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Tachibana Y, Otsuka K, Shiroo T, Asayama Y. Equilibrium phase images of the liver using a contrast-enhancement boost instead of the portal vein phase. World J Radiol 2025; 17:102462. [DOI: 10.4329/wjr.v17.i2.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 01/22/2025] [Accepted: 02/14/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND Three-phase dynamic computed tomography imaging is particularly useful in the liver region. However, dynamic imaging with contrast media has the disadvantage of increased radiation exposure due to multiple imaging sessions. We hypothesized that the contrast enhancement boost (CE-boost) technique could be used to enhance the contrast in equilibrium phase (EP) images and produce enhancement similar to that of portal vein phase (PVP) images, and if this is possible, EP imaging could play the same role as PVP imaging. We also speculated that this might allow the conversion of three-phase dynamic imaging to biphasic dynamic imaging, reducing patients’ radiation exposure.
AIM To determine if the CE-boost of EP, CE-boost (EP) is useful compared to a conventional image.
METHODS We retrospectively analyzed the cases of 52 patients who were diagnosed with liver cancer between January 2016 and October 2022 at our institution. From these computed tomography images, CE-boost images were generated from the EP and plane images. We compared the PVP, EP, and CE-boost (EP) for blood vessels and hepatic parenchyma based on the contrast-to-noise ratio (CNR), signal-to-noise ratio, and figure-of-merit (FOM). Visual assessments were also performed for vessel visualization, lesion conspicuity, and image noise.
RESULTS The CE-boost (EP) images showed significant superiority compared to the PVP images in the CNR, signal-to-noise ratio, and FOM except regarding the hepatic parenchyma. No significant differences were detected in CNR or FOM comparisons within the hepatic parenchyma (P = 0.62, 0.67). The comparison of the EP and CE-boost (EP) images consistently favored CE-boost (EP). Regarding the visual assessment, the CE-boost (EP) images were significantly superior to the PVP images in lesion conspicuity, and the PVP in image noise. The CE-boost (EP) images were significantly better than the EP images in the vessel visualization of segmental branches of the portal vein and lesion conspicuity, and the EP in image noise.
CONCLUSION The image quality of CE-boost (EP) images was comparable or superior to that of conventional PVP and EP. CE-boost (EP) images might provide information comparable to the conventional PVP.
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Affiliation(s)
- Yuji Tachibana
- Department of Radiological Sciences, Faculty of Medicine, Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
| | - Kenichiro Otsuka
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
| | - Tomoaki Shiroo
- Department of Radiology, Division of Medical Technology, Oita University Hospital, Yufu 879-5593, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
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Tachibana Y, Takaji R, Shiroo T, Asayama Y. Deep-learning reconstruction with low-contrast media and low-kilovoltage peak for CT of the liver. Clin Radiol 2024; 79:e546-e553. [PMID: 38238148 DOI: 10.1016/j.crad.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 03/09/2024]
Abstract
AIM To compare images using reduced CM, low-kVp scanning and DLR reconstruction with conventional images (no CM reduction, normal tube voltage, reconstructed with HBIR. To compare images using reduced contrast media (CM), low kilovoltage peak (kVp) scanning and deep-learning reconstruction (DLR) with conventional image quality (no CM reduction, normal tube voltage, reconstructed with hybrid-type iterative reconstruction method [HBIR protocol]). MATERIALS AND METHODS A retrospective analysis was performed on 70 patients with liver disease and three-phase dynamic imaging using computed tomography (CT) from April 2020 to March 2022 at Oita University Hospital. Of these cases, 39 were reconstructed using the DLR protocol at a tube voltage of 80 kVp and CM of 300 mg iodine/kg while 31 were imaged at a tube voltage of 120 kVp with CM of 600 mg iodine/kg and were reconstructed by the usual HBIR protocol. Images from the DLR and HBIR protocols were analysed and compared based on the contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), figure-of-merit (FOM), and visual assessment. The CT dose index (CTDI)vol and size-specific dose estimates (SSDE) were compared with respect to radiation dose. RESULTS The DLR protocol was superior, with significant differences in CNR, SNR, and FOM except hepatic parenchyma in the arterial phase. For visual assessment, the DLR protocol had better values for vascular visualisation for the portal vein, image noise, and contrast enhancement of the hepatic parenchyma. Regarding comparison of the radiation dose, the DLR protocol was superior for all values of CTDIvol and SSDE, with significant differences (p<0.01; max. 52%). CONCLUSION Protocols using DLR with reduced CM and low kVp have better image quality and lower radiation dose compared to protocols using conventional HBIR.
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Affiliation(s)
- Y Tachibana
- Graduate School of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - R Takaji
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - T Shiroo
- Radiology Department, Division of Medical Technology, Oita University Hospital, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - Y Asayama
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan.
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Bongers MN, Walter S, Fritz J, Bier G, Horger M, Artzner C. Interindividual Comparison of Frequency-Selective Nonlinear Blending to Conventional CT for Detection of Focal Liver Lesions Using MRI as the Reference Standard. AJR Am J Roentgenol 2022; 218:1021-1029. [PMID: 35018796 DOI: 10.2214/ajr.21.26922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Diagnosing liver lesions is challenging. CT is used for primary diagnosis, but its contrast resolution is limited. Investigating methods to improve detection of liver lesions is important. OBJECTIVE. The purpose of this study was to evaluate the effect of frequency-selective nonlinear blending on the detectability of liver lesions on CT. METHODS. A retrospective search yielded 109 patients with 356 malignant and benign liver lesions (191 principally diagnosed, 165 incidental findings) who underwent contrast-enhanced CT (CECT) in the portal venous phase and liver MRI between January 2012 and December 2017. Nonlinear blending was applied to CECT examinations, and three blinded readers independently rated the quality (5-point Likert scale) of randomly presented images. Focal lesions (n = 356) were evaluated for lesion identification and categorization to assess sensitivity. For 191 lesions (primary diagnosis), two readers evaluated CECT and nonlinear blending CT to compare lesion size and the accuracy of subjective measurements. A fourth reader performed ROI measurements for calculation of contrast-to-noise ratio (CNR), and a fifth reader reviewed MRI as the standard of reference. Statistics included interobserver agreement, quantitative comparisons of CNR, lesion size, and subjective image analyses of image quality and sensitivity for detecting liver lesions. RESULTS. Three readers rated the image quality of nonlinear blending CT (rating, 4; 10th-90th percentiles, 4-5) higher than that of CECT (rating, 2; 10th-90th percentiles, 1-3) (p < .001). CECT had good interreader agreement (interclass correlation coefficient [ICC], 0.81; 95% CI, 0.76-0.85), as did nonlinear blending CT (ICC, 0.75; 95% CI, 0.69-0.79). The median CNR of liver lesions increased with nonlinear blending (CECT, 4.18 [10th-90th percentiles, 1.67-9.06]; nonlinear blending CT, 12.49 [10th-90th percentiles, 6.18-23.39]; p < .001). Bland-Altman analysis of lesion size showed a reduction in underestimation from 2.5 (SD, 9.2) mm (95% CI, 1.2-3.9 mm) with CECT to 0.1 (SD, 3.9) mm (95% CI, -0.68 to 0.46 mm) for nonlinear blending CT (concordance correlation coefficient, 0.99). Sensitivity for detecting liver lesions increased to 86% for nonlinear blending CT. The sensitivity of CECT was 76%. CONCLUSION. Frequency-selective nonlinear blending in CECT increases image quality and CNR, increases the precision of size measurement, and increases sensitivity for detecting liver lesions. CLINICAL IMPACT. Use of nonlinear blending CT improves liver lesion detection and increases the accuracy of lesion size measurement, which is important when local ablation or liver transplant is being considered.
