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Mohammadi A, Bartholmae W, Woisetschläger M. Comparison of multiphase data from CT perfusion vs clinical 4-phase CT scans with respect to image quality, lesion detection, and LI-RADS classification in HCC patients. Heliyon 2022; 8:e08757. [PMID: 35146150 PMCID: PMC8819526 DOI: 10.1016/j.heliyon.2022.e08757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/16/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of this study was to assess the image quality and diagnostic performance of reconstructed arterial (A) and portal venous (PV) phases in computed tomography perfusion (CTP) scans compared to the corresponding phases in standard 4-phase CT and to assess the utility for LI-RADS classification using CTP and 4-phase 4CT. Methods A total of 26 scans with each method (CTP and 4-phase CT) from 19 hepatocellular carcinoma patients were analyzed and compared. Arterial and PV phases reconstructed by advanced modeled iterative reconstruction at strength 4 (ADMIRE 4) from raw CTP data were compared with image sets from arterial and PV phases of 4-phase CT (ADMIRE 3) in the same patient with respect to image quality. Results Quantitative image analysis showed that reconstructed CTP datasets were equivalent to 4-phase CT image sets. Qualitative image analysis revealed similar lesion detection rates with the 2 methods for patients with an abdominal diameter ≤36 cm and body weight <90 kg, but lower detection rates with CTP for patients with an abdominal diameter >37 cm. There was no difference in Liver Imaging Reporting and Data System (LI-RADS) classifications between the 2 methods. Conclusion Reconstructed CTP images can potentially replace 4-phase CT images in patients weighing <90 kg and with a body diameter <37 cm, as the 2 methods are comparable in terms of quantitative image quality and ability to detect and classify lesions based on LI-RADS criteria. Reconstructed A- and PV-CTP images have comparable image quality to 4-phase CT. Reconstructed A- and PV-CTP images can be used for LI-RADS classification of HCC. A-/PV-CTP has the potential to reliably detect lesions in patients weighing <90 kg with body diameter ≤36 cm.
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Affiliation(s)
- A Mohammadi
- Department of Radiology, Department of Medical and Health Sciences, Linköping, Sweden
| | - W Bartholmae
- Department of Radiology, Department of Medical and Health Sciences, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - M Woisetschläger
- Department of Radiology, Department of Medical and Health Sciences, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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2
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Anders SM, Helena G, Katharina B, Raquel T, Torkel BB. Visualization of the renal artery in kidney transplant patients using time-resolved computed tomography angiography. Acta Radiol Open 2021; 10:20584601211046334. [PMID: 34616566 PMCID: PMC8489769 DOI: 10.1177/20584601211046334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background Transplant renal artery stenosis (TRAS) is a post-operative complication which most often occurs between 3 months and 2 years after transplantation. TRAS is associated with kidney failure and hypertension and, thereby, with an increased risk of cardiovascular events. Purpose The purpose of this retrospective study was to report our experience of perfusion computed tomography angiography (P-CTA) to identify a 50% lumen reduction (as compared to digital subtraction angiography, DSA), assess its subjective image quality and evaluate if contrast-induced acute kidney injury (CI-AKI) occurred. Material and Methods All 13 patients who had undergone P-CTA for suspected TRAS at our institution were retrospectively evaluated. At P-CTA, eight or 12 g of iodine were administered intravenously, and five to seven scan sequences were merged into time-resolved images after motion correction. Eight patients underwent subsequent DSA. Results The average patient weight was 76 kg (range 55-97 kg). Image quality was rated as good or excellent for all patients, and pathological changes were shown in 10 of 13 patients undergoing P-CTA. Two patients had a serum creatinine increase of >26 μmol/L during the first 3 days, but serum creatinine was significantly lower in all patients 1 month after P-CTA (165+/-69 μmol/L versus 232+/-66 μmol/L, P < .01). The diagnosis at P-CTA was verified in all eight patients who underwent DSA. However, in two cases with suspected stenosis, renal function was restored without angioplasty. Conclusion Anatomy and blood flow of the transplant renal artery can be visualized using less than a third of the standard contrast media dose by using P-CTA technique.
