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Mulé S, Pigneur F, Quelever R, Tenenhaus A, Baranes L, Richard P, Tacher V, Herin E, Pasquier H, Ronot M, Rahmouni A, Vilgrain V, Luciani A. Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma? Eur Radiol 2017; 28:1977-1985. [PMID: 29168007 DOI: 10.1007/s00330-017-5151-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/14/2017] [Accepted: 10/19/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To determine the degree of relationship between iodine concentrations derived from dual-energy CT (DECT) and perfusion CT parameters in patients with advanced HCC under treatment. METHODS In this single-centre IRB approved study, 16 patients with advanced HCC treated with sorafenib or radioembolization who underwent concurrent dynamic perfusion CT and multiphase DECT using a single source, fast kV switching DECT scanner were included. Written informed consent was obtained for all patients. HCC late-arterial and portal iodine concentrations, blood flow (BF)-related and blood volume (BV)-related perfusion parameters maps were calculated. Mixed-effects models of the relationship between iodine concentrations and perfusion parameters were computed. An adjusted p value (Bonferroni method) < 0.05 was considered significant. RESULTS Mean HCC late-arterial and portal iodine concentrations were 22.7±12.7 mg/mL and 18.7±8.3 mg/mL, respectively. Late-arterial iodine concentration was significantly related to BV (mixed-effects model F statistic (F)=28.52, p<0.0001), arterial BF (aBF, F=17.62, p<0.0001), hepatic perfusion index (F=28.24, p<0.0001), positive enhancement integral (PEI, F=66.75, p<0.0001) and mean slope of increase (F=32.96, p<0.0001), while portal-venous iodine concentration was mainly related to BV (F=29.68, p<0.0001) and PEI (F=66.75, p<0.0001). CONCLUSIONS In advanced HCC lesions, DECT-derived late-arterial iodine concentration is strongly related to both aBF and BV, while portal iodine concentration mainly reflects BV, offering DECT the ability to evaluate both morphological and perfusion changes. KEY POINTS • Late-arterial iodine concentration is highly related to arterial BF and BV. • Portal iodine concentration mainly reflects tumour blood volume. • Dual-energy CT offers significantly decreased radiation dose compared with perfusion CT.
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Affiliation(s)
- Sébastien Mulé
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France.
| | - Frédéric Pigneur
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France
| | - Ronan Quelever
- GE Healthcare, 283 rue de la Minière, 78530, Buc, France
| | - Arthur Tenenhaus
- Laboratoire des Signaux et Systèmes, Université Paris-Saclay, Orsay, France.,Biostatistics and bioinformatics core facility, Brain and Spine Institute, Paris, France
| | - Laurence Baranes
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France
| | | | - Vania Tacher
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France.,Faculté de Médecine, Université Paris Est Creteil, Creteil, France.,, INSERM IMRB, U 955, Equipe 18, Creteil, France
| | - Edouard Herin
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France
| | - Hugo Pasquier
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France.,Faculté de Médecine, Université Paris Est Creteil, Creteil, France
| | - Maxime Ronot
- Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Beaujon, 100 boulevard General Leclerc, 92118, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Alain Rahmouni
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France.,Faculté de Médecine, Université Paris Est Creteil, Creteil, France
| | - Valérie Vilgrain
- Service de Radiologie, AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Beaujon, 100 boulevard General Leclerc, 92118, Clichy, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Alain Luciani
- Service d'Imagerie Médicale, AP-HP, Hôpitaux Universitaires Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Creteil Cedex, France.,Faculté de Médecine, Université Paris Est Creteil, Creteil, France.,, INSERM IMRB, U 955, Equipe 18, Creteil, France
