences, Medical University of South Carolina, 96 Jonathan Lucas Street, MSC 323, Charleston, SC 29425, USA.
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40
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Addley HC, Griffin N, Shaw AS, Mannelli L, Parker RA, Aitken S, Wood H, Davies S, Alexander GJ, Lomas DJ. Accuracy of hepatocellular carcinoma detection on multidetector CT in a transplant liver population with explant liver correlation. Clin Radiol 2011; 66:349-56. [PMID: 21295772 DOI: 10.1016/j.crad.2010.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/18/2010] [Accepted: 11/21/2010] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the diagnostic accuracy of multidetector computed tomography (MDCT) for hepatocellular carcinoma (HCC) in cirrhotic patients undergoing liver transplantation. Secondary aims were to examine the effect of radiologist experience and lesion size on diagnostic accuracy. MATERIALS AND METHODS Thirty-nine patients (72% male with a mean age of 56.5 years) underwent liver transplantation following preoperative triple-phase MDCT examination of the liver. MDCT examinations were retrospectively independently reviewed by three radiologists for the presence and location of suspected HCCs, with the diagnostic confidence recorded using a five-point confidence scale. MDCT examinations were compared with explant specimens for histopathological correlation. RESULTS Histopathological results demonstrated 46 HCCs in 29 of the 39 patients. Analysis demonstrated a sensitivity of 65-75% and specificity of 47-88% for detection of HCC lesions. The sensitivity dropped to 48-57% for lesions of size ≤20mm. As the diagnostic confidence increased, there was a further decrease in the sensitivity (4-26%). The radiologist with the greatest number of years experience was found to have a significantly higher accuracy of detection of HCC lesions compared with the least experienced radiologist. CONCLUSION Larger lesion size of HCC and greater number of years experience of the radiologist resulted in significantly higher accuracy of HCC lesion detection. The overall sensitivity and specificity results for MDCT detection of HCC are comparable to previous helical CT imaging.
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Affiliation(s)
- H C Addley
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
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41
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Furlan A, Marin D, Vanzulli A, Patera GP, Ronzoni A, Midiri M, Bazzocchi M, Lagalla R, Brancatelli G. Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout. Br J Radiol 2010; 84:403-12. [PMID: 21081569 DOI: 10.1259/bjr/18329080] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Our aim was to compare retrospectively hepatic venous and delayed phase images for the detection of tumour washout during multiphasic multidetector row CT (MDCT) of the liver in patients with hepatocellular carcinoma (HCC). METHODS 30 cirrhotic patients underwent multiphasic MDCT in the 90 days before liver transplantation. MDCT was performed before contrast medium administration and during hepatic arterial hepatic venous and delayed phases, images were obtained at 12, 55 and 120 s after trigger threshold. Two radiologists qualitatively evaluated images for lesion attenuation. Tumour washout was evaluated subjectively and objectively. Tumour-to-liver contrast (TLC) was measured for all pathologically proven HCCs. RESULTS 48 HCCs were detected at MDCT. 46 of the 48 tumours (96%) appeared as either hyper- or isoattenuating during the hepatic arterial phase subjective washout was present in 15 HCCs (33%) during the hepatic venous phase and in 35 (76%) during the delayed phase (p<0.001, McNemar's test). Objective washout was present in 30 of the 46 HCCs (65%) during the hepatic venous phase and in 42 of the HCCs (91%) during the delayed phase (p=0.001). The delayed phase yielded significantly higher mean TLC absolute values compared with the hepatic venous phase (-16.1±10.8 HU vs -10.5±10.2 HU; p<0.001). CONCLUSIONS The delayed phase is superior to the hepatic venous phase for detection of tumour washout of pathologically proven HCC in cirrhotic patients.
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Affiliation(s)
- A Furlan
- Institute of Diagnostic Radiology, University of Udine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia Udine, Italy.
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42
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Sixty-Four-Multidetector-Row Computed Tomography Angiography With Bolus Tracking to Time Arterial-Phase Imaging in Healthy Liver. J Comput Assist Tomogr 2010; 34:883-91. [DOI: 10.1097/rct.0b013e3181dd80c8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Shin DH, Lee MH, Kim DY, Lee KJ, Park JY, Ahn SH, Han KH, Chon CY. [A case of hepatic congestion due to right heart failure mimicking liver tumor]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 56:264-7. [PMID: 20962564 DOI: 10.4166/kjg.2010.56.4.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This report describes a patient with hepatic congestion due to right heart failure mimicking liver tumor. The patient had a history of breast cancer and left total mastectomy 30 years ago, tricuspid valve regurgitation and tricuspid valve replacement 4 years ago. Three years ago, abdominal contrast-enhanced computed tomography (CT) was performed to evaluate inguinal hernia, which revealed multiple small hepatic nodules. After 1 year, the number and size of liver nodules were increased in CT scan. The patient underwent gun biopsy and histopathology revealed sinusoid enlargement. The patient recently had jaundice, abdominal distension, and peripheral edema. Liver dynamic CT scan was done to evaluate the palpable liver. The number and size of liver nodules were more increased in CT than 2 years ago. In magnetic resonance imaging (MRI), numerous variable sized ill-defined nodules replacing entire liver with progressing centripetal enhancement, which were suggestive of malignancy such as angiosarcoma, were noted. MRI finding suspects malignancy or hemangiosarcoma. Finally, the patient received repeated gun biopsy, and histopathology revealed findings compatible with hepatic congestion.