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Affiliation(s)
- Svensson-Marcial Anders
- Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.,Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden
| | - Genberg Helena
- Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden.,Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Brehmer Katharina
- Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.,Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden
| | - Themudo Raquel
- Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.,Departments of Molecular Medicine and Surgery, Clinical Physiology at Karolinska Institute, Stockholm, Sweden
| | - Brismar B Torkel
- Department of Radiology, Karolinska University Hospital, Huddinge, Sweden.,Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology at Karolinska Institute, Stockholm, Sweden
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3
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Earley NF, Hall JL, Brown H, Schwarz T. Early partial portal venous contrast enhancement in canine CT-Angiography. Vet Radiol Ultrasound 2020; 61:628-635. [PMID: 32790224 DOI: 10.1111/vru.12902] [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: 09/06/2019] [Revised: 05/13/2020] [Accepted: 06/02/2020] [Indexed: 01/03/2023] Open
Abstract
Early partial portal vein contrast enhancement (EPoVE) during the late arterial phase is seen in CT angiography of dogs. Previously, it has been a finding attributed to arterioportal vascular anomalies. However, EPoVE may be a normal feature of venous return from abdominal organs. This prospective, descriptive study investigated the origin of EPoVE using four-dimensional CT (4D-CT). Sixteen dogs undergoing 4D-CT for disease of the cranial abdomen were prospectively collected. Regions of interest were placed in the hepatic artery (HA), gastroduodenal vein (GV), extrahepatic portal vein (EHPV) cranial and caudal to the GV, and splenic vein (SV) caudal to its EHPV entry. Times to earliest, partial, full, and maximal vascular enhancement were recorded. A mixed model analysis of variance was used to compare time-to-contrast enhancement between vessels. The number, origin, and time of EPoVE were recorded if visible. A total of 24 EPoVE areas were observed in all dogs. Most dogs had either one (10/16) or two (5/16) areas of EPoVE. The origin of EPoVE was identified in 14 of 24 areas: the GV in five areas, cranial mesenteric vein in four areas, pancreatic branch of SV in three areas, and SV in two areas. The time-to-contrast-enhancement was significantly different for the individual veins compared to the HA. EPoVE during the late arterial phase is a common phenomenon of early portal venous drainage of abdominal organs; it should not be interpreted as pathognomonic for arterioportal vascular anomalies, which should be diagnosed based on additional criteria.
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Affiliation(s)
- Naomi F Earley
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
| | | | - Helen Brown
- The Roslin Institute, University of Edinburgh, Midlothian, UK
| | - Tobias Schwarz
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, UK
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Tsuboyama T, Jost G, Pietsch H, Tomiyama N. Effect of Gadoxetic Acid Injection Duration on Tumor Enhancement in Arterial Phase Liver MRI. Acad Radiol 2020; 27:e216-e223. [PMID: 31787566 DOI: 10.1016/j.acra.2019.10.018] [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: 08/25/2019] [Revised: 10/14/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Rapid injection of gadoxetic acid has been shown not to increase tumor enhancement in arterial phase liver MRI for unknown reasons. This study aimed to investigate the effect of injection durations on peak contrast concentration in tumors and to correlate it with signal enhancement in gadoxetic acid-enhanced arterial phase MRI. MATERIALS AND METHODS Gadoxetic acid-enhanced arterial phase MRI was obtained using a bolus-tracking technique with injection durations of 1, 3, and 6s in six rabbits with VX2 liver tumors. The peak concentration of gadoxetic acid in the aorta and tumor was estimated by iopromide-enhanced time-resolved CT using the same injection volume and durations with those for MRI. Signal enhancement on MRI and peak enhancement on CT were compared and correlated. RESULTS There was no significant difference in MR signal enhancement of tumors among the 3 injection durations (p = 0.87). In CT, shorter injection durations significantly increased peak contrast concentration in the aorta (p < 0.01) but produced equivalent peak contrast concentration in tumors (p = 0.24). The longer injections resulted in the stronger correlation between peak contrast concentration in CT and MR signal enhancement in tumors (r = 0.31, 0.43, and 0.86 with 1s-, 3s-, and 6s-injection, respectively) with a statistical significance only found with 6s-injection (p = 0.03). CONCLUSION Estimation of contrast concentration by CT demonstrated that shorter injections did not increase peak contrast concentration in tumors despite increased peak concentration in the aorta. Furthermore, tumor signal enhancement in gadoxetic acid-enhanced arterial phase MRI was less correlated with the peak contrast concentration with shorter injections.