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Affiliation(s)
- Malte N Bongers
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str 3, Tübingen 72076, Germany
| | - Sven Walter
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str 3, Tübingen 72076, Germany
- Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Jan Fritz
- Department of Radiology, NYU Grossman School of Medicine, New York, NY
| | - Georg Bier
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str 3, Tübingen 72076, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str 3, Tübingen 72076, Germany
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Str 3, Tübingen 72076, Germany
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Korngold EK, Moreno C, Kim DH, Fowler KJ, Cash BD, Chang KJ, Gage KL, Gajjar AH, Garcia EM, Kambadakone AR, Liu PS, Macomber M, Marin D, Pietryga JA, Santillan CS, Weinstein S, Zreloff J, Carucci LR. ACR Appropriateness Criteria® Staging of Colorectal Cancer: 2021 Update. J Am Coll Radiol 2022; 19:S208-S222. [PMID: 35550803 DOI: 10.1016/j.jacr.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/19/2022]
Abstract
Preoperative imaging of rectal carcinoma involves accurate assessment of the primary tumor as well as distant metastatic disease. Preoperative imaging of nonrectal colon cancer is most beneficial in identifying distant metastases, regardless of primary T or N stage. Surgical treatment remains the definitive treatment for colon cancer, while organ-sparing approach may be considered in some rectal cancer patients based on imaging obtained before and after neoadjuvant treatment. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Elena K Korngold
- Oregon Health and Science University, Portland, Oregon; Section Chief, Body Imaging; Chair, P&T Committee; Modality Chief, CT.
| | - Courtney Moreno
- Emory University, Atlanta, Georgia; Chair America College of Radiology CT Colonography Registry Committee
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin; Vice Chair of Education (University of Wisconsin Dept of Radiology)
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California; ACR LI-RADS Working Group Chair
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association; Chief of GI, UTHealth
| | - Kevin J Chang
- Boston University Medical Center, Boston, Massachusetts; Director of MRI, Associate Chief of Abdominal Imaging; ACR Chair of Committee on C-RADS
| | - Kenneth L Gage
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Aakash H Gajjar
- PRiSMA Proctology Surgical Medicine & Associates, Houston, Texas; American College of Surgeons
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Avinash R Kambadakone
- Massachusetts General Hospital, Boston, Massachusetts; Division Chief, Abdominal Imaging, Massachusetts General Hospital; Medical Director, Martha's Vineyard Hospital Imaging
| | - Peter S Liu
- Cleveland Clinic, Cleveland, Ohio; Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland OH
| | | | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | - Cynthia S Santillan
- University of California San Diego, San Diego, California; Vice Chair of Clinical Operations for Department of Radiology
| | - Stefanie Weinstein
- University of California San Francisco, San Francisco, California; Associate Chief of Radiology, San Francisco VA Health Systems
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia; Director MR and CT at VCUHS; Section Chief Abdominal Imaging VCUHS
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Evaluation of celiac disease with uniphasic and multiphasic dynamic MDCT imaging. Abdom Radiol (NY) 2021; 46:5564-5573. [PMID: 34415409 DOI: 10.1007/s00261-021-03253-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE An analysis of dynamic contrast MRI has been shown to provide valuable information about disease activity in Crohn's disease and Celiac disease (CD). However, there are no reports of dynamic multi-detector computer tomography use in patients with CD. The aim of this study is to determine and compare the perfusion dynamics of the patients treated with control subjects and the perfusion dynamics in patients with untreated CD, using dynamic contrast in MDCT and compare studying contrast dynamics in Marsh types as well. METHODS In this retrospective study, uniphasic and multiphasic MDCT, untreated, treated, incompatible CD patients and healthy control group duodenum wall thickness and HU values were compared in terms of patient groups and modified Marsh types. RESULT In dynamic CT, the highest contrast curve was observed in the untreated group and Marsh type 1. While the contrast curve of the untreated and non-compliant patients increased rapidly and showed wash out, the type 4 contrast curve was observed, whereas the treated and control group slowly increased type 5 contrast curve. In the contrast-enhanced CT in the venous phase, in the ROC analysis between Marsh 1-2 and Marsh 3a-c, the sensitivity was 97% and the specificity was 87% when the cut off was taken as 4.45 mm for wall thickness (p: 0.005). CONCLUSION Contrast-enhanced single-phase and dynamic MDCT imaging in CD patients may be useful in evaluating the inflammatory and pathological process in the small intestine.
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Nagayama Y, Iyama A, Oda S, Taguchi N, Nakaura T, Utsunomiya D, Kikuchi Y, Yamashita Y. Dual-layer dual-energy computed tomography for the assessment of hypovascular hepatic metastases: impact of closing k-edge on image quality and lesion detectability. Eur Radiol 2018; 29:2837-2847. [PMID: 30377793 DOI: 10.1007/s00330-018-5789-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/17/2018] [Accepted: 09/21/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the image quality of virtual-monoenergetic-imaging (VMI) from dual-layer dual-energy CT (DLCT) for the assessment of hypovascular liver metastases and its effect on lesion detectability. METHODS Eighty-one patients with hypovascular-liver-metastases undergoing portal-venous-phase abdominal DLCT were included. Polyenergetic-images (PEI) and VMI at 40-200 keV (VMI40-200, 10-keV interval) were reconstructed. Image noise, tumor-to-liver contrast, and contrast-to-noise ratio (CNR) of hepatic parenchyma and metastatic nodules (n = 288) were measured to determine the optimal monoenergetic levels. Two radiologists independently and subjectively assessed the image quality (image contrast, image noise, and diagnostic confidence) of PEI and optimal VMI on 5-point scales to determine the best energy. For 38 patients having up to 10 metastases each with diameters < 25 mm (153 lesions), we compared blindly assessed lesion detectability and conspicuity between PEI and VMI at the best energy. RESULTS Image noise of VMI40-200 was consistently lower than that of PEI (p < 0.01). Tumor-to-liver contrast and CNR increased as the energy decreased with CNR at VMI40-70 being higher than that observed on PEI (p < 0.01). The highest subjective score for diagnostic confidence was assigned at VMI40 followed by VMI50-70, all of which were significantly better than that of PEI (p < 0.01, kappa = 0.75). Lesion detectability at VMI40 was significantly superior to PEI, especially for lesions with diameters of < 10 mm (p < 0.01, kappa ≥ 0.6). CONCLUSIONS VMI40-70 provided a better subjective and objective image quality for the evaluation of hypovascular liver metastases, and the lesion detectability was improved with use of VMI40 compared with conventional PEI. KEY POINTS • DLCT-VMI at 40-70 keV provides a superior subjective and objective image quality compared with conventional PEI for the assessment of hypovascular hepatic metastases during portal venous phase. • Tumor-to-liver contrast and CNR of hypovascular hepatic metastases was maximized at 40 keV without a relevant increase in the image noise. • VMI at 40 keV yields a superior lesion detectability, especially for small (< 1 cm) metastatic nodules compared with conventional PEI.
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Affiliation(s)
- Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
| | - Ayumi Iyama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Narumi Taguchi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yoko Kikuchi
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
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Fowler KJ, Kaur H, Cash BD, Feig BW, Gage KL, Garcia EM, Hara AK, Herman JM, Kim DH, Lambert DL, Levy AD, Peterson CM, Scheirey CD, Small W, Smith MP, Lalani T, Carucci LR. ACR Appropriateness Criteria ® Pretreatment Staging of Colorectal Cancer. J Am Coll Radiol 2018; 14:S234-S244. [PMID: 28473079 DOI: 10.1016/j.jacr.2017.02.012] [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] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 12/17/2022]
Abstract
Colorectal cancers are common tumors in the United States and appropriate imaging is essential to direct appropriate care. Staging and treatment differs between tumors arising in the colon versus the rectum. Local staging for colon cancer is less integral to directing therapy given radical resection is often standard. Surgical options for rectal carcinoma are more varied and rely on accurate assessment of the sphincter, circumferential resection margins, and peritoneal reflection. These important anatomic landmarks are best appreciated on high-resolution imaging with transrectal ultrasound or MRI. When metastatic disease is suspected, imaging modalities that provide a global view of the body, such as CT with contrast or PET/CT may be indicated. Rectal cancer often metastasizes to the liver and so MRI of the liver with and without contrast provides accurate staging for liver metastases. This article focuses on local and distant staging and reviews the appropriateness of different imaging for both variants. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Kathryn J Fowler
- Principal Author, Mallinckrodt Institute of Radiology, Saint Louis, Missouri.
