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Harashima S, Fukui R, Samejima W, Hirose Y, Kariyasu T, Nishikawa M, Yamaguchi H, Machida H. Virtual Monochromatic Imaging of Half-Iodine-Load, Contrast-Enhanced Computed Tomography with Deep Learning Image Reconstruction in Patients with Renal Insufficiency: A Clinical Pilot Study. J NIPPON MED SCH 2025; 92:69-79. [PMID: 40058838 DOI: 10.1272/jnms.jnms.2025_92-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2025]
Abstract
BACKGROUND We retrospectively examined image quality (IQ) of thin-slice virtual monochromatic imaging (VMI) of half-iodine-load, abdominopelvic, contrast-enhanced CT (CECT) by dual-energy CT (DECT) with deep learning image reconstruction (DLIR). METHODS In 28 oncology patients with moderate-to-severe renal impairment undergoing half-iodine-load (300 mgI/kg) CECT by DECT during the nephrographic phase, we reconstructed VMI at 40-70 keV with a slice thickness of 0.625 mm using filtered back-projection (FBP), hybrid iterative reconstruction (HIR), and DLIR; measured contrast-noise ratio (CNR) of the liver, spleen, aorta, portal vein, and prostate/uterus; and determined the optimal keV to achieve the maximal CNR. At the optimal keV, two independent radiologists compared each organ's CNR and subjective IQ scores among FBP, HIR, and DLIR to subjectively grade image noise, contrast, sharpness, delineation of small structures, and overall IQ. RESULTS CNR of each organ increased continuously from 70 to 40 keV using FBP, HIR, and DLIR. At 40 keV, CNR of the prostate/uterus was significantly higher with DLIR than with FBP; however, CNR was similar between FBP and HIR and between HIR and DLIR. The CNR of all other organs increased significantly from FBP to HIR to DLIR (P < 0.05). All IQ scores significantly improved from FBP to HIR to DLIR (P < 0.05) and were acceptable in all patients with DLIR only. CONCLUSIONS The combination of 40 keV and DLIR offers the maximal CNR and a subjectively acceptable IQ for thin-slice VMI of half-iodine-load CECT.
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Affiliation(s)
- Shingo Harashima
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
| | - Rika Fukui
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
| | - Wakana Samejima
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
| | - Yuta Hirose
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
| | - Toshiya Kariyasu
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
| | - Makiko Nishikawa
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
| | - Hidenori Yamaguchi
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
- Department of Radiology, Nippon Medical School Tama Nagayama Hospital
| | - Haruhiko Machida
- Department of Radiology, Tokyo Women's Medical University Adachi Medical Center
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Kan NN, Yu CY, Cheng YF, Hsu CC, Chen CL, Hsu HW, Weng CC, Tsang LLC, Chuang YH, Huang PH, Lim WX, Chen CP, Liao CC, Ou HY. Combined Hounsfield units of hepatocellular carcinoma on computed tomography and PET as a noninvasive predictor of early recurrence after living donor liver transplantation: Time-to-recurrence survival analysis. Eur J Radiol 2024; 177:111551. [PMID: 38875747 DOI: 10.1016/j.ejrad.2024.111551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/26/2024] [Accepted: 06/02/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Liver transplantation is an effective treatment for preventing hepatocellular carcinoma (HCC) recurrence. This retrospective study aimed to quantitatively evaluate the attenuation in Hounsfield units (HU) on contrast-enhanced computed tomography (CECT) as a prognostic factor for hepatocellular carcinoma (HCC) following liver transplantation as a treatment. Our goal is to optimize its predictive ability for early tumor recurrence and compare it with the other imaging modality-positron emission tomography (PET). METHODS In 618 cases of LDLT for HCC, only 131 patients with measurable viable HCC on preoperative CECT and preoperative positron emission tomography (PET) evaluations were included, with a minimum follow-up period of 6 years. Cox regression models were developed to identify predictors of postoperative recurrence. Performance metrics for both CT and PET were assessed. The correlation between these two imaging modalities was also evaluated. Survival analyses were conducted using time-dependent receiver operating characteristic (ROC) curve analysis and area under the curve (AUC) to assess accuracy and determine optimized cut-off points. RESULTS Univariate and multivariate analyses revealed that both arterial-phase preoperative tumor attenuation (HU) and PET were independent prognostic factors for recurrence-free survival. Both lower arterial tumor enhancement (Cut-off value = 59.2, AUC 0.88) on CT and PET positive (AUC 0.89) increased risk of early tumor recurrence 0.5-year time-dependent ROC. Composites with HU < 59.2 and a positive PET result exhibited significantly higher diagnostic accuracy in detecting early tumor recurrence (AUC = 0.96). CONCLUSION Relatively low arterial tumor enhancement values on CECT effectively predict early HCC recurrence after LDLT. The integration of CT and PET imaging may serve as imaging markers of early tumor recurrence in HCC patients after LDLT.
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Affiliation(s)
- Na-Ning Kan
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chun-Yen Yu
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Fan Cheng
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Chin Hsu
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsien-Wen Hsu
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ching-Chun Weng
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Leo Leung-Chit Tsang
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yi-Hsuan Chuang
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Po-Hsun Huang
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Xiong Lim
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Pei Chen
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chien-Chang Liao
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsin-You Ou
- Liver Transplantation Program and Departments of Diagnostic Radiology and Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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Ryu HS, Kim HJ, Ji WB, Kim BC, Kim JH, Moon SK, Kang SI, Kwak HD, Kim ES, Kim CH, Kim TH, Noh GT, Park BS, Park HM, Bae JM, Bae JH, Seo NE, Song CH, Ahn MS, Eo JS, Yoon YC, Yoon JK, Lee KH, Lee KH, Lee KY, Lee MS, Lee SH, Lee JM, Lee JE, Lee HH, Ihn MH, Jang JH, Jeon SK, Chae KJ, Choi JH, Pyo DH, Ha GW, Han KS, Hong YK, Hong CW, Kwak JM, Korean Colon Cancer Multidisciplinary Committee. Colon cancer: the 2023 Korean clinical practice guidelines for diagnosis and treatment. Ann Coloproctol 2024; 40:89-113. [PMID: 38712437 PMCID: PMC11082542 DOI: 10.3393/ac.2024.00059.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 05/08/2024] Open
Abstract
Colorectal cancer is the third most common cancer in Korea and the third leading cause of death from cancer. Treatment outcomes for colon cancer are steadily improving due to national health screening programs with advances in diagnostic methods, surgical techniques, and therapeutic agents.. The Korea Colon Cancer Multidisciplinary (KCCM) Committee intends to provide professionals who treat colon cancer with the most up-to-date, evidence-based practice guidelines to improve outcomes and help them make decisions that reflect their patients' values and preferences. These guidelines have been established by consensus reached by the KCCM Guideline Committee based on a systematic literature review and evidence synthesis and by considering the national health insurance system in real clinical practice settings. Each recommendation is presented with a recommendation strength and level of evidence based on the consensus of the committee.
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Affiliation(s)
- Hyo Seon Ryu
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Collaboration, Seoul, Korea
| | - Woong Bae Ji
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Byung Chang Kim
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Ji Hun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Kyung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
| | - Han Deok Kwak
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Sun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Gyoung Tae Noh
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Byung-Soo Park
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyeung-Min Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Jeong Mo Bae
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ni Eun Seo
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Hoon Song
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Sun Ahn
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine and Molecular Imaging, Korea University College of Medicine, Seoul, Korea
| | - Young Chul Yoon
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joon-Kee Yoon
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Ha Lee
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyung Hee Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kil-Yong Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Myung Su Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Lee
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Han Hee Lee
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myong Hoon Ihn
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Je-Ho Jang
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Kum Ju Chae
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jin-Ho Choi
- Center for Lung Cancer, Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Hee Pyo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gi Won Ha
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Young Ki Hong
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
| | - Jung-Myun Kwak
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Korean Colon Cancer Multidisciplinary Committee
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
- Institute for Evidence-based Medicine, Cochrane Collaboration, Seoul, Korea
- Division of Colon and Rectal Surgery, Department of Surgery, Korea University Ansan Hospital, Ansan, Korea
- Center for Colorectal Cancer, National Cancer Center, Goyang, Korea
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Korea
- Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Hematology-Oncology, Ajou University School of Medicine, Suwon, Korea
- Department of Nuclear Medicine and Molecular Imaging, Korea University College of Medicine, Seoul, Korea
- Department of General Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Korea
- Department of Surgery, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- Division of Gastroenterology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
- Department of Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
- Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea
- Center for Lung Cancer, Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Masuda T, Nakaura T, Funama Y, Sato T, Nagayama Y, Kidoh M, Yoshida M, Arao S, Ono A, Hiratsuka J, Hirai T, Awai K. Can Machine Learning Identify the Intravenous Contrast Dose and Injection Rate Needed for Optimal Enhancement on Dynamic Liver Computed Tomography? J Comput Assist Tomogr 2023; Publish Ahead of Print:00004728-990000000-00168. [PMID: 37380150 DOI: 10.1097/rct.0000000000001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVES This study aimed to investigate whether machine learning (ML) is useful for predicting the contrast material (CM) dose required to obtain a clinically optimal contrast enhancement in hepatic dynamic computed tomography (CT). METHODS We trained and evaluated ensemble ML regressors to predict the CM doses needed for optimal enhancement in hepatic dynamic CT using 236 patients for a training data set and 94 patients for a test data set. After the ML training, we randomly divided using the ML-based (n = 100) and the body weight (BW)-based protocols (n = 100) by the prospective trial. The BW protocol was performed using routine protocol (600 mg/kg of iodine) by the prospective trial. The CT numbers of the abdominal aorta and hepatic parenchyma, CM dose, and injection rate were compared between each protocol using the paired t test. Equivalence tests were performed with equivalent margins of 100 and 20 Hounsfield units for the aorta and liver, respectively. RESULTS The CM dose and injection rate for the ML and BW protocols were 112.3 mL and 3.7 mL/s, and 118.0 mL and 3.9 mL/s (P < 0.05). There were no significant differences in the CT numbers of the abdominal aorta and hepatic parenchyma between the 2 protocols (P = 0.20 and 0.45). The 95% confidence interval for the difference in the CT number of the abdominal aorta and hepatic parenchyma between 2 protocols was within the range of predetermined equivalence margins. CONCLUSIONS Machine learning is useful for predicting the CM dose and injection rate required to obtain the optimal clinical contrast enhancement for hepatic dynamic CT without reducing the CT number of the abdominal aorta and hepatic parenchyma.