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5
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Woisetschläger M, Henriksson L, Bartholomae W, Gasslander T, Björnsson B, Sandström P. Iterative reconstruction algorithm improves the image quality without affecting quantitative measurements of computed tomography perfusion in the upper abdomen. Eur J Radiol Open 2020; 7:100243. [PMID: 32642503 PMCID: PMC7334814 DOI: 10.1016/j.ejro.2020.100243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
Iterative image-reconstruction algorithm (ADMIRE) did not affect the quantitative measurements in CT perfusion. Iterative image-reconstruction algorithm (ADMIRE) did not affect the time attenuation curves in CT perfusion. Image noise was lower, but the SNR was higher, for iterative reconstructions in CT perfusion examinations with higher strength of noise reduction.
Objective To investigate differences between reconstruction algorithms in quantitative perfusion values and time-attenuation curves in computed tomography perfusion (CTP) examinations of the upper abdomen. Methods Twenty-six CTP examinations were reconstructed with filtered back projection and an iterative reconstruction algorithm, advanced modeled iterative reconstruction (ADMIRE), with different levels of noise-reduction strength. Using the maximum-slope model, quantitative measurements were obtained: blood flow (mL/min/100 mL), blood volume (mL/100 mL), time to peak (s), arterial liver perfusion (mL/100 mL/min), portal venous liver perfusion (mL/100 mL/min), hepatic perfusion index (%), temporal maximum intensity projection (Hounsfield units (HU)) and temporal average HU. Time-attenuation curves for seven sites (left liver lobe, right liver lobe, hepatocellular carcinoma, spleen, gastric wall, pancreas, portal vein) were obtained. Mixed-model analysis was used for statistical evaluation. Image noise and the signal:noise ratio (SNR) were compared between four reconstructions, and statistical analysis of these reconstructions was made with a related-samples Friedman’s two-way analysis of variance by ranks test. Results There were no significant differences for quantitative measurements between the four reconstructions for all tissues. There were no significant differences between the AUC values of the time-attenuation curves between the four reconstructions for all tissues, including three automatic measurements (portal vein, aorta, spleen). There was a significant difference in image noise and SNR between the four reconstructions. Conclusions ADMIRE did not affect the quantitative measurements or time-attenuation curves of tissues in the upper abdomen. The image noise was lower, and the SNR higher, for iterative reconstructions with higher noise-reduction strengths.
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Key Words
- 4D computed tomography
- ADMIRE, advanced modelled iterative reconstruction
- ALP, arterial liver perfusion
- AUC, area under the curve
- Abdomen
- BF, blood flow
- BMI, body mass index
- BV, blood volume
- CTP, computed tomography perfusion
- FBP, filtered back projection
- GFR, glomerular filtration rate
- HCC, hepatocellular carcinoma
- HPI, hepatic perfusion index
- Image reconstruction
- LI-RADS-5, liver imaging reporting and data system
- Liver
- PVP, portal venous liver perfusion
- Perfusion
- Radiation dosage
- SNR, signal to noise ratio
- TAC, time attenuation curve
- TACE, transarterial chemoembolization
- TTP, time to peak
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Affiliation(s)
- Mischa Woisetschläger
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Lilian Henriksson
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Wolf Bartholomae
- Department of Radiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Thomas Gasslander
- Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Surgery in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Morsbach F, Zhang YH, Martin L, Lindqvist C, Brismar T. Body composition evaluation with computed tomography: Contrast media and slice thickness cause methodological errors. Nutrition 2019; 59:50-55. [DOI: 10.1016/j.nut.2018.08.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/11/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
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7
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Svensson A, Brismar TB. Visualization of the peripheral vascularity by time-resolved computed tomography: a case report. Acta Radiol Open 2019; 8:2058460118820059. [PMID: 30729034 PMCID: PMC6357294 DOI: 10.1177/2058460118820059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Runoff computed tomography angiography (CTA) is commonly used to diagnose peripheral artery disease (PAD) of the lower extremities. However, the risk of non-conclusive examination due to suboptimal timing and overrunning the contrast medium bolus is a major pitfall that must be considered. Here we describe two case studies using dynamic time-resolved CTA imaging of the peripheral vascularity.