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Affiliation(s)
- Dong Ho Shin
- Department of Internal Medicine, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea
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Altenbernd J, Heusner TA, Ringelstein A, Ladd SC, Forsting M, Antoch G. Dual-energy-CT of hypervascular liver lesions in patients with HCC: investigation of image quality and sensitivity. Eur Radiol 2010; 21:738-43. [PMID: 20936520 DOI: 10.1007/s00330-010-1964-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 08/19/2010] [Accepted: 08/20/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate dual-energy CT of hypervascular liver lesions in patients with HCC. METHODS Forty patients with hepatocellular carcinomas were investigated with abdominal dual-energy CT. In each patient unenhanced and contrast-enhanced imaging with arterial und portovenous delay were performed. Hypervascular lesions were documented on arterial phase 80-kVp images, 140-kVp images, and the averaged arterial images by two radiologists. Subjective image quality (5-point scale, from 5 [excellent] to 1 [not interpretable]) was rated on all images. RESULTS The mean number of hypervascular HCC lesions detected was 3.37 ± 1.28 on 80-kVp images (p < 0.05), 1.43 ± 1.13 on 140-kVp images (p < 0.05), and 2.57 ± 1.2 on averaged images. The image quality was 0.3 ± 0.5 for 80-kVp (p < 0.05), 1.6 ± 0.5 for 140-kVp (p < 0.05) and 3.2 ± 0.4 for the averaged images. CONCLUSION Low-kVp images of dual-energy datasets are more sensitive in detecting hypervascular liver lesions. However, this increase in sensitivity goes along with a decrease in the subjective image quality of low-kVp images.
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Affiliation(s)
- Jens Altenbernd
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Yamaguchi I, Kidoya E, Suzuki M, Kimura H. Optimizing scan timing of hepatic arterial phase by physiologic pharmacokinetic analysis in bolus-tracking technique by multi-detector row computed tomography. Radiol Phys Technol 2010; 4:43-52. [DOI: 10.1007/s12194-010-0105-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Revised: 08/30/2010] [Accepted: 08/31/2010] [Indexed: 11/29/2022]
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Massironi S, Conte D, Sciola V, Pirola L, Paggi S, Fraquelli M, Ciafardini C, Spampatti MP, Peracchi M. Contrast-enhanced ultrasonography in evaluating hepatic metastases from neuroendocrine tumours. Dig Liver Dis 2010; 42:635-41. [PMID: 20172770 DOI: 10.1016/j.dld.2010.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 02/06/2023]
Abstract
OBJECTIVES At presentation, gastroenteropancreatic neuroendocrine tumours (GEP NETs) frequently show prognostically negative hepatic involvement. The aim of this study was to characterise hepatic metastases of GEP NETs as revealed by contrast-enhanced ultrasonography (CEUS), which allows the fine definition of the microvascular system, and to correlate these findings to the biological behaviour of the tumour. METHODS Eighteen out of 62 GEP NET patients examined between January 2007 and September 2008 had histologically proven hepatic metastases from primary ileal (#6), gastric (#1) or rectal (#1) carcinoids, pancreatic tumours (#7), or primary duodenal (#2) or occult gastrinomas (#1), and all underwent low mechanical index real-time CEUS with SonoVue injection. RESULTS Strong early enhancement in the arterial phase was observed in 15 cases (83%), and a rapid wash-out in the portal venous phase in 14 (78%). In the late venous phase, the lesions were hypoechoic in 12 cases (67%), isoechoic in five (28%), and hyperechoic in one (0.05%). The time of arterial enhancement correlated with the Ki-67 proliferative index (r(s)=0.516; p=0.028). CONCLUSIONS Most of the neuroendocrine liver metastases showed increased arterial enhancement at CEUS, a behaviour that is similar to that of hepatocellular carcinomas and the opposite of that of other metastases. CEUS can be a useful diagnostic means of characterising such metastases.
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Affiliation(s)
- Sara Massironi
- Gastroenterology Unit II, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via F Sforza 35, 20122 Milano, Italy.