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Affiliation(s)
- Takanori Masuda
- From the Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Kumamoto University, Kumamoto
| | - Tomoyasu Sato
- Department of Diagnostic Radiology, Tsuchiya General Hospital
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University
| | - Masato Yoshida
- Department of Diagnostic Radiology, Tsuchiya General Hospital
| | - Shinichi Arao
- From the Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama
| | - Atsushi Ono
- From the Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama
| | - Junichi Hiratsuka
- From the Department of Radiological Technology, Faculty of Health Science and Technology, Kawasaki University of Medical Welfare, Okayama
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
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Cao L, Liu X, Qu T, Cheng Y, Li J, Li Y, Chen L, Niu X, Tian Q, Guo J. Improving spatial resolution and diagnostic confidence with thinner slice and deep learning image reconstruction in contrast-enhanced abdominal CT. Eur Radiol 2023; 33:1603-1611. [PMID: 36190531 DOI: 10.1007/s00330-022-09146-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate image quality and diagnostic confidence improvement using a thin slice and a deep learning image reconstruction (DLIR) in contrast-enhanced abdominal CT. METHODS Forty patients with hepatic lesions in enhanced abdominal CT were retrospectively analyzed. Images in the portal phase were reconstructed at 5 mm and 1.25 mm slice thickness using the 50% adaptive statistical iterative reconstruction (ASIR-V) (ASIR-V50%) and at 1.25 mm using DLIR at medium (DLIR-M) and high (DLIR-H) settings. CT number and standard deviation of the hepatic parenchyma, spleen, portal vein, and subcutaneous fat were measured, and contrast-to-noise ratio (CNR) was calculated. Edge-rise-slope (ERS) was measured on the portal vein to reflect spatial resolution and the CT number skewness on liver parenchyma was calculated to reflect image texture. Two radiologists blindly assessed the overall image quality including subjective noise, image contrast, visibility of small structures using a 5-point scale, and object sharpness and lesion contour using a 4-point scale. RESULTS For the 1.25-mm images, DLIR significantly reduced image noise, improved CNR and overall subjective image quality compared to ASIR-V50%. Compared to the 5-mm ASIR-V50% images, DLIR images had significantly higher scores in the visibility and contour for small structures and lesions; as well as significantly higher ERS and lower CT number skewness. At a quarter of the signal strength, the 1.25-mm DLIR-H images had a similar subjective noise score as the 5-mm ASIR-V50% images. CONCLUSION DLIR significantly reduces image noise and maintains a more natural image texture; image spatial resolution and diagnostic confidence can be improved using thin slice images and DLIR in abdominal CT. KEY POINTS • DLIR further reduces image noise compared with ASIR-V while maintaining favorable image texture. • In abdominal CT, thinner slice images improve image spatial resolution and small object visualization but suffer from higher image noise. • Thinner slice images combined with DLIR in abdominal CT significantly suppress image noise for detecting low-density lesions while significantly improving image spatial resolution and overall image quality.
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Affiliation(s)
- Le Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Xiang Liu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Tingting Qu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Yannan Cheng
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Jianying Li
- CT Research Center, GE Healthcare China, Beijing, 100176, China
| | - Yanan Li
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Lihong Chen
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Xinyi Niu
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Qian Tian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China
| | - Jianxin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, People's Republic of China.
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Li Q, Wei Y, Che F, Zhang T, Yao S, Zhao J, Zhang Y, Tang H, Song B. Multiparametric Magnetic Resonance Imaging Improves the Prognostic Outcomes in Patients With Intrahepatic Cholangiocarcinoma After Curative-Intent Resection. Front Oncol 2022; 12:756726. [PMID: 35356226 PMCID: PMC8959855 DOI: 10.3389/fonc.2022.756726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/09/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The prognosis of patients with intrahepatic cholangiocarcinoma remains unclear. Thus, this study aimed at investigating whether additional multiparametric magnetic resonance imaging (mpMRI) would guide additional treatment and improve the prognostic outcomes of intrahepatic cholangiocarcinoma patients. METHODS AND MATERIALS This retrospective study included 256 patients undergoing dynamic enhanced computed tomography scan only (CT group) and 31 patients undergoing both mpMRI and computed tomography scans (CT+MR group). Propensity score matching (PSM) was used to minimize the potential selection bias and confounding effects. The overall survival (OS) and recurrence-free survival (RFS) rates were compared between the two groups. RESULTS More nodules (n = 6), additional biliary dilation (n = 4), and peritumoral parenchymal arterial phase hyperenhancement (n = 18) were found with the additional mpMRI scan, which led to treatment modification. Cox regression analysis revealed the survival advantage of additional mpMRI imaging based on the OS (HR 0.396, 95% CI 0.239-0.657, p < 0.001; PSM HR 0.400, 95% CI 0.218-0.736, p = 0.003) and RFS (HR 0.558, 95% CI 0.352-0.882, p = 0.013; PSM HR 0.508, 95% CI 0.288-0.897, p = 0.020). CONCLUSIONS Additional mpMRI helps clinicians to select better treatment options, lower the risk of tumor recurrence, and improve the overall survival.
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Affiliation(s)
- Qian Li
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Yi Wei
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Feng Che
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Tong Zhang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Shan Yao
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Jian Zhao
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - YuHui Zhang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Medical School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Hehan Tang
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
| | - Bin Song
- Department of Radiology, Sichuan University West China Hospital, Chengdu, China
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de Jong DJ, Veldhuis WB, Wessels FJ, de Vos B, Moeskops P, Kok M. Towards Personalised Contrast Injection: Artificial-Intelligence-Derived Body Composition and Liver Enhancement in Computed Tomography. J Pers Med 2021; 11:jpm11030159. [PMID: 33668286 PMCID: PMC7996171 DOI: 10.3390/jpm11030159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 12/11/2022] Open
Abstract
In contrast-enhanced computed tomography, total body weight adapted contrast injection protocols have proven successful in achieving a homogeneous enhancement of vascular structures and liver parenchyma. However, because solid organs have greater perfusion than adipose tissue, the lean body weight (fat-free mass) rather than the total body weight is theorised to cause even more homogeneous enhancement. We included 102 consecutive patients who underwent a multiphase abdominal computed tomography between March 2016 and October 2019. Patients received contrast media (300 mgI/mL) according to bodyweight categories. Using regions of interest, we measured the Hounsfield unit (HU) increase in liver attenuation from unenhanced to contrast-enhanced computed tomography. Furthermore, subjective image quality was graded using a four-point Likert scale. An artificial intelligence algorithm automatically segmented and determined the body compositions and calculated the percentages of lean body weight. The hepatic enhancements were adjusted for iodine dose and iodine dose per total body weight, as well as percentage lean body weight. The associations between enhancement and total body weight, body mass index, and lean body weight were analysed using linear regression. Patients had a median age of 68 years (IQR: 58–74), a total body weight of 81 kg (IQR: 73–90), a body mass index of 26 kg/m2 (SD: ±4.2), and a lean body weight percentage of 50% (IQR: 36–55). Mean liver enhancements in the portal venous phase were 61 ± 12 HU (≤70 kg), 53 ± 10 HU (70–90 kg), and 53 ± 7 HU (≥90 kg). The majority (93%) of scans were rated as good or excellent. Regression analysis showed significant correlations between liver enhancement corrected for injected total iodine and total body weight (r = 0.53; p < 0.001) and between liver enhancement corrected for lean body weight and the percentage of lean body weight (r = 0.73; p < 0.001). Most benefits from personalising iodine injection using %LBW additive to total body weight would be achieved in patients under 90 kg. Liver enhancement is more strongly associated with the percentage of lean body weight than with the total body weight or body mass index. The observed variation in liver enhancement might be reduced by a personalised injection based on the artificial-intelligence-determined percentage of lean body weight.
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Affiliation(s)
- Daan J. de Jong
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
| | - Wouter B. Veldhuis
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
| | - Frank J. Wessels
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
| | - Bob de Vos
- Quantib-U, Padualaan 8, 3584 CH Utrecht, The Netherlands; (B.d.V.); (P.M.)
| | - Pim Moeskops
- Quantib-U, Padualaan 8, 3584 CH Utrecht, The Netherlands; (B.d.V.); (P.M.)
| | - Madeleine Kok
- Department of Radiology, University Medical Center Utrecht, Heilberglaan 100, 3584 CX Utrecht, The Netherlands; (D.J.d.J.); (W.B.V.); (F.J.W.)