| | - Harmeet Kaur
- Co-author, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Brooks D Cash
- University of South Alabama, Mobile, Alabama; American Gastroenterological Association
| | - Barry W Feig
- University of Texas MD Anderson Cancer Center, Houston, Texas; American College of Surgeons
| | | | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Joseph M Herman
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, Maryland
| | - David H Kim
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Drew L Lambert
- University of Virginia Health System, Charlottesville, Virginia
| | - Angela D Levy
- Georgetown University Hospital, Washington, District of Columbia
| | | | | | - William Small
- Stritch School of Medicine Loyola University Chicago, Maywood, Illinois
| | - Martin P Smith
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tasneem Lalani
- Speciality Chair, Inland Imaging Associates and University of Washington, Seattle, Washington
| | - Laura R Carucci
- Panel Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Kessler DE, Weiss J, Rempp H, Pereira PL, Nikolaou K, Clasen S, Hoffmann R. In vitro artifact assessment of an MR-compatible, microwave antenna device for percutaneous tumor ablation with fluoroscopic MRI-sequences. MINIM INVASIV THER 2017; 27:60-68. [PMID: 29231067 DOI: 10.1080/13645706.2017.1414062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate artifact configuration and diameters of a magnetic resonance (MR) compatible microwave (MW) applicator using near-realtime MR-fluoroscopic sequences for percutaneous tumor ablation procedures. MATERIAL AND METHODS Two MW applicators (14 G and 16 G) were tested in an ex-vivo phantom at 1.5 T with two 3 D fluoroscopic sequences: T1-weighted spoiled Gradient Echo (GRE) and T1/T2-weighted Steady State Free Precession (SSFP) sequence. Applicator orientation to main magnetic field (B0), slice orientation and phase encoding direction (PED) were systematically varied. The influence of these variables was assessed with ANOVA and post-hoc testing. RESULTS The artifact was homogenous along the whole length of both antennas with all tested parameters. The tip artifact diameter of the 16 G antenna measured 6.9 ± 1.0 mm, the shaft artifact diameter 8.6 ± 1.2 mm and the Tip Location Error (TLE) was 1.5 ± 1.2 mm.The tip artifact diameter of the 14 G antenna measured 7.7 ± 1.2 mm, the shaft artifact diameter 9.6 ± 1.5 mm and TLE was 1.6 ± 1.2 mm. Orientation to B0 had no statistically significant influence on tip artifact diameters (16 G: p = .55; 14 G: p = .07) or TLE (16 G: p = .93; 14 G: p = .26). GRE sequences slightly overestimated the antenna length with TLE(16 G) = 2.6 ± 0.5 mm and TLE(14 G) = 2.7 ± 0.7 mm. CONCLUSIONS The MR-compatible MW applicator's artifact seems adequate with an acceptable TLE for safe applicator positioning during near-realtime fluoroscopic MR-guidance.
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Affiliation(s)
- David-Emanuel Kessler
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Jakob Weiss
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Hansjörg Rempp
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Philippe L Pereira
- b Department of Radiology, Minimally Invasive Therapies and Nuclear Medicine , SLK-Kliniken Heilbronn , Heilbronn , Germany
| | - Konstantin Nikolaou
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Stephan Clasen
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
| | - Rüdiger Hoffmann
- a Department of Diagnostic and Interventional Radiology , Eberhard Karls University , Tuebingen , Germany
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Zhang X, Li S, Liu W, Huang N, Li J, Cheng L, Xu K. Double-low protocol for hepatic dynamic CT scan: Effect of low tube voltage and low-dose iodine contrast agent on image quality. Medicine (Baltimore) 2016; 95:e4004. [PMID: 27368012 PMCID: PMC4937926 DOI: 10.1097/md.0000000000004004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The radiation-induced carcinogenesis from computed tomography (CT) and iodine contrast agent induced nephropathy has attracted international attention. The reduction of the radiation dose and iodine intake in CT scan is always a direction for researchers to strive. The purpose of this study was to evaluate the feasibility of a "double-low" (i.e., low tube voltage and low-dose iodine contrast agent) scanning protocol for dynamic hepatic CT with the adaptive statistical iterative reconstruction (ASIR) in patients with a body mass index (BMI) of 18.5 to 27.9 kg/m.A total of 128 consecutive patients with a BMI between 18.5 and 27.9 kg/m were randomly assigned into 3 groups according to tube voltage, iodine contrast agent, and reconstruction algorithms. Group A (the "double-low" protocol): 100 kVp tube voltage with 40% ASIR, iodixanol at 270 mg I/mL, group B: 120 kVp tube voltage with filtered back projection (FBP), iodixanol at 270 mg I/ mL, and group C: 120 kVp tube voltage with FBP, ioversol at 350 mg I/ mL.The volume CT dose index (CTDIvol) and effective dose (ED) in group A were lower than those in group B and C (all P < 0.01). The iodine intake in group A was decreased by approximately 26.5% than group C, whereas no statistical difference was observed between group A and B (P > 0.05). There was no significant difference of the CT values between group A and C (P > 0.05), which both showed higher CT values than that in group B (P < 0.001). However, no statistic difference was observed in the contrast-to-noise ratio (CNR), the signal-to-noise ratio (SNR), and image-quality scores among the 3 groups (all P > 0.05). Near-perfect consistency of the evaluation for group A, B, and C (Kenall's W = 0.921, 0.874, and 0.949, respectively) was obtained by the 4 readers with respect to the overall image quality.These results suggested that the "double-low" protocol with ASIR algorithm for multi-phase hepatic CT scan can dramatically decrease radiation dose and iodine intake with adequate image quality in patients with BMI of 18.5 to 27.9 kg/m.
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Affiliation(s)
- Xiuli Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Shaodong Li
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Wenlou Liu
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan
| | | | - Jingjing Li
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
- School of Medical Imaging, Xuzhou Medical University, Xuzhou
| | - Li Cheng
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
- School of Medical Imaging, Xuzhou Medical University, Xuzhou
- Correspondence: Kai Xu, Department of Radiology, Affiliated Hospital of Xuzhou Medical University, School of Medical Imaging, Xuzhou Medical University, No. 99 West Huai-hai Road, Xuzhou 221004, China (e-mail: )
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Öztürk H. Comparing RECIST with EORTC criteria in metastatic bladder cancer. J Cancer Res Clin Oncol 2016; 142:187-94. [PMID: 26208817 DOI: 10.1007/s00432-015-2022-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 07/16/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare RECIST and EORTC criteria in an evaluation of response to therapy in metastatic bladder cancer and to assess their influence on decisions to administer additional therapy. MATERIALS AND METHODS A total of 42 untreated patients (38 male, 4 female) with metastatic bladder cancer were included in the study, which took place between July 2007 and April 2013. The mean age was 66.1 ± 9.93 years (range 41-84 years). A total of 144 metastatic foci were evaluated using multislice CT and (18)FDG-PET/CT before and after first-line chemotherapy. The locations, sizes, numbers and SUV(max) of the metastatic foci before and after chemotherapy were recorded, and the response to therapy was evaluated separately using RECIST and EORTC criteria, after which a statistical comparison was made. RESULTS According to the RECIST and EORTC criteria, the rate of complete remission (CR) was 9.5 and 16.6 %, the rate of partial remission (PR) was 28.6 and 40.5 %, the rate of stable disease (SD) was 23.8 and 14.3 %, and the rate of progressive disease (PD) was 31.0 and 28.6 %, respectively. The overall response rate (ORR) was 38.1 versus 57.1 %, respectively, and there were no differences between the two criteria in terms of their detection of progressive disease. The rate of SD was higher with RECIST criteria; however, the difference between the two criteria was not significant in terms of PR and CR. CONCLUSION A group of patients that had been determined as having a SD according to RECIST criteria were grouped as PR and/or CR according to EORTC criteria. Additional chemotherapy protocols can be used in second-line chemotherapy and/or cisplatin-resistant patients, according to RECIST criteria. In evaluating the response to first-line chemotherapy for metastatic bladder cancer, EORTC criteria, using (18)FDG-PET/CT scans, can be considered as a more applicable and accurate diagnostic tool. The anatomical findings obtained through imaging methods and from functional/metabolic data obtained by PET/CT can be useful in the planning of second- or third-line chemotherapy, and a high accuracy in re-staging can spare patients from second-line or even third-line chemotherapy.
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, School of Medicine, Sifa University, Izmir, Turkey.