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Affiliation(s)
- Anders Svensson
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Division of Medical Imaging and Technology, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
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8
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Brehmer K, Brismar TB, Morsbach F, Svensson A, Stål P, Tzortzakakis A, Voulgarakis N, Fischer MA. Triple Arterial Phase CT of the Liver with Radiation Dose Equivalent to That of Single Arterial Phase CT: Initial Experience. Radiology 2018; 289:111-118. [DOI: 10.1148/radiol.2018172875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Katharina Brehmer
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Torkel B. Brismar
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Fabian Morsbach
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Anders Svensson
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Per Stål
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Antonios Tzortzakakis
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Nikolaos Voulgarakis
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
| | - Michael A. Fischer
- From the Department of Clinical Science, Intervention and Technology (CLINTEC), Radiology Unit, Karolinska Institutet, Alfred Nobels alle 8, 141 52 Huddinge, C1:46 14186 Stockholm, Sweden
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9
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Ohmura T, Lee Y, Takahashi N, Toyoshima H. [Novel Perfusion Evaluation Method Using Phase-ratio Image Map in Head 4D-CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:1125-1131. [PMID: 29151545 DOI: 10.6009/jjrt.2017_jsrt_73.11.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE CT perfusion (CTP) is a powerful tool for the assessment of cerebrovascular disease. However, CTP maps are significantly different depending on CTP software and algorithm, even when using identical image data. We developed a phase-ratio image map (PI map), which was a novel perfusion map, without using CTP software. The purpose of this study was to investigate the usefulness of the PI map by comparing it with a positron emission tomography (PET) image. METHODS Twenty patients (16 men, 4 women; mean age: 61.6 years) with unilateral cervical and intracranial steno-occlusive disease underwent CTP. CTP source images were obtained at 1-s intervals of 23 times and 5 intervals using dynamic multiphase imaging. An early-phase image was generated by computing the average of CT images for 5 s in the vicinity of the peak enhancement curve of a normal hemisphere. A delayed-phase image was generated by computing the average of CT images for 5 s immediately after the early phase. The PI map was created by dividing the delayed-phase image by the early-phase image. We investigated the validity of the PI map compared with PET-cerebral blood flow (CBF). Lesion-to-normal ratios between a PET-CBF and the PI map or two conventional CTP-CBFs were observed and compared, and the relative errors were also compared. RESULT There was a strong correlation between the PET-CBF and the PI map (R=0.82). Correlations between the PET-CBF and two CTP-CBFs were weak (R=0.30) and middle (R=0.62), respectively. The relative error between the PI map and the PET-CBF was within 10% in most cases. CONCLUSION The PI map was more similar to the PET-CBF on perfusion evaluation, and did not depend on CTP software. The robustness and simplicity of the PI mapping method would be advantageous compared with conventional CTP mapping methods.
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Affiliation(s)
- Tomomi Ohmura
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita.,Department of Radiological Technology, Graduate School of Health Sciences, Niigata University
| | - Yongbum Lee
- Department of Radiological Technology, Graduate School of Health Sciences, Niigata University
| | - Noriyuki Takahashi
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita
| | - Hideto Toyoshima
- Department of Radiology and Nuclear Medicine, Research Institute for Brain and Blood Vessels-Akita
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10
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Wang X, Henzler T, Gawlitza J, Diehl S, Wilhelm T, Schoenberg S, Jin Z, Xue H, Smakic A. Image quality of mean temporal arterial and mean temporal portal venous phase images calculated from low dose dynamic volume perfusion CT datasets in patients with hepatocellular carcinoma and pancreatic cancer. Eur J Radiol 2016; 85:2104-2110. [DOI: 10.1016/j.ejrad.2016.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/22/2016] [Accepted: 09/24/2016] [Indexed: 01/28/2023]
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11