- Correspondence: ; Tel.: +31-88-75555-55
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Zafeirakis AG, Limouris GS. Non-invasive Radiological Modalities for the Evaluation of Neuroendocrine Liver Tumors. LIVER INTRA-ARTERIAL PRRT WITH 111IN-OCTREOTIDE 2021:119-129. [DOI: 10.1007/978-3-030-70773-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Individual Optimization of Contrast Media Injection Protocol at Hepatic Dynamic Computed Tomography Using Patient-Specific Contrast Enhancement Optimizer. J Comput Assist Tomogr 2020; 44:230-235. [PMID: 32195801 DOI: 10.1097/rct.0000000000001000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We developed a patient-specific contrast enhancement optimizer (p-COP) that can exploratorily calculate the contrast injection protocol required to obtain optimal enhancement at target organs using a computer simulator. Appropriate contrast media dose calculated by the p-COP may minimize interpatient enhancement variability. Our study sought to investigate the clinical utility of p-COP in hepatic dynamic computed tomography (CT). METHODS One hundred thirty patients (74 men, 56 women; median age, 65 years) undergoing hepatic dynamic CT were randomly assigned to 1 of 2 contrast media injection protocols using a random number table. Group A (n = 65) was injected with a p-COP-determined iodine dose (developed by Higaki and Awai, Hiroshima University, Japan). In group B (n = 65), a standard protocol was used. The variability of measured CT number (SD) between the 2 groups of aortic and hepatic enhancement was compared using the F test. In the equivalence test, the equivalence margins for aortic and hepatic enhancement were set at 50 and 10 Hounsfield units (HU), respectively. The rate of patients with an acceptable aortic enhancement (250-350 HU) for the diagnosis of hypervascular liver tumors was compared using the χ test. RESULTS The mean ± SD values of aortic and hepatic enhancement were 311.0 ± 39.9 versus 318.7 ± 56.5 and 59.0 ± 11.5 versus 58.6 ± 11.8 HU in groups A and B, respectively. Although the SD for aortic enhancement was significantly lower in group A (P = 0.006), the SD for hepatic enhancement was not significantly different (P = 0.871). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 groups was within the range of the equivalence margins. The number of patients with acceptable aortic enhancement was significantly greater in group A than in group B (P < 0.01). CONCLUSIONS The p-COP software reduced interpatient variability in aortic enhancement and obtained acceptable aortic enhancement at a significantly higher rate compared with the standard injection protocol for hepatic dynamic CT.
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Contrast Material Injection Protocol With the Dose Determined According to Lean Body Weight at Hepatic Dynamic Computed Tomography: Comparison Among Patients With Different Body Mass Indices. J Comput Assist Tomogr 2019; 43:736-740. [PMID: 31609293 DOI: 10.1097/rct.0000000000000909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to compare enhancement of the aorta and liver on hepatic dynamic computed tomography scans acquired with contrast material doses based on the lean body weight (LBW) or the total body weight (TBW). METHODS We randomly divided 529 patients (279 men, 250 women; median age, 66 years) scheduled for hepatic dynamic computed tomography into 2 groups. The LBW patients (n = 278) were injected with 679 mg iodine/kg (men) or 762 mg iodine/kg (women). The TBW group (n = 251) was injected with 600 mg iodine/kg TBW. Each group was subdivided into the 3 classes based on the body mass index (BMI; low, normal, high). Aortic enhancement during the hepatic arterial phase and hepatic enhancement during the portal venous phase was compared. The aortic and hepatic equivalence margins were 100 and 20 Hounsfield units, respectively. RESULTS Comparison of the median iodine dose in patients with a normal or high BMI showed that it was significantly lower under the LBW protocol than the TBW protocol (558.2 and 507.0 mg iodine/kg, P < 0.001, respectively). However, in patients with a low BMI, the LBW protocol delivered a significantly higher dose than the TBW protocol (620.7 vs 600.0 mg iodine/kg, P < 0.001). The 95% confidence interval for the difference in aortic and hepatic enhancement between the 2 protocols was within the range of the predetermined equivalence margins in all BMI subgroups. CONCLUSIONS Contrast enhancement was equivalent under both protocols. The LBW protocol can avoid iodine overdosing, especially in patients with a high BMI.
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Comparison of Abdominal Computed Tomographic Enhancement and Organ Lesion Depiction Between Weight-Based Scanner Software Contrast Dosing and a Fixed-Dose Protocol in a Tertiary Care Oncologic Center. J Comput Assist Tomogr 2019; 43:155-162. [PMID: 30211799 DOI: 10.1097/rct.0000000000000789] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the quality of enhancement and solid-organ lesion depiction using weight-based intravenous (IV) contrast dosing calculated by injector software versus fixed IV contrast dose in oncologic abdominal computed tomographic (CT) examinations. METHODS This institutional review board-exempt retrospective cohort study included 134 patients who underwent single-phase abdominal CT before and after implementation of weight-based IV contrast injector software. Patient weight, height, body mass index, and body surface area were determined. Two radiologists qualitatively assessed examinations (4 indicating markedly superior to -4 indicating markedly inferior), and Hounsfield unit measurements were performed. RESULTS Enhancement (estimated mean, -0.05; 95% confidence interval [CI], -0.19 to 0.09; P = 0.46) and lesion depiction (estimated mean, -0.01; 95% CI, -0.10 to 0.07; P = 0.79) scores did not differ between CT examinations using weight-based IV contrast versus fixed IV contrast dosing when a minimum of 38.5 g of iodine was used. However, the scores using weight-based IV contrast dosing were lower when the injector software calculated and delivered less than 38.5 g of iodine (estimated mean, -0.81; 95% CI, -1.06 to -0.56; P < 0.0001). There were no significant differences in measured Hounsfield units between the CT examinations using weight-based IV contrast dosing versus fixed IV contrast dosing. CONCLUSIONS Oncologic CT image quality was maintained or improved with weight-based IV contrast dosing using injector software when using a minimum amount of 38.5 g of iodine.
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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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State-of-the-Art Diagnosis and Treatment of Melanoma. J Comput Assist Tomogr 2018; 42:331-339. [DOI: 10.1097/rct.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ko Y, Kim J, Park JKH, Kim H, Cho JY, Kang SB, Ahn S, Lee KJ, Lee KH. Limited detection of small (≤ 10 mm) colorectal liver metastasis at preoperative CT in patients undergoing liver resection. PLoS One 2017; 12:e0189797. [PMID: 29244853 PMCID: PMC5731738 DOI: 10.1371/journal.pone.0189797] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/02/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To retrospectively determine the sensitivity of preoperative CT in the detection of small (≤ 10 mm) colorectal liver metastasis (CRLM) nodules in patients undergoing liver resection. METHODS The institutional review board approved the study and waived informed consent. We included 461 pathologically confirmed CRLM nodules in 211 patients (including 71 women; mean age, 66.4 years) who underwent 229 liver resections following abdominal CT. Prior to 163 resections, gadoxetic acid-enhanced liver MR imaging was also performed. Nodules were matched between pathology reports and prospective CT reports following a predefined algorithm. Per-nodule sensitivity of CT was calculated by nodule-size category. Generalized estimating equations were used to adjust for within-case correlation. RESULTS Fourteen nodule sizes were missing in the pathology report. Nodules of 1-5 mm and 6-10 mm accounted for 8.1% (n = 36) and 23.5% (n = 105) of the remaining 447 nodules, and the number of nodules gradually decreased as nodule size increased beyond 10 mm. The overall sensitivity of CT was 81.2% (95% confidence interval, 77.1%, 85.2%; 365/461). The sensitivity was 8% (0%, 17%; 3/36), 55% (45%, 65%; 59/105), 91%, 95%, and 100% for nodules of 1-5 mm, 6-10 mm, 11-15 mm, 16-20 mm, and >20 mm, respectively. The nodule-size distribution was similar between resections undergoing gadoxetic acid-enhanced MR imaging and those not undergoing the MR imaging. CONCLUSION CT has limited sensitivity for nodules of ≤ 10 mm and particularly of ≤ 5 mm.
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Affiliation(s)
- Yousun Ko
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
| | - Jihang Kim
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | | | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyong Joon Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
| | - Kyoung Ho Lee
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea
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Abstract
BACKGROUND Imaging plays an important role not only in screening, evaluating, staging, and monitoring disease, but also in surveillance following tumor ablation. Advances in imaging techniques have increased our ability to detect and characterize focal liver lesions, resulting in improvements in diagnostic capability and improved monitoring of liver metastases. This has led to increased interest in both hepatic imaging and image-guided hepatic interventions. METHODS Several imaging options are reviewed according to their effective application, notably computed tomography (CT), CT during arterial portography, ultrasound, magnetic resonance imaging, positron emission tomography, and integrated PET/CT imaging. RESULTS Although there are exceptions regarding imaging options based on patient selection and on institution preference and expertise, multidetector helical CT scanning remains the dominant modality in the evaluation of suspected hepatic metastases, and for preoperative planning, treatment monitoring, and posttreatment follow-up. CONCLUSIONS Ultimately, the choice of imaging modality must be based not only on the patient and the clinical situation, but also on the imaging expertise within each institution.