- Basmane Hospital of Sifa University, Fevzipasa Boulevard No: 172/2, Basmane, 35240, Konak, Izmir, Turkey.
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Nakamoto A, Kim T, Hori M, Onishi H, Tsuboyama T, Sakane M, Tatsumi M, Tomiyama N. Clinical evaluation of image quality and radiation dose reduction in upper abdominal computed tomography using model-based iterative reconstruction; comparison with filtered back projection and adaptive statistical iterative reconstruction. Eur J Radiol 2015; 84:1715-23. [DOI: 10.1016/j.ejrad.2015.05.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Imaging Approach to Hepatocellular Carcinoma, Cholangiocarcinoma, and Metastatic Colorectal Cancer. Surg Oncol Clin N Am 2015; 24:19-40. [DOI: 10.1016/j.soc.2014.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Kim HJ, Lee SS, Byun JH, Kim JC, Yu CS, Park SH, Kim AY, Ha HK. Incremental value of liver MR imaging in patients with potentially curable colorectal hepatic metastasis detected at CT: a prospective comparison of diffusion-weighted imaging, gadoxetic acid-enhanced MR imaging, and a combination of both MR techniques. Radiology 2014; 274:712-22. [PMID: 25286324 DOI: 10.1148/radiol.14140390] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To prospectively compare diagnostic performance of diffusion-weighted (DW) imaging, gadoxetic acid-enhanced magnetic resonance (MR) imaging, both techniques combined (combined MR imaging), and computed tomography (CT) for detecting colorectal hepatic metastases and evaluate incremental value of MR for patients with potentially curable colorectal hepatic metastases detected with CT. MATERIALS AND METHODS In this institutional review board-approved prospective study, with informed consent, 51 patients (39 men, 12 women; mean age, 62 years) with potentially resectable hepatic metastases detected with CT underwent liver MR, including DW imaging and gadoxetic acid-enhanced MR. Two independent readers reviewed DW, gadoxetic acid-enhanced, combined MR, and CT image sets to detect hepatic metastases. The figure-of-merit (FOM) value representing overall diagnostic performance, sensitivity, and positive predictive value (PPV) for each image set were analyzed by using free-response receiver operating characteristic analysis and generalized estimating equations. RESULTS There were 104 hepatic metastases in 47 patients. The pooled FOM values, sensitivities, and PPVs of combined MR (FOM value, 0.93; sensitivity, 98%; and PPV, 88%) and gadoxetic acid-enhanced MR (FOM value, 0.92; sensitivity, 95%; and PPV, 90%) were significantly higher than those of CT (FOM value, 0.82; sensitivity, 85%; and PPV, 73%) (P < .006). The pooled FOM value and sensitivity of combined MR (FOM value, 0.92; sensitivity, 95%) was also significantly higher than that of DW imaging (FOM value, 0.82; sensitivity, 79%) for metastases (≤1-cm diameter) (P ≤ .003). DW imaging showed significantly higher pooled sensitivity (79%) and PPV (60%) than CT (sensitivity, 50%; PPV, 33%) for the metastases (≤1-cm diameter) (P ≤ .004). In 47 patients with hepatic metastases, combined MR depicted more metastases than CT in 10 and 14 patients, respectively, according to both readers. CONCLUSION Gadoxetic acid-enhanced MR and combined MR are more accurate than CT in detecting colorectal hepatic metastases, have an incremental value when added to CT alone for detecting additional metastases, and can be routinely performed in patients with potentially curable hepatic metastases detected with CT.
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Affiliation(s)
- Hye Jin Kim
- From the Department of Radiology and Research Institute of Radiology (H.J.K., S.S.L., J.H.B., S.H.P., A.Y.K., H.K.H.) and Department of Surgery (J.C.K., C.S.Y.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songa-Gu, Seoul 138-736, Korea
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Cooper A, Aloia TA. Managing Disappearing Liver Metastases Following Chemotherapy. CURRENT COLORECTAL CANCER REPORTS 2014. [DOI: 10.1007/s11888-014-0215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Preoperative evaluation of colorectal liver metastases: comparison of gadopentetate dimeglumine and gadoxetic-acid-enhanced 1.5-T MRI. Clin Imaging 2014; 38:273-8. [PMID: 24559747 DOI: 10.1016/j.clinimag.2013.12.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 12/16/2013] [Accepted: 12/31/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to compare the diagnostic performance of gadopentetate dimeglumine and gadoxetic-acid-enhanced MRI in patients with colorectal liver metastases. METHODS Thirty patients were included and divided into three sets, as follows: gadopentetate dimeglumine set-hepatic arterial phase, portal venous phase, and delay phase; gadoxetic acid set-hepatic arterial phase, portal venous phase, and delay phase; combined set-gadoxetic acid set and hepatobiliary phase. The accuracy was assessed by the area under the alternative-free response receiver operating characteristic curve; the sensitivity and positive predictive value were calculated. RESULTS There were 81 colorectal liver metastases in all. Both readers noted higher diagnostic accuracies of the combined set than the other two sets. In the group of small lesions, both readers detected significantly higher sensitivities and positive predictive value on the combined set than the other two sets. CONCLUSIONS The combined set showed higher accuracy and sensitivity, especially significantly higher accuracy and sensitivity on small lesions.
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Lee KH, Lee JM, Park JH, Kim JH, Park HS, Yu MH, Yoon JH, Han JK, Choi BI. MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent gadoxetic acid. Korean J Radiol 2013; 14:894-904. [PMID: 24265564 PMCID: PMC3835636 DOI: 10.3348/kjr.2013.14.6.894] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/04/2013] [Indexed: 12/16/2022] Open
Abstract
Objective To compare the diagnostic performance of gadoxetic acid-enhanced magnetic resonance (MR) imaging with that of triple-phase multidetector-row computed tomography (MDCT) in the detection of liver metastasis. Materials and Methods Our institutional review board approved this retrospective study and waived informed consent. The study population consisted of 51 patients with hepatic metastases and 62 patients with benign hepatic lesions, who underwent triple-phase MDCT and gadoxetic acid-enhanced MRI within one month. Two radiologists independently and randomly reviewed MDCT and MRI images regarding the presence and probability of liver metastasis. In order to determine additional value of hepatobiliary-phase (HBP), the dynamic-MRI set alone and combined dynamic-and-HBP set were evaluated, respectively. The standard of reference was a combination of pathology diagnosis and follow-up imaging. For each reader, diagnostic accuracy was compared using the jackknife alternative free-response receiver-operating-characteristic (JAFROC). Results For both readers, average JAFROC figure-of-merit (FOM) was significantly higher on the MR image sets than on the MDCT images: average FOM was 0.582 on the MDCT, 0.788 on the dynamic-MRI set and 0.847 on the combined HBP set, respectively (p < 0.0001). The differences were more prominent for small (≤ 1 cm) lesions: average FOM values were 0.433 on MDCT, 0.711 on the dynamic-MRI set and 0.828 on the combined HBP set, respectively (p < 0.0001). Sensitivity increased significantly with the addition of HBP in gadoxetic acid-enhanced MR imaging (p < 0.0001). Conclusion Gadoxetic acid-enhanced MRI shows a better performance than triple-phase MDCT for the detection of hepatic metastasis, especially for small (≤ 1 cm) lesions.
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Affiliation(s)
- Kyung Hee Lee
- Division of Abdominal Imaging, Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
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Takumi K, Fukukura Y, Nagasato K, Nakajo M, Natsugoe S, Higashi M. Intrahepatic bile duct adenoma mimicking hepatic metastasis: case report and review of the literature. Magn Reson Med Sci 2013; 12:141-5. [PMID: 23666160 DOI: 10.2463/mrms.2012-0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We present a case of bile duct adenoma that mimicked hepatic metastasis from gastric cancer. The adenoma exhibited prolonged enhancement on dynamic computed tomography, hyperintensity on diffusion-weighted imaging, and diminished uptake of superparamagnetic iron oxide and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid on magnetic resonance imaging, resembling those of adenocarcinomas. Knowledge of the imaging findings of this rare entity may aid correct diagnosis.
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Affiliation(s)
- Koji Takumi
- Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima 890-8544, Japan.
