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Yan C, Xia C, Cao Q, Zhang J, Gao M, Han J, Liang X, Zhang M, Wang L, Zhao L. Predicting High-Risk Esophageal Varices in Cirrhosis: A Multi-Parameter Splenic CT Study. Acad Radiol 2024:S1076-6332(24)00419-7. [PMID: 38997882 DOI: 10.1016/j.acra.2024.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/14/2024]
Abstract
RATIONALE AND OBJECTIVES To explore the value of splenic hemodynamic parameters from low-dose one-stop dual-energy and perfusion CT (LD-DE&PCT) in non-invasively predicting high-risk esophageal varices (HREV) in cirrhotic patients. METHODS We retrospectively analyzed cirrhotic patients diagnosed with esophageal varices (EV) through clinical, laboratory, imaging, and endoscopic examinations from September 2021 to December 2023 in our hospital. All patients underwent LD-DE&PCT to acquire splenic iodine concentration and perfusion parameters. Radiation dose was recorded. Patients were classified into non-HREV and HREV groups based on endoscopy. Univariate and multivariate logistic regression analysis were performed, and the prediction model for HREV was constructed. P < 0.05 was considered statistically significant. RESULTS Univariate analysis revealed that significant differences were found in portal iodine concentration (PIC), blood flow (BF), permeability surface (PS), spleen volume (V-S), total iodine concentration (TIC), and total blood volume of the spleen (BV-S) between groups. TIC demonstrated the highest predictive value with an area under the curve (AUC) value of 0.87. Multivariate analysis showed that PIC, PS, and BV-S were independent risk factors for HREV. The logistic regression model for predicting HREV had an AUC of 0.93. The total radiation dose was 20.66 ± 4.07 mSv. CONCLUSION Splenic hemodynamic parameters obtained from LD-DE&PCT can non-invasively and accurately assess the hemodynamic status of the spleen in cirrhotic patients with EV and predict the occurrence of HREV. Despite the retrospective study design and limited sample size of this study, these findings deserve further validation through prospective studies with larger cohorts.
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Affiliation(s)
- Cheng Yan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Chunhua Xia
- Medical Image Center, The Third Affiliated Hospital of Anhui Medical University/ Hefei No1. People's Hospital (Binhu Campus), Hefei 230601, China
| | - Qiuting Cao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jingwen Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Mingzi Gao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jing Han
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiaohong Liang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Mingxin Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lin Wang
- Department of Gastroenterology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Liqin Zhao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
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2
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Pickhardt PJ, Blake GM, Moeller A, Garrett JW, Summers RM. Post-contrast CT liver attenuation alone is superior to the liver-spleen difference for identifying moderate hepatic steatosis. Eur Radiol 2024:10.1007/s00330-024-10816-2. [PMID: 38834787 DOI: 10.1007/s00330-024-10816-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To assess the diagnostic performance of post-contrast CT for predicting moderate hepatic steatosis in an older adult cohort undergoing a uniform CT protocol, utilizing hepatic and splenic attenuation values. MATERIALS AND METHODS A total of 1676 adults (mean age, 68.4 ± 10.2 years; 1045M/631F) underwent a CT urothelial protocol that included unenhanced, portal venous, and 10-min delayed phases through the liver and spleen. Automated hepatosplenic segmentation for attenuation values (in HU) was performed using a validated deep-learning tool. Unenhanced liver attenuation < 40.0 HU, corresponding to > 15% MRI-based proton density fat, served as the reference standard for moderate steatosis. RESULTS The prevalence of moderate or severe steatosis was 12.9% (216/1676). The diagnostic performance of portal venous liver HU in predicting moderate hepatic steatosis (AUROC = 0.943) was significantly better than the liver-spleen HU difference (AUROC = 0.814) (p < 0.001). Portal venous phase liver thresholds of 80 and 90 HU had a sensitivity/specificity for moderate steatosis of 85.6%/89.6%, and 94.9%/74.7%, respectively, whereas a liver-spleen difference of -40 HU and -10 HU had a sensitivity/specificity of 43.5%/90.0% and 92.1%/52.5%, respectively. Furthermore, livers with moderate-severe steatosis demonstrated significantly less post-contrast enhancement (mean, 35.7 HU vs 47.3 HU; p < 0.001). CONCLUSION Moderate steatosis can be reliably diagnosed on standard portal venous phase CT using liver attenuation values alone. Consideration of splenic attenuation appears to add little value. Moderate steatosis not only has intrinsically lower pre-contrast liver attenuation values (< 40 HU), but also enhances less, typically resulting in post-contrast liver attenuation values of 80 HU or less. CLINICAL RELEVANCE STATEMENT Moderate steatosis can be reliably diagnosed on post-contrast CT using liver attenuation values alone. Livers with at least moderate steatosis enhance less than those with mild or no steatosis, which combines with the lower intrinsic attenuation to improve detection. KEY POINTS The liver-spleen attenuation difference is frequently utilized in routine practice but appears to have performance limitations. The liver-spleen attenuation difference is less effective than liver attenuation for moderate steatosis. Moderate and severe steatosis can be identified on standard portal venous phase CT using liver attenuation alone.