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Affiliation(s)
- Junsung Choi
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Tanaka M, Kishi Y, Esaki M, Nara S, Miyake M, Hiraoka N, Nagino M, Shimada K. Feasibility of Routine Application of Gadoxetic Acid-Enhanced MRI in Combination with Diffusion-Weighted MRI for the Preoperative Evaluation of Colorectal Liver Metastases. Ann Surg Oncol 2016; 23:3991-3998. [PMID: 27357179 DOI: 10.1245/s10434-016-5362-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gadoxetic acid-enhanced magnetic resonance imaging (MRI) in combination with diffusion-weighted MRI (Gd-EOB-MRI/DWI) has become popular for evaluating colorectal liver metastases (CRLM). This retrospective observational study aimed to determine whether this procedure should be indicated prior to hepatectomy in all patients with CRLM. METHODS A retrospective survey of relevant data of patients who had undergone hepatectomy for CRLM from 2008 to 2014 was performed. The rates of detection by contrast-enhanced computed tomography (CE-CT) and Gd-EOB-MRI/DWI were evaluated. In addition, relapse-free and overall survivals after primary hepatectomy were compared between patients who had undergone only CE-CT versus those who had undergone both CE-CT and Gd-EOB-MRI/DWI. RESULTS In all, 419 pathologically confirmed CRLM were resected in 202 hepatectomies in 177 patients. The sensitivity of detection of CRLM was 77 % for CE-CT and 93 % for Gd-EOB-MRI/DWI (P < 0.01). The sensitivity of detection of 1-5, 6-10, and 11-15 mm CRLM by CE-CT was 9.6 % (5/52), 47 % (26/55), and 76 % (57/75), respectively, whereas that by Gd-EOB-MRI/DWI was 54 % (28/52), 91 % (50/55), and 99 % (74/75), respectively; these differences are significant (P < 0.01 for all three groups). Relapse-free (P = 0.99) and overall survival (P = 0.79) did not differ significantly between 37 patients evaluated preoperatively by only CE-CT and 168 patients evaluated by both CE-CT and Gd-EOB-MRI/DWI. CONCLUSION Gd-EOB-MRI/DWI detects small CRLM (≤15 mm) with higher sensitivity than CE-CT. However, whether Gd-EOB-MRI/DWI should be a routine component of preoperative evaluation remains unclear in terms of survival benefit.
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Affiliation(s)
- Masahiro Tanaka
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.,Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Kishi
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Minoru Esaki
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Nara
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Mototaka Miyake
- Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuyoshi Hiraoka
- Division of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuaki Shimada
- Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
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Liu QY, He CD, Zhou Y, Huang D, Lin H, Wang Z, Wang D, Wang JQ, Liao LP. Application of gemstone spectral imaging for efficacy evaluation in hepatocellular carcinoma after transarterial chemoembolization. World J Gastroenterol 2016; 22:3242-3251. [PMID: 27004002 PMCID: PMC4790000 DOI: 10.3748/wjg.v22.i11.3242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/31/2015] [Accepted: 01/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the value of gemstone spectral imaging (GSI) in efficacy evaluation in hepatocellular cancer (HCC) after transcatheter arterial chemoembolization (TACE) treatment.
METHODS: Thirty patients with HCC underwent GSI, including nonenhanced, arterial, portalvenous and delayed phase scans, after TACE treatment. Arterial phase images were acquired with GSI for reconstruction of virtual nonenhanced images and color overlay images. Digital subtraction angiography (DSA) was performed in all these patients. Two blinded and independent readers evaluated the data in two reading sessions; standard nonenhanced, arterial, portalvenous, and delayed phase images were read in session A, and the optimal monochromatic images, iodine/water based images and spectrum features were read in session B. Sensitivity and specificity were calculated with the DSA data as the reference standard. The sensitivity and specificity were compared using the χ2 test.
RESULTS: DSA revealed 154 lesions in 30 patients, and 100 of them had blood supply. Overall sensitivity and specificity were 72% (72/100) and 77.8% (42/54) for session A, and 97% (97/100) and 94.4% (51/54) for session B, respectively. The sensitivity and specificity of the two reading sessions were significantly different (χ2 = 23.04, χ2 = 7.11, P < 0.05).
CONCLUSION: Compared with conventional CT, GSI could significantly improve the detection of small and multiple lesions without increasing the radiation dose. Based on spectrum features, GSI could assess tumor homogeneity and more accurately identify residual tumors and recurrent or metastatic lesions during efficacy evaluation and follow-up in HCC after TACE treatment.
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Mainenti PP, Romano F, Pizzuti L, Segreto S, Storto G, Mannelli L, Imbriaco M, Camera L, Maurea S. Non-invasive diagnostic imaging of colorectal liver metastases. World J Radiol 2015; 7:157-169. [PMID: 26217455 PMCID: PMC4506934 DOI: 10.4329/wjr.v7.i7.157] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/10/2015] [Accepted: 06/01/2015] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the few malignant tumors in which synchronous or metachronous liver metastases [colorectal liver metastases (CRLMs)] may be treated with surgery. It has been demonstrated that resection of CRLMs improves the long-term prognosis. On the other hand, patients with un-resectable CRLMs may benefit from chemotherapy alone or in addition to liver-directed therapies. The choice of the most appropriate therapeutic management of CRLMs depends mostly on the diagnostic imaging. Nowadays, multiple non-invasive imaging modalities are available and those have a pivotal role in the workup of patients with CRLMs. Although extensive research has been performed with regards to the diagnostic performance of ultrasonography, computed tomography, positron emission tomography and magnetic resonance for the detection of CRLMs, the optimal imaging strategies for staging and follow up are still to be established. This largely due to the progressive technological and pharmacological advances which are constantly improving the accuracy of each imaging modality. This review describes the non-invasive imaging approaches of CRLMs reporting the technical features, the clinical indications, the advantages and the potential limitations of each modality, as well as including some information on the development of new imaging modalities, the role of new contrast media and the feasibility of using parametric image analysis as diagnostic marker of presence of CRLMs.
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Koiwahara G, Tsuda T, Matsuda M, Hirata M, Tanaka H, Hyodo T, Kido T, Mochizuki T. Different enhancement of the hepatic parenchyma in dynamic CT for patients with normal liver and chronic liver diseases and with the dose of contrast medium based on body surface area. Jpn J Radiol 2015; 33:194-200. [PMID: 25673431 DOI: 10.1007/s11604-015-0398-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/26/2015] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to characterize hepatic parenchymal enhancement for normal and diseased liver in dynamic computed tomography (CT) with the dose of contrast medium calculated on the basis of body surface area (BSA). MATERIALS AND METHODS The records of 328 consecutive patients who underwent triple-phase contrast-enhanced CT were retrospectively reviewed. The patients were divided into four groups: normal liver (n = 125), chronic hepatitis (CH) (n = 92), Child-Pugh grade A liver cirrhosis (LC-A) (n = 78), and Child-Pugh grade B liver cirrhosis (LC-B) (n = 33). All patients received 22 g I m(-2) as contrast material, calculated on the basis of BSA. CT values were measured in the region of interest during the pre-contrast, arterial, and portal phases, and the change in the CT value (ΔHU, where HU is Hounsfield units) compared with pre-contrast images was calculated. RESULTS Mean ΔHU for the hepatic parenchyma for the normal liver, CH, LC-A, and LC-B groups during the portal phase was 55.5 ± 11.8 HU, 55.2 ± 12.5 HU, 50.0 ± 13.0 HU, and 43.0 ± 12.7 HU, respectively; generalized estimating equation analysis showed the differences were significant (p < 0.01). CONCLUSION Hepatic parenchymal enhancement during the portal phase decreased as the severity of chronic liver damage increased.
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Affiliation(s)
- Gen Koiwahara
- Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitukawa, Toon, Ehime, 791-0925, Japan,
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Dobeli KL, Lewis SJ, Meikle SR, Thiele DL, Brennan PC. Exposure (mAs) optimisation of a multi-detector CT protocol for hepatic lesion detection: Are thinner slices better? J Med Imaging Radiat Oncol 2014; 58:137-43. [PMID: 24641178 DOI: 10.1111/1754-9485.12104] [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: 12/14/2012] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this work was to determine the exposure-optimised slice thickness for hepatic lesion detection with CT. METHODS A phantom containing spheres (diameter 9.5, 4.8 and 2.4 mm) with CT density 10 HU below the background (50 HU) was scanned at 125, 100, 75 and 50 mAs. Data were reconstructed at 5-, 3- and 1-mm slice thicknesses. Noise, contrast-to-noise ratio (CNR), area under the curve (AUC) as calculated using receiver operating characteristic analysis and sensitivity representing lesion detection were calculated and compared. RESULTS Compared with the 125 mAs/5 mm slice thickness setting, significant reductions in AUC were found for 75 mAs (P < 0.01) and 50 mAs (P < 0.05) at 1- and 3-mm thicknesses, respectively; sensitivity for the 9.5-mm sphere was significantly reduced for 75 (P < 0.05) and 50 mAs (P < 0.01) at 1-mm thickness; sensitivity for the 4.8-mm sphere was significantly lower for 100, 75 and 50 mAs at all three slice thicknesses (P < 0.05). The 2.4-mm sphere was rarely detected. At each slice thickness, noise at 100, 75 and 50 mAs exposures was approximately 10, 30 and 50% higher, respectively, than that at 125 mAs exposure. CNRs decreased in an irregular manner with reductions in exposure and slice thickness. CONCLUSION This study demonstrated no advantage to using slices below 5 mm thickness, and consequently thinner slices are not necessarily better.
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Affiliation(s)
- Karen Leigh Dobeli
- Medical Image Optimisation and Perception Group (MIOPeG), Medical Imaging & Radiation Sciences Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia; Department of Medical Imaging, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
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Affiliation(s)
- Pierre-Jean Valette
- Department of Digestive Radiology, Pavilion H, Hôpital Edouard Herriot, Place d'Arsonval, 69003 Lyon, France.