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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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Onishi H, Murakami T, Kim T, Hori M, Osuga K, Tatsumi M, Higashihara H, Maeda N, Tsuboyama T, Nakamoto A, Tomoda K, Tomiyama N. Abdominal multi-detector row CT: Effectiveness of determining contrast medium dose on basis of body surface area. Eur J Radiol 2011; 80:643-7. [DOI: 10.1016/j.ejrad.2010.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 08/18/2010] [Accepted: 08/26/2010] [Indexed: 10/19/2022]
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Muhi A, Ichikawa T, Motosugi U, Sou H, Nakajima H, Sano K, Sano M, Kato S, Kitamura T, Fatima Z, Fukushima K, Iino H, Mori Y, Fujii H, Araki T. Diagnosis of colorectal hepatic metastases: Comparison of contrast-enhanced CT, contrast-enhanced US, superparamagnetic iron oxide-enhanced MRI, and gadoxetic acid-enhanced MRI. J Magn Reson Imaging 2011; 34:326-35. [DOI: 10.1002/jmri.22613] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Chung WS, Kim MJ, Chung YE, Kim YE, Park MS, Choi JY, Kim KW. Comparison of gadoxetic acid-enhanced dynamic imaging and diffusion-weighted imaging for the preoperative evaluation of colorectal liver metastases. J Magn Reson Imaging 2011; 34:345-53. [PMID: 21702068 DOI: 10.1002/jmri.22671] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 05/06/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To retrospectively compare the diagnostic accuracy for the detection of colorectal liver metastases between gadoxetic acid-enhanced MRI (EOB-MRI) and diffusion-weighted imaging (DWI) on 3.0 Tesla (T) system, and then to determine whether a combination of the two techniques may improve the diagnostic performance. MATERIALS AND METHODS Forty-seven patients underwent MR imaging at 3.0T, including DWI (DWI set) and dynamic and hepatobiliary phase EOB-MRI (EOB set) for the preoperative evaluation of colorectal liver metastases. All suspicious metastases were confirmed by hepatic surgery. Two blinded readers independently reviewed three different image sets, which consisted of DWI set, EOB set, and combined set. The accuracy was assessed by the area (Az) under the alternative-free response receiver operating characteristic curve, and the sensitivity and positive predictive value (PPV) were calculated. RESULTS We found a total of 78 confirmed colorectal liver metastases in 42 of 47 patients. Each reader noted higher diagnostic accuracy of combined set of EOB-MRI and DWI than DWI set and EOB set, without statistical significance. Regardless of the size of colorectal liver metastasis, each reader detected significantly more metastases on combined set than on DWI set, and PPV was significantly higher with DWI set than with EOB set or with combined set for one reader. CONCLUSION EOB-MRI was more useful for the detection of colorectal liver metastases, while DWI was more useful for their characterization. The combination of EOB-MRI and DWI showed significantly higher accuracy and sensitivity for the preoperative detection of small colorectal liver metastases than DWI.
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Affiliation(s)
- Woo-Suk Chung
- Department of Diagnostic Radiology, Institute of Gastroenterology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Imaging Evaluation in Colorectal Cancer Liver Metastases. CURRENT COLORECTAL CANCER REPORTS 2011. [DOI: 10.1007/s11888-011-0089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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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Guenette JP, Dupuy DE. Radiofrequency ablation of colorectal hepatic metastases. J Surg Oncol 2011; 102:978-87. [PMID: 21166002 DOI: 10.1002/jso.21658] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Radiofrequency ablation (RFA) may be performed intraoperatively, laparoscopically, or percutaneously. The percutaneous approach is associated with the least procedural risk and may be performed under local anesthesia. Percutaneous RFA should be considered a primary treatment option for patients with unresectable hepatic tumors or conditions that prohibit general anesthesia or abdominal surgery. Continually improving thermal ablation and imaging technologies are likely to further increase tumor ablation efficacy and expand its role in treatment of hepatic metastases.
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Affiliation(s)
- Jeffrey P Guenette
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island 02903, USA
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Maggiori L, Bretagnol F, Sibert A, Paradis V, Vilgrain V, Panis Y. Selective portal vein ligation and embolization induce different tumoral responses in the rat liver. Surgery 2010; 149:496-503. [PMID: 21167542 DOI: 10.1016/j.surg.2010.10.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 10/19/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Portal vein ligation (PVL) and portal vein embolization (PVE) are used to enhance liver volume before hepatectomy for colorectal liver metastasis (LM). Impact of such techniques on tumor growth is not well known. This experimental study aimed to assess impact of PVE and PVL on LM growth in a murine model of colorectal LM. METHODS Single macroscopic tumor was induced by injection of 0.5 × 10(6) DHD/K12 cells under the liver capsule of BDIX rats at day 0. Multiple microscopic tumors were obtained by intra-portal injection of 1 × 10(6) cells at day 7. At day 8, rats were divided in 3 groups: PVE group (selective 70% PVE), PVL group (selective 70% PVL); control group (sham laparotomy). Rats were sacrificed at day 37 (11 in PVE, 12 in PVL, and 10 rats in control groups). Liver volume and LM volumes were assessed. RESULTS Nonoccluded liver volume was larger in the PVE and PVL groups vs control group (P < .0001 and P < .0001, respectively) but showed no difference in PVE vs PVL groups (P = .08). LM volume in the occluded liver was smaller in the PVE vs control groups (P = .006) and larger in the PVL vs control groups (P = .001). LM volume in the nonoccluded liver was larger in the PVE and PVL groups vs control group (P = .010 and P = .010, respectively) but showed no difference in PVE vs PVL groups (P= .878). CONCLUSION Both PVL and PVE modify tumor growth, especially in nonoccluded lobe. These results could be of clinical importance in humans where both techniques are widely used.
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Affiliation(s)
- Léon Maggiori
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Clichy, France
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Muhi A, Ichikawa T, Motosugi U, Sou H, Nakajima H, Sano K, Kitamura T, Faima Z, Fukushima K, Araki T, Iino H, Mori Y, Fujii H. Diagnosis of colorectal hepatic metastases: Contrast-enhanced ultrasonography versus contrast-enhanced computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging with diffusion-weighted imaging. J Magn Reson Imaging 2010; 32:1132-40. [DOI: 10.1002/jmri.22360] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Assessment of liver metastases from colorectal adenocarcinoma following chemotherapy: SPIO-MRI versus FDG-PET/CT. Radiol Med 2010; 115:1087-100. [PMID: 20574703 DOI: 10.1007/s11547-010-0560-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 11/27/2009] [Indexed: 01/06/2023]
Abstract
PURPOSE This study compared superparamagnetic iron-oxide-enhanced magnetic resonance imaging (SPIO-MRI) and combined fluorodeoxyglucose positron emission tomography and computed tomography (FDG-PET/CT) in evaluating liver metastases from colorectal adenocarcinoma following chemotherapy. MATERIALS AND METHODS Nineteen patients were included in this retrospective study. SPIO-MRI and PET/CT results were compared with surgery, intraoperative ultrasound and pathology results in 11 patients and with the follow-up in eight patients. RESULTS SPIO-MRI and PET/CT identified 125 and 71 metastases, respectively. False negative lesions were 11 for SPIO-MRI and 65 for PET/CT. In the whole study population, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 92% and 52% (p<0.001) and the per-segment analysis a sensitivity of 99% and 79% (p<0.001), respectively. In patients who underwent surgery, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 85% and 58% (p<0.05) and the per-segment analysis a sensitivity of 97% and 63% (p<0.05), respectively. In patients who underwent follow-up, the per-lesion analysis of SPIO-MRI and PET/CT showed a sensitivity of 97% and 47% (p<0.001) and the per-segment analysis a sensitivity of 100% and 63% (p<0.007), respectively. For lesions ≥15 and <30 mm and for lesions <15 mm, SPIO-MRI demonstrated a higher sensitivity than PET/CT (p<0.001). CONCLUSIONS SPIO-MRI appears superior to PET/CT in evaluating liver metastases from colorectal adenocarcinoma following chemotherapy.