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Muenzel D, Lo GC, Yu HS, Parakh A, Patino M, Kambadakone A, Rummeny EJ, Sahani DV. Material density iodine images in dual-energy CT: Detection and characterization of hypervascular liver lesions compared to magnetic resonance imaging. Eur J Radiol 2017; 95:300-306. [PMID: 28987684 DOI: 10.1016/j.ejrad.2017.08.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/15/2017] [Accepted: 08/28/2017] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the diagnostic potential of Material Density (MD) iodine images in dual-energy CT (DECT) for the detection and characterization of hypervascular liver lesions compared to monenergetic 65keV images, using MRI as the standard. MATERIALS AND METHODS The study complied with HIPAA guidelines and was approved by the institutional review board. Fifty-two patients (36 men, 16 women; age range, 29-87 years) with 236 hypervascular liver lesions (benign, n=31; malignant, n=205; mean diameter, 29.4mm; range: 6-90.6mm) were included. All of them underwent both contrast-enhanced single-source DECT and contrast-enhanced abdominal MRI within three months. Late arterial phase CT imaging was performed with dual energies of 140 and 80kVp. Protocol A showed monoenergetic 65keV images, and protocol B presented MD-iodine images. Three radiologists qualitatively evaluated randomized images, and lesion detection, characterization, and reader confidence were recorded. Liver-to-lesion ratio (LLR) and contrast-to-noise ratio (CNR) were assessed on protocol A, protocol B, and MRI. Paired t-tests were used to compare LLR, CNR, and the number of detected lesions. RESULTS LLR was significantly increased in protocol B (2.8±2.33) compared to protocol A (0.77±0.55) and MRI (0.61±0.66). CNR was significantly higher in protocol B (0.08±0.04) compared to protocol A (0.01±0.01) and MRI (0.01±0.01). All three observers correctly identified more liver lesions using protocol B vs protocol A: 83.13% vs 63.64%, 84.57% vs 68.09%, and 79.37% vs 65.52%. There was no significant difference between the three observers in classification of a lesion as benign or malignant. However, higher diagnostic confidence was reported more frequently by the experienced radiologist when using protocol B vs protocol A (84.6% vs 75%). CONCLUSION MD-iodine images in DECT help to increase the conspicuity and detection of hypervascular liver lesions.
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Affiliation(s)
- Daniela Muenzel
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA; Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675 Munich, Germany.
| | - Grace C Lo
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
| | - Hei Shun Yu
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
| | - Manuel Patino
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675 Munich, Germany
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston MA 02114, USA
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Bretas EAS, Torres US, Torres LR, Bekhor D, Saito Filho CF, Racy DJ, Faggioni L, D'Ippolito G. Is liver perfusion CT reproducible? A study on intra- and interobserver agreement of normal hepatic haemodynamic parameters obtained with two different software packages. Br J Radiol 2017; 90:20170214. [PMID: 28830195 DOI: 10.1259/bjr.20170214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the agreement between the measurements of perfusion CT parameters in normal livers by using two different software packages. METHODS This retrospective study was based on 78 liver perfusion CT examinations acquired for detecting suspected liver metastasis. Patients with any morphological or functional hepatic abnormalities were excluded. The final analysis included 37 patients (59.7 ± 14.9 y). Two readers (1 and 2) independently measured perfusion parameters using different software packages from two major manufacturers (A and B). Arterial perfusion (AP) and portal perfusion (PP) were determined using the dual-input vascular one-compartmental model. Inter-reader agreement for each package and intrareader agreement between both packages were assessed with intraclass correlation coefficients (ICC) and Bland-Altman statistics. RESULTS Inter-reader agreement was substantial for AP using software A (ICC = 0.82) and B (ICC = 0.85-0.86), fair for PP using software A (ICC = 0.44) and fair to moderate for PP using software B (ICC = 0.56-0.77). Intrareader agreement between software A and B ranged from slight to moderate (ICC = 0.32-0.62) for readers 1 and 2 considering the AP parameters, and from fair to moderate (ICC = 0.40-0.69) for readers 1 and 2 considering the PP parameters. CONCLUSION At best there was only moderate agreement between both software packages, resulting in some uncertainty and suboptimal reproducibility. Advances in knowledge: Software-dependent factors may contribute to variance in perfusion measurements, demanding further technical improvements. AP measurements seem to be the most reproducible parameter to be adopted when evaluating liver perfusion CT.