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Affiliation(s)
- Perry J Pickhardt
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA.
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Alex Moeller
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - John W Garrett
- The University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
| | - Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, MD, USA
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3
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Zheng T, Qu Y, Chen J, Yang J, Yan H, Jiang H, Song B. Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers. Abdom Radiol (NY) 2024; 49:2098-2115. [PMID: 38372765 DOI: 10.1007/s00261-024-04225-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
A diagnosis of cirrhosis initiates a shift in the management of chronic liver disease and affects the diagnostic workflow and treatment decision of primary liver cancer. Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability. Various qualitative and quantitative imaging biomarkers based on ultrasound, CT and MRI have been proposed for noninvasive diagnosis of cirrhosis. Qualitative imaging features are easy to apply but have moderate diagnostic sensitivity. Elastography techniques allow quantitative assessment of liver stiffness and are highly accurate for cirrhosis diagnosis. Ultrasound elastography are widely used in clinical practice, while MR elastography has narrower availability. Although not applicable in clinical practice yet, other quantitative imaging features, including liver surface nodularity, linear and volumetric measurement, extracellular volume fraction, liver enhancement on hepatobiliary phase, and parameters derived from diffusion-weighted imaging, can provide additional information of liver morphology, perfusion, and function, thus may increase diagnosis performance. The introduction of radiomics and deep learning has further improved diagnostic accuracy while reducing subjectivity. Several imaging features may also help to assess liver function and outcomes in patients with cirrhosis. In this review, we summarize the qualitative and quantitative imaging biomarkers for noninvasive cirrhosis diagnosis, and the assessment of liver function and outcomes, and discuss the challenges and future directions in this field.
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Affiliation(s)
- Tianying Zheng
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Yali Qu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hualin Yan
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China.
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4
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Gómez FM, Van der Reijd DJ, Panfilov IA, Baetens T, Wiese K, Haverkamp-Begemann N, Lam SW, Runge JH, Rice SL, Klompenhouwer EG, Maas M, Helmberger T, Beets-Tan RG. Imaging in interventional oncology, the better you see, the better you treat. J Med Imaging Radiat Oncol 2023; 67:895-902. [PMID: 38062853 DOI: 10.1111/1754-9485.13610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/22/2023] [Indexed: 01/14/2024]
Abstract
Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up.
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Affiliation(s)
- Fernando M Gómez
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ilia A Panfilov
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tarik Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kevin Wiese
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Siu W Lam
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jurgen H Runge
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Samuel L Rice
- Radiology, Interventional Radiology Section, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und Minimal-Invasive Therapie, München Klinik Bogenhausen, Munich, Germany
| | - Regina Gh Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
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5
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Borges AP, Antunes C, Caseiro-Alves F. Spectral CT: Current Liver Applications. Diagnostics (Basel) 2023; 13:diagnostics13101673. [PMID: 37238163 DOI: 10.3390/diagnostics13101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
Using two different energy levels, dual-energy computed tomography (DECT) allows for material differentiation, improves image quality and iodine conspicuity, and allows researchers the opportunity to determine iodine contrast and radiation dose reduction. Several commercialized platforms with different acquisition techniques are constantly being improved. Furthermore, DECT clinical applications and advantages are continually being reported in a wide range of diseases. We aimed to review the current applications of and challenges in using DECT in the treatment of liver diseases. The greater contrast provided by low-energy reconstructed images and the capability of iodine quantification have been mostly valuable for lesion detection and characterization, accurate staging, treatment response assessment, and thrombi characterization. Material decomposition techniques allow for the non-invasive quantification of fat/iron deposition and fibrosis. Reduced image quality with larger body sizes, cross-vendor and scanner variability, and long reconstruction time are among the limitations of DECT. Promising techniques for improving image quality with lower radiation dose include the deep learning imaging reconstruction method and novel spectral photon-counting computed tomography.