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Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases. Eur Radiol 2010; 20:2690-8. [DOI: 10.1007/s00330-010-1842-3] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 12/21/2022]
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Sofue K, Tsurusaki M, Miyake M, Sakurada A, Arai Y, Sugimura K. Detection of hepatic metastases by superparamagnetic iron oxide-enhanced MR imaging: prospective comparison between 1.5-T and 3.0-T images in the same patients. Eur Radiol 2010; 20:2265-73. [PMID: 20428875 DOI: 10.1007/s00330-010-1798-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To prospectively compare the diagnostic performance of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging at 3.0 T and 1.5 T for detection of hepatic metastases. METHODS A total of 28 patients (18 men, 10 women; mean age, 61 years) with 80 hepatic metastases were prospectively examined by SPIO-enhanced MR imaging at 3.0 T and 1.5 T. T1-weighted gradient-recalled-echo (GRE) images, T2*-weighted GRE images and T2-weighted fast spin-echo (SE) images were acquired. The tumour-to-liver contrast-to-noise ratio (CNR) of the lesions was calculated. Three observers independently reviewed each image. Image artefacts and overall image quality were analysed, sensitivity and positive predictive value for the detection of hepatic metastases were calculated, and diagnostic accuracy using the receiver-operating characteristics (ROC) method was evaluated. RESULTS The tumour-to-liver CNRs were significantly higher at 3.0 T. Chemical shift and motion artefact were more severe, and overall image quality was worse on T2-weighted fast SE images at 3.0 T. Overall image quality of the two systems was similar on T1-weighted GRE images and T2*-weighted GRE images. Sensitivity and area under the ROC curve for the 3.0-T image sets were significantly higher. CONCLUSION SPIO-enhanced MR imaging at 3.0 T provided better diagnostic performance for detection of hepatic metastases than 1.5 T.
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Affiliation(s)
- Keitaro Sofue
- Department of Radiology, National Cancer Center, Tokyo, Japan
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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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Floriani I, Torri V, Rulli E, Garavaglia D, Compagnoni A, Salvolini L, Giovagnoni A. Performance of imaging modalities in diagnosis of liver metastases from colorectal cancer: a systematic review and meta-analysis. J Magn Reson Imaging 2010; 31:19-31. [PMID: 20027569 DOI: 10.1002/jmri.22010] [Citation(s) in RCA: 183] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Surgery of liver metastases can be effective, and the appropriate selection of surgical candidates relies first on imaging. Different techniques are available, but information on their relative performance is unclear. The aim of this overview is to assess the imaging modality performance in the diagnosis of colorectal cancer (CRC) liver metastases. MEDLINE and EMBASE were searched for articles published from January 2000 to August 2008. Eligible trials had to be conducted on patients with diagnosis/suspicion of CRC liver metastases, comparing more than two modalities among MRI, computed tomography (CT), positron emission tomography using fluoro-18-deoxyglucose (FDG-PET), ultrasonography (US). Pooled estimates of sensitivity, specificity were calculated and pair-wise comparisons were performed. Of 6030 screened articles, 25 were eligible. Sensitivity and specificity on a per-patient basis for US, CT, MRI, and FDG-PET were 63.0% and 97.6%, 74.8% and 95.6%, 81.1% and 97.2, and 93.8% and 98.7%, respectively. On a per-lesion basis, sensitivity was 86.3%, 82.6%, 86.3%, and 86.0%, respectively. Specificity was reported in few studies. MRI showed a better sensitivity than CT in per-patient (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.47-0.99; P = 0.05) and in per-lesion analysis (OR: 0.66; 95% CI: 0.55-0.80; P < 0.0001). In per-lesion analysis, the difference was higher when liver-specific contrast agents were administered. Available evidence supports the MRI use for the detection of CRC liver metastases.
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Affiliation(s)
- Irene Floriani
- Department of Oncology, Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy.
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Choi JY, Choi JS, Kim MJ, Lim JS, Park MS, Kim JH, Chung YE. Detection of hepatic hypovascular metastases: 3D gradient echo MRI using a hepatobiliary contrast agent. J Magn Reson Imaging 2010; 31:571-8. [DOI: 10.1002/jmri.22076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Differential diagnosis between metastatic tumors and nonsolid benign lesions of the liver using ferucarbotran-enhanced MR imaging. Eur J Radiol 2010; 73:125-30. [DOI: 10.1016/j.ejrad.2008.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 08/01/2008] [Accepted: 09/24/2008] [Indexed: 11/18/2022]
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Terraz S, Cernicanu A, Lepetit-Coiffé M, Viallon M, Salomir R, Mentha G, Becker CD. Radiofrequency ablation of small liver malignancies under magnetic resonance guidance: progress in targeting and preliminary observations with temperature monitoring. Eur Radiol 2009; 20:886-97. [PMID: 19760231 DOI: 10.1007/s00330-009-1611-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 07/06/2009] [Accepted: 08/06/2009] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of magnetic resonance (MR)-guided radiofrequency (RF) ablation for small liver tumours with poor conspicuity on both contrast-enhanced ultrasonography (US) and computed tomography (CT), using fast navigation and temperature monitoring. METHODS Sixteen malignant liver nodules (long-axis diameter, 0.6-2.4 cm) were treated with multipolar RF ablation on a 1.5-T wide-bore MR system in ten patients. Targeting was performed interactively, using a fast steady-state free precession sequence. Real-time MR-based temperature mapping was performed, using gradient echo-echo planar imaging (GRE-EPI) and hardware filtering. MR-specific treatment data were recorded. The mean follow-up time was 19 +/- 7 months. RESULTS Correct placement of RF electrodes was obtained in all procedures (image update, <500 ms; mean targeting time, 21 +/- 11 min). MR thermometry was available for 14 of 16 nodules (88%) with an accuracy of 1.6 degrees C in a non-heated region. No correlation was found between the size of the lethal thermal dose and the ablation zone at follow-up imaging. The primary and secondary effectiveness rates were 100% and 91%, respectively. CONCLUSIONS RF ablation of small liver tumours can be planned, targeted, monitored and controlled with MR imaging within acceptable procedure times. Temperature mapping is technically feasible, but the clinical benefit remains to be proven.
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Affiliation(s)
- Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland.
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35
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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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Sugimoto K, Shiraishi J, Moriyasu F, Saito K, Doi K. Improved detection of hepatic metastases with contrast-enhanced low mechanical-index pulse inversion ultrasonography during the liver-specific phase of sonazoid: observer performance study with JAFROC analysis. Acad Radiol 2009; 16:798-809. [PMID: 19394876 DOI: 10.1016/j.acra.2008.12.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 12/22/2008] [Accepted: 12/24/2008] [Indexed: 12/27/2022]
Abstract
RATIONALE AND OBJECTIVES To compare B-mode ultrasonography (US) alone with the combination of B-mode and contrast-enhanced (Sonazoid) late-phase pulse-inversion US for the detection of hepatic metastases by use of jackknife free-response receiver-operating characteristic (JAFROC) analysis. MATERIALS AND METHODS Twenty-seven patients with 57 hepatic metastases and 6 patients without hepatic metastases underwent B-mode and contrast-enhanced US. We used the diagnoses established by contrast-enhanced computed tomography and contrast-enhanced US as the standard of reference. All ultrasonographic scanning was performed by an experienced radiologist with a routine clinical procedure. All scanning data were archived with digital cine clips. A review system, which can display pairs of cine clips for B-mode and contrast-enhanced US side by side, was developed for off-site observer study. Seven radiologists interpreted each case individually first by B-mode US only, and then by the combination with contrast-enhanced US by identifying locations of possible candidates for hepatic metastasis with their confidence ratings. The figure-of-merit (FOM) values, sensitivity, and false-positives per case were estimated for B-mode US alone, and for the combination of B-mode and contrast-enhanced US. RESULTS The sensitivities of the combined ultrasonographic imaging (mean, 72.2%) were clearly improved from that of B-mode US alone (mean, 41.6%) while reducing the average number of false positives from 1.1 to 0.5 per case. In the jackknife analysis, there was a statistically significant difference between mean FOM values for the combined imaging (0.76) and for B-mode US alone (0.44, P < .00001). CONCLUSION Evaluating cine clips of contrast-enhanced liver US together with B-mode US could improve physicians' accuracy for detection of hepatic metastases.