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Affiliation(s)
- Elisa Almeida Sathler Bretas
- 1 Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil.,2 Department of Radiology, Grupo Fleury, São Paulo, Brazil
| | | | - Lucas Rios Torres
- 2 Department of Radiology, Grupo Fleury, São Paulo, Brazil.,3 Department of Imaging, Hospital Beneficência Portuguesa, São Paulo, Brazil
| | - Daniel Bekhor
- 1 Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Douglas Jorge Racy
- 3 Department of Imaging, Hospital Beneficência Portuguesa, São Paulo, Brazil
| | - Lorenzo Faggioni
- 4 Department of Diagnostic and Interventional Radiology, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe D'Ippolito
- 1 Department of Imaging, Universidade Federal de São Paulo, São Paulo, Brazil.,2 Department of Radiology, Grupo Fleury, São Paulo, Brazil
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Chen X, Xu Y, Duan J, Li C, Sun H, Wang W. Correlation of iodine uptake and perfusion parameters between dual-energy CT imaging and first-pass dual-input perfusion CT in lung cancer. Medicine (Baltimore) 2017; 96:e7479. [PMID: 28700488 PMCID: PMC5515760 DOI: 10.1097/md.0000000000007479] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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
To investigate the potential relationship between perfusion parameters from first-pass dual-input perfusion computed tomography (DI-PCT) and iodine uptake levels estimated from dual-energy CT (DE-CT).The pre-experimental part of this study included a dynamic DE-CT protocol in 15 patients to evaluate peak arterial enhancement of lung cancer based on time-attenuation curves, and the scan time of DE-CT was determined. In the prospective part of the study, 28 lung cancer patients underwent whole-volume perfusion CT and single-source DE-CT using 320-row CT. Pulmonary flow (PF, mL/min/100 mL), aortic flow (AF, mL/min/100 mL), and a perfusion index (PI = PF/[PF + AF]) were automatically generated by in-house commercial software using the dual-input maximum slope method for DI-PCT. For the dual-energy CT data, iodine uptake was estimated by the difference (λ) and the slope (λHU). λ was defined as the difference of CT values between 40 and 70 KeV monochromatic images in lung lesions. λHU was calculated by the following equation: λHU = |λ/(70 - 40)|. The DI-PCT and DE-CT parameters were analyzed by Pearson/Spearman correlation analysis, respectively.All subjects were pathologically proved as lung cancer patients (including 16 squamous cell carcinoma, 8 adenocarcinoma, and 4 small cell lung cancer) by surgery or CT-guided biopsy. Interobserver reproducibility in DI-PCT (PF, AF, PI) and DE-CT (λ, λHU) were relatively good to excellent (intraclass correlation coefficient [ICC]Inter = 0.8726-0.9255, ICCInter = 0.8179-0.8842; ICCInter = 0.8881-0.9177, ICCInter = 0.9820-0.9970, ICCInter = 0.9780-0.9971, respectively). Correlation coefficient between λ and AF, and PF were as follows: 0.589 (P < .01) and 0.383 (P < .05). Correlation coefficient between λHU and AF, and PF were as follows: 0.564 (P < .01) and 0.388 (P < .05).Both the single-source DE-CT and dual-input CT perfusion analysis method can be applied to assess blood supply of lung cancer patients. Preliminary results demonstrated that the iodine uptake relevant parameters derived from DE-CT significantly correlated with perfusion parameters derived from DI-PCT.
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Multislice Analysis of Blood Flow Values in CT Perfusion Studies of Lung Cancer. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3236893. [PMID: 28164118 PMCID: PMC5259676 DOI: 10.1155/2017/3236893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022]
Abstract
Objectives. Tumour heterogeneity represents a key issue in CT perfusion (CTp), where all studies are usually based on global mean or median values of perfusion maps, often computed on whole tumour. We sought to determine whether, and to what extent, such global values can be representative of tumour heterogeneity, with respect to single slices, and could be used for therapy assessment. Materials and Methods. Twelve patients with one primary non-small cell lung cancer lesion were enrolled in this study, for a total amount of 26 CTp examinations and 118 slices. Mean and median blood flow (BF) values, calculated voxel-based, were computed on each slice and the whole tumour. To measure functional heterogeneity, entropy was calculated on BF values as well. Results. Most of the slices were not represented by the global BF values computed on the whole tumour. In addition, there are a number of lesions having equivalent global BF values, but they are composed of slices having very different heterogeneity distributions, that is, entropy values. Conclusions. Global mean/median BF values of the single slices separately should be considered for clinical assessment, only if interpreted through entropy computed on BF values. The numerical equivalence between global BF values of different lesions may correspond to different clinical status, thus inducing possible errors in choice of therapy when considering global values only.
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