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Affiliation(s)
- Ana P Borges
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Célia Antunes
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
| | - Filipe Caseiro-Alves
- Medical Imaging Department, Coimbra University Hospitals, 3004-561 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Academic and Clinical Centre of Coimbra, 3000-370 Coimbra, Portugal
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6
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Narita K, Nakamura Y, Higaki T, Kondo S, Honda Y, Kawashita I, Mitani H, Fukumoto W, Tani C, Chosa K, Tatsugami F, Awai K. Iodine maps derived from sparse-view kV-switching dual-energy CT equipped with a deep learning reconstruction for diagnosis of hepatocellular carcinoma. Sci Rep 2023; 13:3603. [PMID: 36869102 PMCID: PMC9984536 DOI: 10.1038/s41598-023-30460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
Deep learning-based spectral CT imaging (DL-SCTI) is a novel type of fast kilovolt-switching dual-energy CT equipped with a cascaded deep-learning reconstruction which completes the views missing in the sinogram space and improves the image quality in the image space because it uses deep convolutional neural networks trained on fully sampled dual-energy data acquired via dual kV rotations. We investigated the clinical utility of iodine maps generated from DL-SCTI scans for assessing hepatocellular carcinoma (HCC). In the clinical study, dynamic DL-SCTI scans (tube voltage 135 and 80 kV) were acquired in 52 patients with hypervascular HCCs whose vascularity was confirmed by CT during hepatic arteriography. Virtual monochromatic 70 keV images served as the reference images. Iodine maps were reconstructed using three-material decomposition (fat, healthy liver tissue, iodine). A radiologist calculated the contrast-to-noise ratio (CNR) during the hepatic arterial phase (CNRa) and the equilibrium phase (CNRe). In the phantom study, DL-SCTI scans (tube voltage 135 and 80 kV) were acquired to assess the accuracy of iodine maps; the iodine concentration was known. The CNRa was significantly higher on the iodine maps than on 70 keV images (p < 0.01). The CNRe was significantly higher on 70 keV images than on iodine maps (p < 0.01). The estimated iodine concentration derived from DL-SCTI scans in the phantom study was highly correlated with the known iodine concentration. It was underestimated in small-diameter modules and in large-diameter modules with an iodine concentration of less than 2.0 mgI/ml. Iodine maps generated from DL-SCTI scans can improve the CNR for HCCs during hepatic arterial phase but not during equilibrium phase in comparison with virtual monochromatic 70 keV images. Also, when the lesion is small or the iodine concentration is low, iodine quantification may result in underestimation.
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Affiliation(s)
- Keigo Narita
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Toru Higaki
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Graduate School of Advanced Science and Engineering, Hiroshima University, 1-4-1 Kagamiyama, Higashi-Hiroshima, Hiroshima, 739-8527, Japan
| | - Shota Kondo
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Honda
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ikuo Kawashita
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hidenori Mitani
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Wataru Fukumoto
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Chihiro Tani
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Keigo Chosa
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Reginelli A, Del Canto M, Clemente A, Gragnano E, Cioce F, Urraro F, Martinelli E, Cappabianca S. The Role of Dual-Energy CT for the Assessment of Liver Metastasis Response to Treatment: Above the RECIST 1.1 Criteria. J Clin Med 2023; 12:jcm12030879. [PMID: 36769527 PMCID: PMC9917684 DOI: 10.3390/jcm12030879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023] Open
Abstract
Imaging assessment of liver lesions is fundamental to predict therapeutic response and improve patient survival rates. Dual-Energy Computed Tomography (DECT) is an increasingly used technique in the oncologic field with many emerging applications. The assessment of iodine concentration within a liver lesion reflects the biological properties of the tumor and provides additional information to radiologists that is normally invisible to the human eye. The possibility to predict tumor aggressiveness and therapeutic response based on quantitative and reproducible parameters obtainable from DECT images could improve clinical decisions and drive oncologists to choose the best therapy according to metastasis biological features. Moreover, in comparison with standard dimensional criteria, DECT provides further data on the cancer microenvironment, especially for patients treated with antiangiogenic-based drugs, in which tumor shrinkage is a late parameter of response. We investigated the predictive role of DECT in the early assessment of liver metastasis response to treatment in comparison with standard dimensional criteria during antiangiogenetic-based therapy.