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Ohnishi H, Sakaguchi K, Nouso K, Kobayashi Y, Nakamura S, Tanaka H, Miyake Y, Shoji B, Iwadou S, Shiratori Y. Outcome of small liver nodules detected by computed tomographic angiography in patients with hepatocellular carcinoma. Hepatol Int 2010; 4:562-8. [PMID: 21063478 DOI: 10.1007/s12072-010-9190-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2009] [Accepted: 07/09/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE Hepatic lesions identified by computed tomography (CT) during arterial portography (CTAP) or CT hepatic arteriography (CTHA) in hepatocellular carcinoma (HCC) patients are sometimes too small to be diagnosed as HCC. We undertook this cohort study to assess whether these small lesions are actually HCC, and to clarify the effectiveness of these imaging examinations in a clinical setting. METHODS We assessed the characteristics of 74 tiny lesions detected by CTAP and/or CTHA, but not by CT in 67 patients. RESULTS Seven out of 10 nodules were histologically confirmed as HCC and 18 out of 64 lesions increased in size and showed typical findings of HCC during the follow-up period. Multivariate analysis revealed that the size of the main tumor (>30 mm in diameter) was associated with the presence of tiny additional HCC lesions (P = 0.002). CONCLUSIONS These findings indicate that CTAP and CTHA are recommended for determining the stage of HCC, especially when the HCC nodule is larger than 30 mm in diameter.
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Affiliation(s)
- Hideki Ohnishi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, Okayama 700-8558 Japan
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Abstract
BACKGROUND Imaging of the liver is a key component in the detection, diagnosis, management, and follow-up of patients with hepatocellular carcinoma. METHODS The author uses his own experience as well as a review of pertinent literature to describe the capabilities and the limitations of the principal currently available imaging techniques for the liver. RESULTS Ultrasound is widely available, but sensitivity and specificity for small nodules are limited. Computed tomography effectively demonstrates extrahepatic lesions and can differentiate between cysts or hemangiomas and hepatocellular carcinomas. Magnetic resonance imaging better characterizes hepatic lesions, but positron emission tomography is of limited value. CONCLUSIONS Cross-sectional imaging with ultrasound, CT, or MRI is critical for nodule characterization in the cirrhotic liver, surgical planning of HCC, and treatment response evaluation.
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Affiliation(s)
- Eric K Outwater
- Department of Radiology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Ayyappan AP, Jhaveri KS. CT and MRI of hepatocellular carcinoma: an update. Expert Rev Anticancer Ther 2010; 10:507-19. [PMID: 20397916 DOI: 10.1586/era.10.24] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and one of the few malignancies with an increasing incidence in the USA. Imaging plays a crucial role in early detection, accurate staging and planning management strategies. Contrast material-enhanced MRI or computed tomography (CT) are the best imaging techniques currently available for the noninvasive diagnosis of HCC. The diagnosis of HCC is strongly dependent on hemodynamic features (arterial hypervascularity and washout in the venous phase) on dynamic imaging, and biopsy is no longer recommended for tumors with classical imaging features prior to treatment. The major challenge for radiologists in imaging cirrhosis is the characterization of hypervascular nodules smaller than 2 cm, which often have nonspecific imaging characteristics. In this review, we discuss the role of CT and MRI in the diagnosis and staging of HCC. The strengths and current limitations of these imaging modalities are highlighted.
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Affiliation(s)
- Anoop P Ayyappan
- Texas Tech University Health Sciences Center, Paul L Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, USA.
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Park Y, Kim SH, Kim SH, Jeon YH, Lee J, Kim MJ, Choi D, Lee WJ, Kim H, Koo JH, Lim HK. Gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI versus gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for preoperatively detecting hepatocellular carcinoma: an initial experience. Korean J Radiol 2010; 11:433-40. [PMID: 20592927 PMCID: PMC2893314 DOI: 10.3348/kjr.2010.11.4.433] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 04/09/2010] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE This study was designed to compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging (MRI) with gadobenate dimeglumine-enhanced MRI for preoperatively detecting hepatocellular carcinoma (HCC). MATERIALS AND METHODS Eighteen consecutive patients (17 men and one woman, age range: 31-73 years) with 22 HCCs underwent examinations with gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI on a 3.0-Tesla unit. The diagnosis of HCC was established after surgical resection and pathological conformation. Three observers independently reviewed each MR image in a random order on a tumor-by-tumor basis. The diagnostic accuracy of these techniques for the detection of HCC was assessed by performing an alternative free-response receiver operating characteristic (ROC) analysis. The sensitivity and positive predictive values were evaluated. RESULTS The average value of the area under the ROC curve (Az) for gadoxetic acid enhanced MRI (0.887) was not significantly different from the Az (0.899) for gadobenate dimeglumine-enhanced MRI (p > 0.05). The overall sensitivities of gadoxetic acid enhanced MRI and gadobenate dimeglumine-enhanced MRI were 80% and 83%, respectively, with no significant difference (p > 0.05). The differences of the positive predictive values for the two contrast agents for each observer were not statistically significant (p > 0.05). CONCLUSION The diagnostic performance of gadoxetic acid-enhanced MRI and gadobenate dimeglumine-enhanced MRI for preoperatively detecting HCC is quite similar.
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Affiliation(s)
- Yulri Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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