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Affiliation(s)
- Katsutoshi Sugimoto
- Kurt Rossmann Laboratories for Radiologic Imaging Research, Department of Radiology, The University of Chicago, 5841 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
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Imaging of small hepatic metastases of colorectal carcinoma: how to use superparamagnetic iron oxide-enhanced magnetic resonance imaging in the multidetector-row computed tomography age? J Comput Assist Tomogr 2009; 33:266-72. [PMID: 19346857 DOI: 10.1097/rct.0b013e31817f5c82] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare the accuracy of dynamic contrast-enhanced multidetector-row computed tomography (CT) and superparamagnetic iron oxide-enhanced magnetic resonance imaging (MRI) in the evaluation of small hepatic metastases of colorectal carcinoma. MATERIALS AND METHODS Of 94 patients with colorectal carcinoma analyzed, 76 hepatic metastases (<2 cm) were diagnosed in 17 patients. Superparamagnetic iron oxide (SPIO)-magnetic resonance (precontrast and postcontrast MRI) and dynamic contrast-enhanced multidetector-row CT (dynamic CT [precontrast, arterial, portal-venous, and delayed phase]) were evaluated. The alternative free-response receiver operating characteristic analysis was performed, and the sensitivities and positive predictive values were analyzed. RESULTS The Az values and sensitivities of portal-venous phase CT, dynamic CT, and SPIO-MRI (0.62/59%, 0.69/61%, and 0.67/61%) were identical. The mean positive predictive value of dynamic CT (82%) was inferior to that of SPIO-MRI (91%). CONCLUSIONS The diagnostic ability of dynamic CT is identical to that of SPIO-MRI in Az value and sensitivity. Superparamagnetic iron oxide-MRI should be recommended only if an equivocal lesion is detected by dynamic CT.
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Advances in radiological imaging of gastrointestinal tumors. Crit Rev Oncol Hematol 2008; 69:153-67. [PMID: 18674926 DOI: 10.1016/j.critrevonc.2008.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 05/02/2008] [Accepted: 06/26/2008] [Indexed: 02/06/2023] Open
Abstract
This article summarizes the recent advances in radiological imaging in the hepatogastrointestinal field in terms of detection, characterization and staging of tumors. Introduction of multidetector row computed tomography technology has helped computed tomography to excel in its already established indications, and has expanded its capabilities by adding new clinical applications, such as computed tomography angiography, liver perfusion, computed tomography enterography or enteroclysis, and virtual colonoscopy. Contrast-enhanced ultrasound has dramatically changed the role of ultrasound in liver tumor characterization, detection, and other applications. Combining the advantages of unsurpassed soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging of the gastrointestinal tract has become increasingly used clinically. Moreover, substantial progress in molecular and cellular magnetic resonance imaging has been achieved in the past few years. Particularly, the increasing number of available specific contrast agents dedicated to the evaluation of the liver and lymph nodes shows promises in the area of oncologic abdominal imaging.
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Abstract
For most solid neoplasms, medical imaging is a vital component of tumor staging and surveillance. Imaging strategies vary according to the type and grade of primary neoplasm, tumor stage at diagnosis, tumor markers, previous therapies, and patient symptoms. In this article, we address imaging of individual organs (lung, liver, adrenals) and outline imaging strategies for specific types of neoplasms.
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Affiliation(s)
- Donald L Klippenstein
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY 14214, USA.
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41
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CT laparoscopy for detecting small superficial metastatic lesions of the liver surface: initial experience. AJR Am J Roentgenol 2008; 190:1314-7. [PMID: 18430849 DOI: 10.2214/ajr.07.2887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the efficacy of CT laparoscopy in the detection of superficial metastasis of the liver surface. SUBJECTS AND METHODS From April 1, 2007, to July 1, 2007, a total of 34 consecutively registered patients (19 men, 15 women; median age, 55 years) with various intraabdominal malignant tumors underwent preoperative CT and composed the study population. All patients underwent superparamagnetic iron oxide-enhanced MRI and portal phase contrast-enhanced 64-MDCT, including CT laparoscopy. CT laparoscopy is a form of volume-rendering 3D imaging of the liver that depicts the liver surface in detail. RESULTS Among 23 patients who underwent surgery for management of a primary tumor, four patients had seven superficial metastatic lesions of the liver surface. None of these lesions had been detected with preoperative axial CT or superparamagnetic iron oxide-enhanced MRI. In contrast, CT laparoscopy revealed four of seven lesions in four patients. On a lesion-by-lesion basis, the sensitivity was 57%, the positive predictive value was 100%, and the accuracy was 57%. CONCLUSION Our initial experience proves that CT laparoscopy is a promising method for detecting small superficial metastatic lesions of the liver surface. The findings can influence decisions regarding tumor resectability.
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Gines A, Cassivi SD, Martenson JA, Schleck C, Deschamps C, Sinicrope FA, Alberts SR, Murray JA, Zinsmeister AR, Vazquez-Sequeiros E, Nichols FC, Miller RC, Quevedo JF, Allen MS, Alexander JA, Zais T, Haddock MG, Romero Y. Impact of endoscopic ultrasonography and physician specialty on the management of patients with esophagus cancer. Dis Esophagus 2008; 21:241-50. [PMID: 18430106 PMCID: PMC2577373 DOI: 10.1111/j.1442-2050.2007.00766.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
While endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are the most accurate techniques for locoregional staging of esophageal cancer, little evidence exists that these innovations impact on clinical care. The objective on this study was to determine the frequency with which EUS and EUS-FNA alter the management of patients with localized esophageal cancer, and assess practice variation among specialists at a tertiary care center. Three gastroenterologists, three medical oncologists, three radiation oncologists and four thoracic surgeons were asked to independently report their management recommendations as the anonymized staging information of 50 prospectively enrolled patients from another study were sequentially disclosed on-line. Compared to initial management recommendations, that were based upon history, physical examination, upper endoscopy and CT scan results, EUS prompted a change in management 24% (95% CI: 12-36%) of the time; usually to a more resource-intensive approach (71%), for example from recommending palliation to recommending neoadjuvant chemoradiation therapy. EUS-FNA plus cytology results altered management an additional 8% (95% CI: 6-15%) of the time. Agreement between specialists ranged from fair (intraclass correlation [ICC=0.32) to substantial (ICC=0.65); improving with additional information. Among specialists, agreement was greatest for patients with stage I disease. EUS and EUS-FNA changed patient management the most for patients with stages IIA, IIB or III disease. EUS, with or without FNA, significantly impacts the management of patients with localized esophageal cancer. With respect to the optimal treatment for each patient, agreement among physicians incrementally increases with endoscopic ultrasound results. Specialty training appears to influence therapeutic decision-making behavior.
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Affiliation(s)
- A. Gines
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - S. D. Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - J. A. Martenson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - C. Schleck
- Division of Biostatistics, Mayo Clinic, Rochester, Minnesota
| | - C. Deschamps
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - F. A. Sinicrope
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota,Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - S. R. Alberts
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - J. A. Murray
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | | | | | - F. C. Nichols
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - R. C. Miller
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - J. F. Quevedo
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - M. S. Allen
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota
| | - J. A. Alexander
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - T. Zais
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota
| | - M. G. Haddock
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Y. Romero
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota,Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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Can contrast-enhanced ultrasonography replace multidetector-computed tomography in the detection of liver metastases from colorectal cancer? Eur J Radiol 2007; 69:308-13. [PMID: 18068925 DOI: 10.1016/j.ejrad.2007.10.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 10/10/2007] [Accepted: 10/31/2007] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the sensitivity and specificity of contrast-enhanced ultrasonography (CEUS) and 4-slice multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer (CRC). MATERIALS AND METHODS Candidates for this prospective study were 461 consecutive patients referred to the Department of Colorectal Surgery, Aarhus University Hospital with primary or local recurrence of CRC. The patients underwent liver ultrasonography (US), CEUS, MDCT and intraoperative ultrasonography (IOUS). Fine-needle biopsy was performed on all suspicious lesions. The examinations were interpreted blindly and the combination of US, CEUS, biphasic MDCT, IOUS, follow up and biopsy was the gold standard. RESULTS Three hundred and sixty-five patients were included. All patients had undergone preoperative US, CEUS and MDCT and 65.5% had received IOUS. The gold standard found liver metastases in 54 patients (14.8%). Multidetector CT found significantly more metastases than CEUS in 15 (28%) of the patients (p=0.02). In a patient-by-patient analysis MDCT had a non-significantly higher sensitivity in the detection of liver metastases compared to CEUS (0.89 versus 0.80, p=0.06). The specificity of CEUS (0.98) was slightly better than that of MDCT (0.94) (p=0.02). CONCLUSION Multidetector CT found significant more metastases than CEUS, and MDCT had in patient-by-patient analysis a non-significant better sensitivity (p=0.06) in detecting liver metastases in patients with CRC.