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Affiliation(s)
- Alfonso Reginelli
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Mariateresa Del Canto
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-08-1566-5200
| | - Eduardo Gragnano
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Fabrizio Cioce
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Fabrizio Urraro
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Erika Martinelli
- Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, Piazza Miraglia 2, 80138 Naples, Italy
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8
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Mahmoudi S, Bernatz S, Althoff FC, Koch V, Grünewald LD, Scholtz JE, Walter D, Zeuzem S, Wild PJ, Vogl TJ, Kinzler MN. Dual-energy CT based material decomposition to differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Eur J Radiol 2022; 156:110556. [PMID: 36270195 DOI: 10.1016/j.ejrad.2022.110556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 10/07/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the potential of material decomposition in dual-energy CT (DECT) to differentiate intrahepatic cholangiocarcinoma (iCCA) from hepatocellular carcinoma (HCC). METHOD In this retrospective study, we included 94 patients (26 female (27.7 %), median age 64.5 (interquartile range 55.5-74.5) years) with either iCCA or HCC who underwent abdominal contrast-enhanced DECT in arterial phase. To test for differences between iCCA (n = 47) and HCC (n = 47), we evaluated mean attenuation and DECT material density values including iodine density (ID), normalized iodine uptake (NIU), fat fraction, and lesion-to-liver parenchyma ratio. Histopathology served as reference standard for all lesions. We used univariate logistic regression models for the outcome iCCA versus HCC. ROC curve analysis was applied to assess discriminative ability of the model. Model accuracy was evaluated by calculating the Brier score. Youden index was applied to establish thresholds to differentiate between iCCA and HCC. RESULTS Comparison of quantitative image parameters revealed significant differences between iCCA and HCC for ID (1.6 ± 0.5 mg/ml vs 2.8 ± 0.8 mg/ml, p < 0.001), NIU (14.5 ± 4.8 vs 24.8 ± 10.3, p < 0.001), attenuation (41.9 ± 10.1 HU vs 47.9 ± 8.9 HU, p = 0.003), and fat fraction (12.0 ± 7.8 % vs 9.0 ± 6.4 %, p = 0.045). ROC curve analysis revealed highest ability to differentiate iCCA from HCC for ID (AUC = 0.93, 95 % CI 0.89-0.98). For ID, an optimal threshold of 2.33 mg/dl was determined to discriminate between iCCA and HCC (sensitivity 89.4 %, specificity 76.6 %). CONCLUSIONS DECT-based iodine quantification can serve as a tool for the differentiation of iCCA and HCC in contrast-enhanced CT. ID yielded the highest diagnostic performance and may assist in clinical routine CT diagnostics.
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Affiliation(s)
- Scherwin Mahmoudi
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Simon Bernatz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Friederike C Althoff
- Department of Internal Medicine II, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Leon D Grünewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Jan-Erik Scholtz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Dirk Walter
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Peter J Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany; Wildlab, University Hospital Frankfurt MVZ GmbH, Frankfurt am Main, Germany.
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
| | - Maximilian N Kinzler
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt am Main, Germany.
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9
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Toia GV, Mileto A, Wang CL, Sahani DV. Quantitative dual-energy CT techniques in the abdomen. Abdom Radiol (NY) 2022; 47:3003-3018. [PMID: 34468796 DOI: 10.1007/s00261-021-03266-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Advances in dual-energy CT (DECT) technology and spectral techniques are catalyzing the widespread implementation of this technology across multiple radiology subspecialties. The inclusion of energy- and material-specific datasets has ushered overall improvements in CT image contrast and noise as well as artifacts reduction, leading to considerable progress in radiologists' ability to detect and characterize pathologies in the abdomen. The scope of this article is to provide an overview of various quantitative clinical DECT applications in the abdomen and pelvis. Several of the reviewed applications have not reached mainstream clinical use and are considered investigational. Nonetheless awareness of such applications is critical to having a fully comprehensive knowledge base to DECT and fostering future clinical implementation.
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Affiliation(s)
- Giuseppe V Toia
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Mailbox 3252, Madison, WI, 53792, USA.