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Body size indices to determine iodine mass with contrast-enhanced multi-detector computed tomography of the upper abdomen: does body surface area outperform total body weight or lean body weight? Eur Radiol 2013; 23:1855-61. [DOI: 10.1007/s00330-013-2808-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 01/21/2013] [Accepted: 02/07/2013] [Indexed: 12/17/2022]
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Wang LX, Liu K, Lin GW, Zhai RY. Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI. HEPATITIS MONTHLY 2012; 12:e6212. [PMID: 23087753 PMCID: PMC3475020 DOI: 10.5812/hepatmon.6212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 05/31/2012] [Accepted: 06/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND A solitary necrotic nodule (SNN) of the liver is an uncommon lesion, which is different from primary and metastatic liver cancers. OBJECTIVES To analyze the classification, CT and MR manifestation, and the pathological basis of solitary necrotic nodule of the liver (SNN) in order to evaluate CT and MRI as a diagnosing tool. PATIENTS AND METHODS This study included 29 patients with liver SNNs, out of which 14 had no clinical symptoms and were discovered by routine ultrasound examinations, six were found by computed tomography (CT) due to abdominal illness, four had ovarian tumors, and five had gastrointestinal cancer surgeries, previously. Histologically, these SNNs can be divided into three subtypes, i.e., type I, pure coagulation necrosis (14 cases); type II, coagulation necrosis mixed with liquefaction necrosis (five cases); and type III, multi-nodular fusion (10 cases). CT and magnetic resonance imaging (MRI) patterns were shown to be associated with SNN histology. All patients were treated surgically with good prognosis. RESULTS CT AND MRI APPEARANCE AND CORRELATION WITH PATHOLOGY TYPES: three subtypes of lesions were hypo-density on both pre contrast and post contrast CT, 12 lesions were found the enhanced capsule and 1 lesion of multi- nodular fusion type showed septa enhancement. The lesions were hypo-intensity on T2WI and the lesions of type II showed as mixed hyperintensity on T2WI. The capsule showed delayed enhancement in all cases, and all lesions of multi- nodular fusion type showed delayed septa enhancement on MR images. 15 cases on CT were misdiagnosed and Four cases on MRI were misdiagnosed and the accuracy of CT and MRI were 48.3% and 86.2% respectively. CONCLUSIONS In conclusion, CT and MRI are useful tools for SNN diagnosis.
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Affiliation(s)
- Li Xia Wang
- Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China
| | - Kan Liu
- Department of Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guang Wu Lin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
- Corresponding author: Guang Wu Lin, Department of Radiology, Huadong Hospital, Fudan University, Shanghai 200040, Shanghai, China. Tel.: +86-2162483180, Fax: +86-2162483180, E-mail:
| | - Ren You Zhai
- Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, China
- Corresponding author: Ren You Zhai, Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, 8 Gongtinan Road, Chaoyang District, Beijing 100020, Beijing, China. Tel.: +86-1085231908, Fax: +86-1065935214, E-mail:
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Solitary Necrotic Nodules of the Liver: Histology and Diagnosis With CT and MRI. HEPATITIS MONTHLY 2012. [DOI: 10.5812/hapatmon.6212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Kim YK, Park G, Kim CS, Yu HC, Han YM. Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol 2012; 85:539-47. [PMID: 22556405 DOI: 10.1259/bjr/25139667] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We compared the diagnostic performance of gadoxetic acid-enhanced MRI and 16-slice multidetector CT (MDCT) with respect to their abilities to detect hepatic metastases and differentiate hepatic metastases from hepatic cysts and haemangiomas. METHODS 67 patients with 110 liver metastases (size 0.3-2.5 cm), 33 haemangiomas (size 0.5-1.5 cm) and 17 cysts (size 0.3-1.0 cm) underwent 4-phase MDCT and gadoxetic acid-enhanced MRI, including early dynamic phases, post-contrast T(2) weighted turbo spin echo sequences and 20 min hepatocyte-selective phases. Two observers independently analysed each image in random order. Sensitivity and diagnostic accuracy for lesion detection and differentiation for MDCT and gadoxetic acid-enhanced MRI were calculated using receiver operating characteristic analysis. RESULTS For both observers, the Az values of gadoxetic acid-enhanced MRI (mean, 0.982 and 0.981) were significantly higher than the Az values of MDCT (mean, 0.839 and 0.892) (p<0.05) for the detection of metastases and for the differentiation of metastases from haemangiomas and cysts. Sensitivities of gadoxetic acid-enhanced MRI with regard to the detection and characterisation of liver metastases (mean, 96.9% and 96.0%) were significantly higher than those of MDCT (mean, 78.7% and 75.0%) (p<0.05). CONCLUSION Gadoxetic acid-enhanced MRI showed higher diagnostic accuracy and sensitivity than did MDCT for the detection of hepatic metastases and for the differentiation between hepatic metastases and hepatic haemangiomas or cysts.
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Affiliation(s)
- Y K Kim
- Department of Diagnostic Radiology and Research Institute of Clinical Medicine, Chonbuk National University Hospital and Medical School, Seoul, Republic of Korea.
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Value of visual inspection, bimanual palpation, and intraoperative ultrasonography during hepatic resection for liver metastases of colorectal carcinoma. World J Surg 2012; 35:2779-87. [PMID: 21959929 DOI: 10.1007/s00268-011-1264-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Intraoperative detection of new nodules is common in patients undergoing hepatectomy for colorectal liver metastases, although the value of intraoperative diagnosis is not well assessed. METHODS A prospectively collected and recorded database was retrospectively analyzed. Helical computed tomography (CT) results were correlated with those of the intraoperative diagnosis in 183 consecutive patients undergoing 254 consecutive hepatectomies, including repeated resection for colorectal liver metastases. RESULTS In total, 270 nodules were newly detected during 65 hepatectomies. The sensitivity of CT to detect metastatic nodules was 72.8% (722/992), but it decreased to 34.6% (125/361) for small (≤ 1 cm diameter) tumors. Intraoperative visual inspection and/or palpation detected 207 of 270 nodules. Intraoperative ultrasonography (IOUS) played an important role in identifying deep (≥ 1 cm from the surface) and comparatively small (≤ 1 cm diameter) nodules (4/9 vs. 16/18, respectively, for those >1 cm vs. ≤ 1 cm diameter). The likelihood of intraoperative detection of new nodules increased from 10 in 112 to 6 in 9 when the preoperative tumor number increased from solitary to ≥ 10, resulting in an overall likelihood of 65 in 254 (25.6%). Of 65 patients with new nodules, 21 had at least one nodule that was detected only by IOUS. Preoperatively scheduled hepatectomy was altered in 47 (72%) patients, although additional limited resection(s) were sufficient to remove these nodules in 43 (91%) of them. CONCLUSIONS Visual inspection, palpation, and IOUS had equally indispensable roles in detecting new nodules during hepatectomy. Detection was common and usually necessitated alteration, albeit moderately, of the surgical plan.
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Schuld J, Kollmar O, Seidel R, Black C, Schilling MK, Richter S. Estimate or calculate? How surgeons rate volumes and surfaces. Langenbecks Arch Surg 2012; 397:763-9. [DOI: 10.1007/s00423-012-0942-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 02/22/2012] [Indexed: 10/28/2022]
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Abstract
The diagnostic imaging of hepatocellular carcinoma (HCC) has recently undergone marked progress. The advent of the ultrasound (US) contrast agent Sonazoid, approved in January 2007, and magnetic resonance imaging (MRI) with the liver-specific MRI contrast agent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA-MRI), approved in January 2008, are of particular significance. Sonazoid contrast-enhanced US (Sonazoid-CEUS) is useful not only for the diagnosis of HCC, but also for guiding treatment and assessing treatment response. Sonazoid-CEUS has proven to be particularly effective for screening and staging, which used to be considered impossible with CEUS, through the introduction of the newly developed diagnostic technique of defect reperfusion imaging. It is still not possible if other vascular agents such as SonoVue and Definity are used. In particular, Gd-EOB-DTPA-MRI has been suggested to be much more reliable in the differentiation of early HCC from precancerous dysplastic nodules than any other modalities such as multidetector raw computed tomography, dynamic MRI, and superparamagnetic iron oxide-MRI. A decrease in contrast uptake in the hepatocyte phase observed on EOB-MRI is strongly suggestive of cancer, and the absence of early staining in the arterial phase suggests early HCC. The differential diagnostic capacity of Gd-EOB-DTPA-MRI is considered to far exceed that of what were previously the most useful imaging techniques, computed tomography (CT) during hepatic arteriography or CT during arterial portography, and to be comparable to that of the pathological diagnosis by pathologists specialized in liver.
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama, Osaka, Japan.
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Small colorectal cystic metastases to the liver: still a diagnostic dilemma? A report of a case and a review of the literature. Updates Surg 2011; 64:297-300. [PMID: 21987005 DOI: 10.1007/s13304-011-0115-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 09/26/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND Although cystic colorectal metastases are rare (1.8%), they are still a crucial challenge for the surgeon especially in terms of detection and differential diagnosis. Since prognosis after resection is very good (40% 5-year survival), early diagnosis is essential. CASE REPORT A 55-year-old man was admitted to our hospital with a suspected diagnosis of multiple small liver metastases. He had previously undergone left sided-cholectomy followed by chemotherapy for colonic carcinoma. Computed tomography (CT) revealed multiple small (<15 mm) intrahepatic biliary cysts, suspected for cystic colorectal liver metastases. CONCLUSION The diagnosis of cystic colorectal liver metastases is quite difficult and it is mostly based on the last-generation magnetic resonance (MR). In spite of this, we must often rely on histological results for a definitive diagnosis.