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Layer G, Delorme S. [Radiological diagnosis of hepatic tumors. Part II: Identification and differential diagnosis]. Radiologe 2007; 47:919-31; quiz 932-3. [PMID: 17898982 DOI: 10.1007/s00117-007-1564-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Focal hepatic lesions occur in 5% of the population. The clarification of such common occurrences is of major significance because oncological diseases play an important role with respect to morbidity and mortality of the population. The first part of this review article dealt with the most important aspects of classification, epidemiology and pathology of hepatic tumors for radiologists and the current technical situation with regards to the diagnostic procedure. This second part of the review deals with the significance of radiological procedures for identification and differential diagnosis of hepatic tumors.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus, Johannes-Gutenberg-Universität Mainz, Bremserstrasse 79, 67063, Ludwigshafen, Germany.
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Penno E, Johansson L, Ahlström H, Johnsson C. Ultrasmall iron oxide particle contrast agent and MRI can be used to monitor the effect of anti-rejection treatment. Transplantation 2007; 84:374-9. [PMID: 17700163 DOI: 10.1097/01.tp.0000276957.62313.fe] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of the study was to investigate the feasibility of monitoring anti-rejection treatment using a blood pool contrast agent and magnetic resonance (MR) imaging. METHODS Allogeneic heterotopic heart transplantations in rats were performed. In one group (treated group), a mild acute rejection was developed and subsequently treated and MR imaging was performed before and after anti-rejection treatment. In the other group (nontreated group), a mild acute rejection was developed and allowed to progress without treatment and MR examinations were performed before and after the advance of the acute rejection. After injecting ultrasmall superparamagnetic contrast agent, the relative change of signal intensity (SI) over time was measured. The SI difference between both radiological investigations for every animal was calculated; hence, every animal served as its own control. RESULTS In both treated and nontreated groups, a significant difference over time was found between the two MR examinations seen as a decrease in the treated group and an increase in the nontreatment group. CONCLUSION It is concluded that the effect of anti-rejection treatment can be detected using a blood pool agent and MR imaging, as a change in SI corresponding to changes in the vascular permeability.
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Affiliation(s)
- Eva Penno
- Department of Diagnostic Radiology, Uppsala University Hospital, Uppsala, Sweden.
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47
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Layer G, Bohrer M. [Diagnostic radiology of liver tumors. Part 1: General disease aspects and radiological procedures]. Radiologe 2007; 47:819-29; quiz 830-1. [PMID: 17786401 DOI: 10.1007/s00117-007-1553-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Besides malignant disease, focal liver lesions can also represent benign changes. Among the malignant lesions, in addition to hepatocellular carcinoma, liver metastases should be mentioned. In contrast, benign lesions such as focal nodular hyperplasia and hepatocellular adenoma are rarely encountered. Various radiological procedures are employed for the (differential) diagnosis. The transabdominal ultrasound examination is supplemented by color Doppler procedures, contrast-enhanced or intraoperative ultrasound. Computed tomography (CT) should be performed with native images as well as after using modern nonionic, iodine-containing water-soluble contrast agents; multidetector spiral CT is today's standard. If comparable optimal technology is available on-site, (contrast-enhanced) MRI is preferable. Intra-arterial selective angiography has become less important for detecting and characterizing focal liver changes with the advent of tomographic procedures. The question of whether sonography- or CT-guided biopsy of the liver is needed for further diagnostic work-up, whether a wait-and-see approach is justified, or whether surgery is required to clarify the diagnosis should always be answered on a case-by-case basis.
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Affiliation(s)
- G Layer
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum der Stadt Ludwigshafen gGmbH, Akademisches Lehrkrankenhaus der Johannes Gutenberg Universität Mainz, Bremserstrasse 79, 67063 Ludwigshafen, Deutschland.
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Chua SC, Groves AM, Kayani I, Menezes L, Gacinovic S, Du Y, Bomanji JB, Ell PJ. The impact of 18F-FDG PET/CT in patients with liver metastases. Eur J Nucl Med Mol Imaging 2007; 34:1906-14. [PMID: 17713766 DOI: 10.1007/s00259-007-0518-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2007] [Accepted: 06/19/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to assess the performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) versus dedicated contrast-enhanced CT (CECT) in the detection of metastatic liver disease. METHODS All patients that presented to our Institution with suspected metastatic liver disease who underwent (18)F-FDG PET/CT and CECT within 6 weeks of each other, were retrospectively analyzed, covering a 5-year period. One hundred and thirty-one patients (67 men, 64 women; mean age 62) were identified. Seventy-five had colorectal carcinoma and 56 had other malignancies. The performance of CECT and that of (18)F-FDG-PET/CT in detecting liver metastases were compared. The ability of each to detect local recurrence, extrahepatic metastases and to alter patient management was recorded. The final diagnosis was based on histology, clinical and radiological follow-up (mean 23 months). RESULTS In detecting hepatic metastases, (18)F-FDG-PET/CT yielded 96% sensitivity and 75% specificity, whilst CECT showed 88% sensitivity and 25% specificity. (18)F-FDG-PET/CT and CECT were concordant in 102 out of 131 patients (78%). In the colorectal group (18)F-FDG-PET/CT showed 94% sensitivity and 75% specificity, whilst CECT had 91% sensitivity and 25% specificity. In the noncolorectal group (18)F-FDG-PET/CT showed 98% sensitivity and 75% specificity whilst CECT had 85% sensitivity and 25% specificity. Overall, (18)F-FDG-PET/CT altered patient management over CECT in 25% of patients. CECT did not alter patient management over (18)F-FDG-PET/CT alone in any patients. CONCLUSION (18)F-FDG-PET/CT performed better in detecting metastatic liver disease than CECT in both colorectal and noncolorectal malignancies, and frequently altered patient management. The future role of CECT in these patients may need to be re-evaluated to avoid potentially unnecessary duplication of investigation where (18)F-PET/CT is readily available.
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Affiliation(s)
- Siew C Chua
- Institute of Nuclear Medicine, UCL Hospital, University College London, 235 Euston Road, London, UK
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49
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Abstract
With recent technical advances in hardware, software, and intravenous contrast agents, MRI has evolved into a clinically useful procedure to detect and characterise liver tumours. The combination of MRI systems with larger gradients, improved surface coils, and parallel imaging techniques have produced substantial improvements in MRI quality and speed of image acquisition. Images that previously needed several minutes to acquire can now be obtained in several seconds. The notably faster imaging capabilities of new MRI scanners are ideally suited for dynamic contrast-enhanced liver imaging in which early arterial-phase imaging is best for detecting hepatocellular carcinomas and hypervascular liver metastases. The inherent excellent soft-tissue contrast of MRI can be further improved by non-specific extracellular contrast agents and by liver-specific contrast agents. These contrast agents are now routinely used for liver imaging and improve the sensitivity and specificity of hepatobiliary MRI.
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Affiliation(s)
- Russell N Low
- Sharp and Children MRI Center, 7901 Frost Street, and San Diego Imaging Medical Group, 7910 Frost Street, San Diego, CA 92123, USA.
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50
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Menu Y, Bessoud B, Rocher L, Lesavre A, Phan C, Rangheard AS. Lésions hépatiques en cancérologie générale. ACTA ACUST UNITED AC 2007; 88:1091-103. [PMID: 17762837 DOI: 10.1016/s0221-0363(07)89921-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In order to improve management of oncologic patients, a standardized 5-step approach should be considered: detection, characterization, locoregional and systemic staging, and post treatment follow up. The use of imaging techniques will be adapted to the clinical question at hand during multi-disciplinary review of cases. The role of the radiologist is to review the indications for each imaging modality and incorporate the results in the clinical context.
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Affiliation(s)
- Y Menu
- Service de Radiologie Broca, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin Bicêtre Cedex.
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