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Carolyn L Wang
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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10
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Virarkar MK, Vulasala SSR, Gupta AV, Gopireddy D, Kumar S, Hernandez M, Lall C, Bhosale P. Virtual Non-contrast Imaging in The Abdomen and The Pelvis: An Overview. Semin Ultrasound CT MR 2022; 43:293-310. [PMID: 35738815 DOI: 10.1053/j.sult.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Virtual non-contrast (VNC) imaging is a post-processing technique generated from contrast-enhanced scans using dual-energy computed tomography (DECT). It is generated by removing iodine from imaging acquired at multiple energies. Myriad clinical studies have shown its ability to diagnose the various abdominal and pelvic pathologies discussed in the article. VNC is also a problem-solving tool for characterizing incidentally detected lesions ("incidentalomas"), often decreasing the need for additional follow-up imaging. It also obviates the multiphase image acquisitions to evaluate hematuria, hepatic steatosis, aortic endoleaks, and gastrointestinal bleeding by generating image datasets from different tissue attenuation values. The scope of this article is to provide an overview of various applications of VNC imaging obtained by DECT in the abdomen and pelvis.
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Affiliation(s)
- Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | | | | | | | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Mauricio Hernandez
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Priya Bhosale
- Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
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Hepatobiliary Dual-Energy Computed Tomography. Radiol Clin North Am 2022; 60:731-743. [DOI: 10.1016/j.rcl.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dual-Energy Computed Tomography Imaging in Early-Stage Hepatocellular Carcinoma: A Preliminary Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:2146343. [PMID: 35069041 PMCID: PMC8752295 DOI: 10.1155/2022/2146343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/17/2022]
Abstract
Background This study aims to evaluate the application of dual-energy computed tomography (DECT) for multiparameter quantitative measurement in early-stage hepatocellular carcinoma (HCC). Methods The study retrospectively enrolled 30 patients with early-stage HCC and 43 patients with early-stage HCC who received radiofrequency ablation (RFA) and underwent abdomen enhanced CT scans in GSI mode. The GSI viewer was used for image display and data analysis. The regions of interest (ROIs) were delineated in the arterial phase and the venous phase. The optimal single energy value, CT values on different energy levels (40 keV, 70 keV, 100 keV, and 140 keV), the optimal energy level, the slope of the spectral attenuation curve, the effective atomic number (Zeff), iodine concentration (IC), water concentration (WC), normalized iodine concentration (NIC), and normalized water concentration (NWC) are measured and quantitatively analyzed. Results The CT values of early-stage HCC at different single energy levels in dual phases were significantly different, and the single energy values were negatively correlated with the CT values. In the arterial phase and the venous phase, the optimal energy values for the best contrast-to-noise ratio were (68.34 ± 3.20) keV and (70.14 ± 2.01) keV, respectively. The slope of the spectral attenuation curve showed a downward trend at 40 keV, 70 keV, 100 keV, and 140 keV, but there was no statistically significant difference (P > 0.05). Zeff was positively correlated with IC and standardized IC, but has no significant correlation with WC and NWC in dual phases. Conclusion DECT imaging contains multiparameter information and has different application values for early-stage HCC, and it is necessary to select the parameters reasonably for personalized and comprehensive evaluation.
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Tatsugami F, Higaki T, Nakamura Y, Honda Y, Awai K. Dual-energy CT: minimal essentials for radiologists. Jpn J Radiol 2022; 40:547-559. [PMID: 34981319 PMCID: PMC9162973 DOI: 10.1007/s11604-021-01233-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/02/2021] [Indexed: 12/11/2022]
Abstract
Dual-energy CT, the object is scanned at two different energies, makes it possible to identify the characteristics of materials that cannot be evaluated on conventional single-energy CT images. This imaging method can be used to perform material decomposition based on differences in the material-attenuation coefficients at different energies. Dual-energy analyses can be classified as image data-based- and raw data-based analysis. The beam-hardening effect is lower with raw data-based analysis, resulting in more accurate dual-energy analysis. On virtual monochromatic images, the iodine contrast increases as the energy level decreases; this improves visualization of contrast-enhanced lesions. Also, the application of material decomposition, such as iodine- and edema images, increases the detectability of lesions due to diseases encountered in daily clinical practice. In this review, the minimal essentials of dual-energy CT scanning are presented and its usefulness in daily clinical practice is discussed.