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Multidetector computed tomography follow-up of hypoattenuating small liver lesions in patients with rectal cancer. Am J Clin Oncol 2011; 34:411-6. [PMID: 20686401 DOI: 10.1097/coc.0b013e3181e84e1a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To study the behavior of hypoattenuating liver lesions, deemed too small to characterize at baseline scanning with multidetector computed tomography (CT), in patients with rectal cancer. METHODS Retrospective review of locally advanced rectal cancer patients from a radiation oncology therapy database was conducted. Patients who presented before neoadjuvant chemoradiation without metastases at baseline CT and with follow-up scans for at least 1 year after therapy were evaluated. CT studies were reviewed for the presence and change in size of hypoattenuating liver lesions (<15 mm) at baseline and follow-up. RESULTS A total of 616 consecutive patients from the radiotherapy database were reviewed. Of these, 70 patients with a total of 163 hepatic lesions met the selection criteria. The mean patient age was 62.4 years (range, 26-85 years). All patients subsequently underwent surgery and adjuvant chemotherapy. The mean time of radiographic imaging from baseline CT to most recent surveillance CT was 3.3 years (range, 1.1-7.4 years). Two radiologists independently reviewed the CTs. The lesions were stable in 56 of 70 (80.0%, 95% confidence interval: 69%, 89%) patients. Of 163 lesions, 148 (90.8%) were stable, 8 (4.9%) regressed, and 7 (4.3%) progressed in size. No significant difference in results was found for patients stratified according to T-stage (P = 0.41) and N-stage (P > 0.99). CONCLUSION In patients with rectal cancer, majority of small hypoattenuating liver lesions remain stable and are treated as benign lesions, at multidetector CT follow-up of more than a year. Nevertheless, hepatic lesion stability during systemic therapy should still be interpreted with caution and closely followed for at least 1 year after completion of therapy.
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Rengo M, Bellini D, De Cecco CN, Osimani M, Vecchietti F, Caruso D, Maceroni MM, Lucchesi P, Iafrate F, Paolantonio P, Ferrari R, Laghi A. The optimal contrast media policy in CT of the liver. Part I: Technical notes. Acta Radiol 2011; 52:467-72. [PMID: 21498281 DOI: 10.1258/ar.2011.100499] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Latest developments of multidetector computed tomography (MDCT), which is today considered a real volumetric technique, have revolutionized abdominal imaging. Technological improvements such as higher spatial resolution, larger volume coverage and higher temporal resolution, have reduced scan times allowing CT studies of the abdomen within a single breath-hold. Furthermore, the increased number of slices, the submillimetric collimation, and the use of multiple dynamic post-contrast phases per single examination, may all contribute to increase the radiation exposure of single patients. The aim of this review is to discuss different parameters affecting contrast media enhancement, as vascular enhancement, parenchymal enhancement and timing, in order to minimize the amount of contrast medium injected and the radiation exposure.
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Affiliation(s)
- Marco Rengo
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Davide Bellini
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Carlo N De Cecco
- Department of Radiological Sciences, University of Rome ‘Sapienza’, St Andrea Hospital, Rome
| | - Marcello Osimani
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Fabrizio Vecchietti
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Damiano Caruso
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Marco M Maceroni
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Paola Lucchesi
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
| | - Franco Iafrate
- Department of Radiological Sciences, Sapienza – Università di Roma, Policlinico Umberto I, Rome
| | - Pasquale Paolantonio
- Department of Radiological Sciences, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Riccardo Ferrari
- Department of Radiological Sciences, Azienda Ospedaliera San Giovanni-Addolorata, Rome, Italy
| | - Andrea Laghi
- Department of Radiological, Oncological and Pathological Sciences, University of Rome Sapienza;Polo Pontino, ICOT, Latina
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Hwang SH, Yu JS, Chung JJ, Kim JH, Kim KW. Diagnosing small hepatic cysts on multidetector CT: an additional merit of thinner coronal reformations. Korean J Radiol 2011; 12:341-50. [PMID: 21603293 PMCID: PMC3088851 DOI: 10.3348/kjr.2011.12.3.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 01/05/2011] [Indexed: 12/13/2022] Open
Abstract
Objective We wanted to validate the additional merit of the thinner coronal reformation images from multidetector CT (MDCT) for making the diagnosis of hepatic cysts. Materials and Methods For the 90 benign hepatic cysts confirmed on MRI, the transverse (5-mm thickness) and additional coronal (2-mm thickness) reformation images from MDCT were compared with each other in terms of the Hounsfield units (HUs) and the size of each hepatic cyst. Results The attenuations (mean: 17.2 HUs, standard deviation: ± 14.4) on the thinner coronal images were significantly lower than those (mean: 40.7 HUs; standard deviation: ± 20.6) on the thicker transverse images for the small hepatic cysts (≤ 10 mm on the transverse image, p < 0.01). Twenty-three (79%) of the 29 cysts between 5 mm and 10 mm and 21 (51%) of 41 lesions up to 5 mm showed a mean HU value of 20 or less on the coronal reformation images. Conclusion By reducing the partial volume effect, routine coronal reformation of MDCT with a thinner section thickness can provide another merit for making a confidential diagnosis of many small sub-centimeter hepatic cysts, and these small cysts are not easily characterized on the conventional transverse images.
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Affiliation(s)
- Sung Ho Hwang
- Department of Radiology and the Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul 135-720, Korea
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Stang A, Keles H, Hentschke S, Seydewitz C, Keuchel M, Pohland C, Dahlke J, Weilert H, Wessling J, Malzfeldt E. Real-time ultrasonography-computed tomography fusion imaging for staging of hepatic metastatic involvement in patients with colorectal cancer: initial results from comparison to US seeing separate CT images and to multidetector-row CT alone. Invest Radiol 2011; 45:491-501. [PMID: 20458251 DOI: 10.1097/rli.0b013e3181ddd3da] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To prospectively evaluate the role of real-time ultrasonography (US)-computed tomography (CT) fusion imaging (US-CT) in comparison with US seeing separate CT images (US + CT) and multidetector-row CT (MDCT) for the correct staging of hepatic metastatic involvement in patients with colorectal cancer. METHODS Sixty-four patients with newly diagnosed colorectal cancer and who were referred for abdominopelvic staging before primary tumor resection underwent same-day MDCT, US + CT, and US-CT. Examinations were evaluated on-site by 2 investigators in consensus. Investigators recorded the size and location of detected lesions on segmental liver maps, classified them as being benign, malignant, or indeterminate, and finally assessed the M stage of the liver as being M0, M1, or Mx (indeterminate). All patients underwent surgical exploration including intraoperative US. Reference standard diagnosis was based on findings at surgery, intraoperative US, histopathology, and MDCT follow-up imaging. Differences among investigated modalities were analyzed using McNemar's test. RESULTS The reference standard verified 109 (45 < or = 1 cm) hepatic lesions in 25 patients, including 65 (25 < or = 1 cm) metastases in 16 patients (M1). Regarding the 45 < or = 1 cm liver lesions, rates for detection were significantly higher (P < 0.05) for MDCT (80%, 36/45) and US-CT (77.8%, 35/45) than for US + CT (64.4%, 29/45); the rate for correct classification by US-CT (71.1%, 32/45) was significantly higher than for US + CT (48.9%, 22/45) and MDCT (31.1%, 14/45) (all P < 0.05). On patient-based analysis, specificity of MDCT (85.4%, 41/48) was significantly lower (P < 0.05) than for US-CT (97.9%, 47/48) and US + CT (93.7%, 45/48); the positive predictive value of MDCT (63.1%, 12/19) was not significantly different (P = 0.27) compared with US + CT (82.3%, 14/17) but significantly lower (P < 0.05) than for US-CT (93.7%, 15/16). In 13 patients (59 lesions) with only benign (stage M0) or coexistent benign and malignant lesions (stage M1), indeterminate lesion ratings and indeterminate liver stagings (Mx) occurred both significantly lower (P < 0.05) with US-CT (3.4%, 2/59; and 0%, 0/13) than with US + CT (11.9%, 7/59; and 23.1%, 3/13) or with MDCT (30.5%, 18/59; and 53.8%, 7/13). CONCLUSIONS Based on these initial diagnostic experiences, complementary US-CT fusion imaging of small CT-indeterminate liver lesions may have value in staging patients with colorectal cancer, focusing on patients who were likely to harbor only benign or coexisting benign and malignant liver lesions and in whom change of M staging would change the clinical management.
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Affiliation(s)
- Axel Stang
- Department of Oncology, Asklepios Hospital Altona, Hamburg, Germany.
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Shengping H, Mingliang W, Zhiyuan W, Xuesong Z, Fei M. Gemstone Spectral Monochromatic CT
Imaging: Detection and Classification of
Focal Liver Lesions in Patients with
Pancreatic Cancer. Euroasian J Hepatogastroenterol 2011. [DOI: 10.5005/jp-journals-10018-1017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kondo H, Kanematsu M, Goshima S, Watanabe H, Onozuka M, Moriyama N, Bae KT. Aortic and hepatic enhancement at multidetector CT: evaluation of optimal iodine dose determined by lean body weight. Eur J Radiol 2010; 80:e273-7. [PMID: 21195572 DOI: 10.1016/j.ejrad.2010.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 12/01/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the optimal iodine dose for aortic and hepatic enhancement at MDCT by comparing lean body weight (LBW) with total body weight (TBW). MATERIALS AND METHODS This study was approved by our institutional review committee. One hundred and thirty-six patients were randomized into four groups: 550, 650, 750 mg iodine/(kg of LBW) and 600 mgI/(kg of TBW). The aortic and hepatic contrast enhancements (Δ HUs) during the portal venous-phase and variances of ΔHUs were compared. RESULTS Mean ΔHUs for 550, 650, 750 mgI/kg LBW and 600 mgI/kg TBW were: 95.1, 109.9, 122.4, and 131.2HU, respectively, for the aorta. For the liver, 43.1, 55.4, 60.8, and 63.5 HU. Mean Δ HUs increased with iodine dose per kg LBW (p<0.01), but no significant difference between 750 mgI/kg LBW and 600 mgI/kg TBW groups. Hepatic enhancement increased by ≥50 HU in 94% of patients with 750 mg/kg LBW. Variance of hepatic enhancement was marginally greater in the 600 mgI/kg TBW than in the 550 and 750 mgI/kg LBW. CONCLUSION Hepatic enhancement variation was reduced with iodine doses based on LBW. Iodine dose of 750 mg iodine/kg LBW was appropriate to achieve hepatic enhancement≥50 HU in 94% of patients.