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Affiliation(s)
- Fuminari Tatsugami
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Toru Higaki
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuko Nakamura
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Honda
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Nakamura Y, Higaki T, Honda Y, Tatsugami F, Tani C, Fukumoto W, Narita K, Kondo S, Akagi M, Awai K. Advanced CT techniques for assessing hepatocellular carcinoma. Radiol Med 2021; 126:925-935. [PMID: 33954894 DOI: 10.1007/s11547-021-01366-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is the sixth-most common cancer in the world, and hepatic dynamic CT studies are routinely performed for its evaluation. Ongoing studies are examining advanced imaging techniques that may yield better findings than are obtained with conventional hepatic dynamic CT scanning. Dual-energy CT-, perfusion CT-, and artificial intelligence-based methods can be used for the precise characterization of liver tumors, the quantification of treatment responses, and for predicting the overall survival rate of patients. In this review, the advantages and disadvantages of conventional hepatic dynamic CT imaging are reviewed and the general principles of dual-energy- and perfusion CT, and the clinical applications and limitations of these technologies are discussed with respect to HCC. Finally, we address the utility of artificial intelligence-based methods for diagnosing HCC.
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Affiliation(s)
- Yuko Nakamura
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Toru Higaki
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukiko Honda
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fuminari Tatsugami
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Chihiro Tani
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Wataru Fukumoto
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Keigo Narita
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shota Kondo
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Motonori Akagi
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuo Awai
- Diagnostic Radiology, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Zhan R, Qi R, Huang S, Lu Y, Wang X, Jiang J, Ruan X, Song A. The correlation between hepatic fat fraction evaluated by dual-energy computed tomography and high-risk coronary plaques in patients with non-alcoholic fatty liver disease. Jpn J Radiol 2021; 39:763-773. [PMID: 33818707 DOI: 10.1007/s11604-021-01113-9] [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: 12/28/2020] [Accepted: 03/26/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the relationship between non-alcoholic fatty liver disease (NAFLD) evaluated by a hepatic fat fraction (HFF) using dual-energy computed tomography (DECT) and high-risk coronary plaques (HRP) in NAFLD patients. METHODS We conducted a matched case-control study involving 172 NAFLD individuals recruited from August 2019 to September 2020. They underwent dual-energy coronary computed tomographic angiography and were classified as no-plaque, HRP negative and HRP positive groups. HFF values were measured using multimaterial decomposition algorithm of DECT, and the differences among three groups were compared. Multiple logistic regression analysis was performed to determine the independent correlation between HFF and HRP. Spearman rank correlation was used to assess the correlations between HFF and multiple variables. RESULTS HRP positive group (15.3%) had higher HFF values than no-plaque (6.9%) and HRP negative groups (8.9%) (P < 0.001). After adjusting for confounding variables, the results indicated that HFF was an independent risk factor for HRP (OR 1.93, P < 0.001). Additionally, HFF significantly correlated with coronary artery calcium score, hepatic CT attenuation, epicardial and pericoronary adipose tissue volume, and CT attenuation (all P < 0.001). CONCLUSIONS As a new imaging marker for the quantification of liver fat, HFF was independently associated with HRP.
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Affiliation(s)
- Rui Zhan
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China
| | - Rongxing Qi
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China.
| | - Sheng Huang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China.
| | - Yang Lu
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China
| | - Xiaoyu Wang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China
| | - Jiashen Jiang
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China
| | - Xiwu Ruan
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China
| | - Anyi Song
- Department of Radiology, The Second Affiliated Hospital of Nantong University, No 6 HaiErXiang (North) Road, Chongchuan District, Nantong city, 226001, Jiangsu Province, China
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Abstract
Dual-energy CT (DECT) overcomes several limitations of conventional single-energy CT (SECT) for the evaluation of gastrointestinal diseases. This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging. A head-to-head comparison of technical specifications among DECT scanner implementations is provided. Energy- and material-specific DECT image reconstructions enable retrospective (i.e., after examination acquisition) image quality adjustments that are not possible using SECT. Such adjustments may, for example, correct insufficient contrast bolus or metal artifacts, thereby potentially avoiding patient recalls. A combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can be included in protocols to improve lesion detection and disease characterization. Relevant literature is reviewed regarding use of DECT for evaluation of the liver, gallbladder, pancreas, and bowel. Challenges involving cost, workflow, body habitus, and variability in DECT measurements are considered. Artificial intelligence and machine-learning image reconstruction algorithms, PACS integration, photon-counting hardware, and novel contrast agents are expected to expand the multienergy capability of DECT and further augment its value.
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