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Affiliation(s)
- Hiroshi Kondo
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, 501-1194 Gifu, Japan.
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Niekel MC, Bipat S, Stoker J. Diagnostic imaging of colorectal liver metastases with CT, MR imaging, FDG PET, and/or FDG PET/CT: a meta-analysis of prospective studies including patients who have not previously undergone treatment. Radiology 2010; 257:674-684. [PMID: 20829538 DOI: 10.1148/radiol.10100729] [Citation(s) in RCA: 393] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
PURPOSE To obtain diagnostic performance values of computed tomography (CT), magnetic resonance (MR) imaging, fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET), and FDG PET/CT in the detection of colorectal liver metastases in patients who have not previously undergone therapy. MATERIALS AND METHODS A comprehensive search was performed for articles published from January 1990 to January 2010 that fulfilled the following criteria: a prospective study design was used; the study population included at least 10 patients; patients had histopathologically proved colorectal cancer; CT, MR imaging, FDG PET, or FDG PET/CT was performed for the detection of liver metastases; intraoperative findings or those from histopathologic examination or follow-up were used as the reference standard; and data for calculating sensitivity and specificity were included. Study design characteristics, patient characteristics, imaging features, reference tests, and 2 × 2 tables were recorded. RESULTS Thirty-nine articles (3391 patients) were included. Variation existed in study design characteristics, patient descriptions, imaging features, and reference tests. The sensitivity estimates of CT, MR imaging, and FDG PET on a per-lesion basis were 74.4%, 80.3%, and 81.4%, respectively. On a per-patient basis, the sensitivities of CT, MR imaging, and FDG PET were 83.6%, 88.2%, and 94.1%, respectively. The per-patient sensitivity of CT was lower than that of FDG PET (P = .025). Specificity estimates were comparable. For lesions smaller than 10 mm, the sensitivity estimates for MR imaging were higher than those for CT. No differences were seen for lesions measuring at least 10 mm. The sensitivity of MR imaging increased significantly after January 2004. The use of liver-specific contrast material and multisection CT scanners did not provide improved results. Data about FDG PET/CT were too limited for comparisons with other modalities. CONCLUSION MR imaging is the preferred first-line modality for evaluating colorectal liver metastases in patients who have not previously undergone therapy. FDG PET can be used as the second-line modality. The role of FDG PET/CT is not yet clear owing to the small number of studies. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100729/-/DC1.
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Affiliation(s)
- Maarten Christian Niekel
- Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Mainenti PP, Mancini M, Mainolfi C, Camera L, Maurea S, Manchia A, Tanga M, Persico F, Addeo P, D'Antonio D, Speranza A, Bucci L, Persico G, Pace L, Salvatore M. Detection of colo-rectal liver metastases: prospective comparison of contrast enhanced US, multidetector CT, PET/CT, and 1.5 Tesla MR with extracellular and reticulo-endothelial cell specific contrast agents. ABDOMINAL IMAGING 2010; 35:511-521. [PMID: 19562412 DOI: 10.1007/s00261-009-9555-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 06/11/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND To compare contrast-enhanced US (CE-US), multidetector-CT (MDCT), 1.5 Tesla MR with extra-cellular (Gd-enhanced) and intracellular (SPIO-enhanced) contrast agents and PET/CT, in the detection of hepatic metastases from colorectal cancer. MATERIALS AND METHODS A total of 34 patients with colo-rectal adenocarcinoma underwent preoperatively CE-US, MDCT, Gd- and SPIO-enhanced MR imaging (MRI), and PET/CT. Each set of images was reviewed independently by two blinded observers. The ROC method was used to analyze the results, which were correlated with surgical findings, intraoperative US, histopathology, and MDCT follow-up. RESULTS A total of 57 hepatic lesions were identified: 11 hemangiomas, 29 cysts, 1 focal fatty liver, 16 metastases (dimensional distribution: 5/16 < 5 mm; 3/16 between 5 mm and <10 mm; 8/16 ≥ 10 mm). Six of 34 patients were classified as positive for the presence of at least one metastasis. Considering all the metastases and those ≥ 10 mm, ROC areas showed no significant differences between Gd- and SPIO-enhanced MRI, which performed significantly better than the other modalities (P < 0.05). Considering the lesions <10 mm, ROC areas showed no significant differences between all modalities; however MRI presented a trend to perform better than the other techniques. Considering the patients, ROC areas showed no significant differences between all the modalities; however PET/CT seemed to perform better than the others. CONCLUSIONS Gd- and SPIO-enhanced MRI seem to be the most accurate modality in the identification of liver metastases from colo-rectal carcinoma. PET/CT shows a trend to perform better than the other modalities in the identification of patients with liver metastases.
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Abstract
Quantification of tumor burden and assessment of changes in tumor size after chemotherapy are commonly performed to evaluate treatment response in oncology trials. Validation and adoption of different criteria have been attempted in the past to achieve uniformity in scanning techniques and measurement metrics so that comparison of different oncological trials is feasible. Response assessment of solid tumors is usually consisted of either bidimensional (World Health Organization criteria) or unidimensional (Response Evaluation Criteria in Solid Tumors [RECIST] guidelines) measurement of tumors before and after chemotherapy. RECIST 1.1 criteria have been recently published. In this article, we try to provide a comprehensive review of the tumor response evaluation guidelines that were recently updated in attempts to overcome limitations of the previous criteria as well as incorporate recent advances in imaging techniques.
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Smith JT, Hawkins RM, Guthrie JA, Wilson DJ, Arnold PM, Boyes S, Robinson PJ. Effect of slice thickness on liver lesion detection and characterisation by multidetector CT. J Med Imaging Radiat Oncol 2010; 54:188-93. [DOI: 10.1111/j.1754-9485.2010.02157.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kulemann V, Schima W, Tamandl D, Kaczirek K, Gruenberger T, Wrba F, Weber M, Ba-Ssalamah A. Preoperative detection of colorectal liver metastases in fatty liver: MDCT or MRI? Eur J Radiol 2010; 79:e1-6. [PMID: 20392584 DOI: 10.1016/j.ejrad.2010.03.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the diagnostic value of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative detection of colorectal liver metastases in diffuse fatty infiltration of the liver, associated with neoadjuvant chemotherapy. MATERIALS AND METHODS Twenty preoperative tri-phasic MDCT (4-64-row, Siemens) and dynamic contrast-enhanced MRI (1.5T or 3.0T, Siemens) examinations of patients with colorectal cancer and liver metastases in diffuse steatosis were retrospectively evaluated. All patients underwent surgical resection for liver metastases (time interval 1-60 days). The amount of fatty infiltration of the liver was determined histopathologically by semi-quantitative percent-wise estimation and ranged from 25 to 75%. RESULTS Overall, 51 metastases were found by histopathology of the resected liver segments/lobes. The size of the metastases ranged from 0.4 to 13 cm, with 18 (35%) being up to 1cm in diameter. In the overall rating, MDCT detected 33/51 lesions (65%), and MRI 45/51 (88%). For lesions up to 1cm, MDCT detected only 2/18 (11%) and MRI 12/18 (66%). One false positive lesion was detected by MDCT. Statistical analysis showed that MRI is markedly superior to MDCT, with a statistically significant difference (p<.001), particularly for the detection of small lesions (≤ 1 cm; p<.004). There was no significant difference between the two modalities in the detection of lesions>1cm. CONCLUSION For the detection of colorectal liver metastases after neoadjuvant chemotherapy and consecutive diffuse fatty infiltration of the liver, MRI is superior to MDCT, especially for the detection of small lesions.
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Bellomi M, Travaini LL. Imaging as a surveillance tool in rectal cancer. Expert Rev Med Devices 2010; 7:99-112. [PMID: 20021242 DOI: 10.1586/erd.09.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite advances in diagnosis and treatment, half of patients with treated rectal cancer will die owing to recurrent disease. There is no evidence of benefit on survival from an intensive surveillance program, even if presymptomatic recurrent disease is detected. The aim of this article is to review the results described for the different imaging techniques in diagnosing rectal cancer recurrence in different sites and to discuss their relative clinical impact. The sensitivity of imaging techniques is related to the performance of the machines and the site being examined. Computed tomography is the most used technique owing to its availability, speed, panoramic images and ease of use, while MRI of the pelvis and the liver produces the highest resolution, sensitivity and specificity in these anatomical areas. Owing to its high cost, [(18)F] fluorodeoxyglucose-PET should be used as a third-level examination, a 'problem-solving' method when the site of recurrence is unknown or to rule out other possible sites of recurrence before a second surgery, and, finally, because it offers the possibility to investigate the whole body. The follow-up must be designed for individual patients, taking into account a number of factors. In the near future, whole-body imaging, probably by MRI, that is free from radiation will become the method of choice for screening for recurrent disease.
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Affiliation(s)
- Massimo Bellomi
- Department of Radiology and School of Medicine, University of Milano, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
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Optimal reconstructed section thickness for the detection of liver lesions with multidetector CT. Clin Radiol 2010; 65:193-7. [DOI: 10.1016/j.crad.2009.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 09/24/2009] [Accepted: 10/18/2009] [Indexed: 12/27/2022]
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Kondo H, Kanematsu M, Goshima S, Tomita Y, Kim MJ, Moriyama N, Onozuka M, Shiratori Y, Bae KT. Body size indexes for optimizing iodine dose for aortic and hepatic enhancement at multidetector CT: comparison of total body weight, lean body weight, and blood volume. Radiology 2009; 254:163-9. [PMID: 20019137 DOI: 10.1148/radiol.09090369] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate and compare total body weight (TBW), lean body weight (LBW), and estimated blood volume (BV) for the adjustment of the iodine dose required for contrast material-enhanced multidetector computed tomography (CT) of the aorta and liver. MATERIALS AND METHODS Institutional review committee approval and written informed consent were obtained. One hundred twenty patients (54 men, 66 women; mean age, 64.1 years; range, 19-88 years) who underwent multidetector CT of the upper abdomen were randomized into three groups of 40 patients each: (a) TBW group (0.6 g of iodine per kilogram of TBW), (b) LBW group (0.821 g of iodine per kilogram of LBW), and (c) BV group (men, 8.6 g of iodine per liter of BV; women, 9.9 g of iodine per liter of BV). Change in CT number between unenhanced and contrast-enhanced images per gram of iodine and maximum hepatic enhancement (MHE) adjusted for iodine dose were examined for correlation with TBW, LBW, and BV by using linear regression analysis. RESULTS In the portal venous phase, correlation coefficients for the correlation of change in CT number per gram of iodine with TBW for the aorta and liver were -0.71 and -0.79, respectively, in the TBW group; -0.80 and -0.86, respectively, in the LBW group; and -0.68 and -0.66, respectively, in the BV group. In the liver, they were marginally higher in the LBW group than in the BV group (P = .03). Adjusted MHE remained constant at 77.9 HU +/- 10.2 (standard deviation) in the LBW group with respect to TBW, but it increased in the TBW (r = 0.80, P < .001) and BV (r = 0.70, P < .001) groups as TBW increased. CONCLUSION When LBW, rather than TBW or BV, is used, the iodine dose required to achieve consistent hepatic enhancement may be estimated more precisely and with reduced patient-to-patient variability.
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Affiliation(s)
- Hiroshi Kondo
- Department of Radiology, Gifu University Hospital, 1-1 Yanagido, 501-1194 Gifu, Japan
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Wicherts DA, de Haas RJ, van Kessel CS, Bisschops RHC, Takahara T, van Hillegersberg R, Bipat S, Rinkes IHMB, van Leeuwen MS. Incremental value of arterial and equilibrium phase compared to hepatic venous phase CT in the preoperative staging of colorectal liver metastases: an evaluation with different reference standards. Eur J Radiol 2009; 77:305-11. [PMID: 19695807 DOI: 10.1016/j.ejrad.2009.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2009] [Revised: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the incremental value of arterial and equilibrium phase compared to hepatic venous phase multidetector row CT (MDCT) in the preoperative staging of colorectal liver metastases (CLM) and to determine the influence of the reference standard. MATERIALS AND METHODS Fifty-three consecutive CLM patients underwent 16 detector row CT in hepatic arterial, venous, and equilibrium phase before surgery between March 2003 and January 2007. Detected lesions were characterized by three independent radiologists. The reference standard consisted of intraoperative palpation and ultrasound of the liver, and histopathological examination of the resected specimen. Additionally, data of follow-up CT was added. Statistical analysis was performed on a per-lesion basis. RESULTS According to the reference standard 251 lesions were present, of which 203 (81%) were malignant (mean size: 29.4 ± 22.5 mm), and 41 (16%) were benign (mean size: 8.3 ± 7.7 mm). Sensitivity rates for CLM were comparable between triphasic and hepatic venous phase CT (P>0.05). Sensitivity for the detection of CLM lowered from 60-77% to 52-68% when follow-up CT was added to the reference standard. CONCLUSION Arterial and equilibrium phase CT have no incremental value compared to hepatic venous phase MDCT in the detection of CLM. Sensitivity rates are, however, influenced by the type of reference standard used.
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Affiliation(s)
- Dennis A Wicherts
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Efficacy of perflubutane microbubble-enhanced ultrasound in the characterization and detection of focal liver lesions: phase 3 multicenter clinical trial. AJR Am J Roentgenol 2009; 193:86-95. [PMID: 19542399 DOI: 10.2214/ajr.08.1618] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the efficacy and safety of contrast-enhanced ultrasound performed with perflubutane microbubbles in comparison with unenhanced ultrasound and dynamic CT in the characterization of focal liver lesions during the vascular phase of imaging and in the detection of lesions during the Kupffer phase. SUBJECTS AND METHODS A total of 196 patients were enrolled at 15 centers in Japan. Vascular phase images were obtained before contrast injection until 1 minute after injection. Kupffer phase images were obtained 10 minutes after injection. Dual-phase CT was performed as determined by standard clinical practice at each center. Unenhanced ultrasound, contrast-enhanced ultrasound, and CT images were read by blinded reviewers, and the results they reached regarding characterization and detection were compared with reference standard findings made by onsite investigators. The safety observation period was 72 hours after contrast administration. RESULTS Among the 190 patients included in the characterization analysis, the accuracy of contrast-enhanced ultrasound (88.9%) was significantly greater than that of unenhanced ultrasound (68.4%) and dynamic CT (80.5%) (p < 0.001 and p = 0.008). Among the 191 patients in the detection analysis, the efficacy of contrast-enhanced ultrasound in detection of lesions was significantly higher than that of unenhanced ultrasound and dynamic CT (p < 0.001 and p = 0.008), predominantly because more metastatic lesions were detected (both p < 0.001). In particular, contrast-enhanced ultrasound was superior to dynamic CT in the detection of metastatic lesions measuring 1 cm or smaller. The incidence of adverse events was 49.2% and that of adverse drug reactions was 10.4%. All adverse drug reactions were mild. CONCLUSION Compared with unenhanced ultrasound and dynamic CT, contrast-enhanced ultrasound with perflubutane microbubbles improved diagnostic efficacy in both characterization and detection of focal liver lesions with no serious adverse drug reactions.
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Meijerink MR, van Waesberghe JHTM, Golding RP, van der Weide L, van den Tol P, Meijer S, van Kuijk C. Subtraction-multiphase-CT unbeneficial for early detection of colorectal liver metastases. Eur J Radiol 2009; 74:e132-7. [PMID: 19515521 DOI: 10.1016/j.ejrad.2009.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Revised: 03/30/2009] [Accepted: 05/07/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the value of multiphase-subtraction-CT for early detection of colorectal-liver-metastases (CRLM). METHODS AND MATERIALS In 50 patients suspected of CRLM a routine pre-operative 4-phase-CT-scan of the upper abdomen was obtained. All 12 possible image subtractions between two different phases were constructed applying 3D-image-registration to decrease distortion artefacts induced by differences in inspiration volume. Two experienced radiologists initially reviewed the conventional 4-phase-CT for malignant and/or benign appearing lesions and at least 1-month hereafter the same 4-phase-CT now including the subtracted images. The results were compared to histology reports or to a combination of surgical exploration and intraoperative ultrasound together with results from pre-operative PET and follow-up examinations. RESULTS Although an additional number of 31 malignant appearing lesions were detected on the subtraction images, none proved to represent a true CRLM. Interobserver agreement (kappa) decreased from 0.627 (good) to 0.418 (fair). CONCLUSION Adding linearly co-registered subtraction-CT images to a conventional 4-phase-CT protocol does not improve detection of CRLM.
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Affiliation(s)
- Martijn R Meijerink
- Department of Radiology, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands.
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Endoscopic ultrasound versus CT scan for detection of the metastases to the liver: results of a prospective comparative study. J Clin Gastroenterol 2009; 43:367-73. [PMID: 18981929 DOI: 10.1097/mcg.0b013e318167b8cc] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Computed tomography (CT) scan is a standard test for the detection of the liver metastases; however, metastases are often missed on the CT scan. OBJECTIVE To compare the accuracy of the endoscopic ultrasound (EUS)/endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with CT scan for detection of the liver metastases. DESIGN Prospective study. PATIENTS Subjects with newly diagnosed tumors of the lung, pancreas, biliary tree, esophagus, stomach, and colon were enrolled. INTERVENTIONS A CT scan and EUS examination of the liver was performed. EUS-FNA was performed on noncystic liver lesions. RESULTS One hundred thirty-two cases were enrolled. The presence of liver metastasis was established in 26 cases. The diagnostic accuracy of EUS/EUS-FNA and CT scan was 98% and 92%, respectively (P=0.0578). In comparison to CT scan, EUS detected significantly higher number of metastatic lesions in the liver (40 vs.19; P=0.008). CT scan detected lesions in liver that were too small to be characterized in 8 cases (malignant-3; benign-5). Of these, EUS-FNA correctly characterized the lesion to be malignant in 3/3 cases and benign in 4/5 cases. No complications were observed as a result of EUS-FNA. LIMITATIONS Endoscopist was not blinded to the findings of the CT scan. CONCLUSIONS In comparison with the CT scan, there was trend in favor of EUS/EUS-FNA for the superior diagnostic accuracy. EUS was distinctly superior to the CT scan in detecting the number of metastatic lesions. EUS-FNA was also useful to identify the nature of lesions that were too small to be characterized on the CT scan.
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Kondo H, Kanematsu M, Goshima S, Tomita Y, Miyoshi T, Hatcho A, Moriyama N, Onozuka M, Shiratori Y, Bae KT. Abdominal Multidetector CT in Patients with Varying Body Fat Percentages: Estimation of Optimal Contrast Material Dose. Radiology 2008; 249:872-7. [DOI: 10.1148/radiol.2492080033] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Magnetic resonance imaging of the liver: consensus statement from the 1st International Primovist User Meeting. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s10406-008-0010-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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