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Fischer MA, Marquez HP, Gordic S, Leidner B, Klotz E, Aspelin P, Alkadhi H, Brismar TB. Arterio-portal shunts in the cirrhotic liver: perfusion computed tomography for distinction of arterialized pseudolesions from hepatocellular carcinoma. Eur Radiol 2016; 27:1074-1080. [PMID: 27368924 DOI: 10.1007/s00330-016-4432-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/24/2016] [Accepted: 05/20/2016] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To determine perfusion computed tomography (P-CT) findings for distinction of arterial pseudolesions (APL) from hepatocellular carcinoma (HCC) in the cirrhotic liver. METHODS 32 APL and 21 HCC in 20 cirrhotic patients (15 men; 65 ± 10 years), who underwent P-CT for evaluation of HCC pre- (N = 9) or post- (N = 11) transarterial chemoembolization, were retrospectively included using CT follow-up as the standard of reference. All 53 lesions were qualitatively (visual) and quantitatively (perfusion parameters) analysed according to their shape (wedge, irregular, nodular), location (not-/adjunct to a fistula), arterial liver perfusion (ALP), portal venous liver perfusion (PLP), hepatic perfusion index (HPI). Accuracy for diagnosis of HCC was determined using receiver operating characteristics. RESULTS 18/32 (56 %) APL were wedge shaped, 10/32 (31 %) irregular and 4/32 (12 %) nodular, while 11/21 (52 %) HCC were nodular or 10/21 (48 %) irregular, but never wedge shaped. Significant difference between APL and HCC was seen for lesion shape in pretreated lesions (P < 0.001), and for PLP and HPI in both pre- and post-treated lesions (all, P < 0.001). Diagnostic accuracy for HCC was best for combined assessment of lesion configuration and PLP showing an area under the curve of 0.901. CONCLUSION Combined assessment of lesion configuration and portal venous perfusion derived from P-CT allows best to discriminate APL from HCC with high diagnostic accuracy. KEY POINTS • Arterio-portal shunting is common in the cirrhotic liver, especially after local treatment. • Arterial pseudolesions (APL) due to shunting might mimic hepatocellular carcinoma (HCC). • Perfusion-CT allows for qualitative and quantitative assessment of liver lesions. • Lesion configuration fails to discriminate APL from HCC in locally treated patients. • Integration of quantitative perfusion analysis improves accuracy for diagnosis of HCC.
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Affiliation(s)
- Michael A Fischer
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland. .,Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.
| | - Herman P Marquez
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Sonja Gordic
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Bertil Leidner
- Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden
| | - Ernst Klotz
- Siemens Healthcare, Computed Tomography and Radiation Oncology, DE-91301, Forchheim, Germany
| | - Peter Aspelin
- Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden
| | - Hatem Alkadhi
- Department of Diagnostic and Interventional Radiology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Torkel B Brismar
- Division of Medical Imaging and Technology. Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden
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12
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Fischer MA, Brehmer K, Svensson A, Aspelin P, Brismar TB. Renal versus splenic maximum slope based perfusion CT modelling in patients with portal-hypertension. Eur Radiol 2016; 26:4030-4036. [DOI: 10.1007/s00330-016-4277-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 12/15/2022]
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13
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Hepatocellular Carcinoma Screening With Computed Tomography Using the Arterial Enhancement Fraction With Radiologic-Pathologic Correlation. Invest Radiol 2016; 51:25-32. [DOI: 10.1097/rli.0000000000000201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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14
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Technical prerequisites and imaging protocols for CT perfusion imaging in oncology. Eur J Radiol 2015; 84:2359-67. [PMID: 26137905 DOI: 10.1016/j.ejrad.2015.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/11/2015] [Indexed: 12/29/2022]
Abstract
The aim of this review article is to define the technical prerequisites of modern state-of-the-art CT perfusion imaging in oncology at reasonable dose levels. The focus is mainly on abdominal and thoracic tumor imaging, as they pose the largest challenges with respect to attenuation and patient motion. We will show that low kV dynamic scanning in conjunction with detection technology optimized for low photon fluxes has the highest impact on reducing dose independently of other choices made in the protocol selection. We discuss, derived from relatively simple first principles, on what appropriate temporal sampling and total scan duration depend on and why optimized contrast medium injection protocols are also essential in limiting dose. Finally we will examine the possibility of simultaneously extracting standard morphological and functional information from one single 4D examination as a potential enabler for a more widespread use of dynamic contrast enhanced CT in oncology.
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15
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Fischer MA, Kartalis N, Grigoriadis A, Loizou L, Stål P, Leidner B, Aspelin P, Brismar TB. Perfusion computed tomography for detection of hepatocellular carcinoma in patients with liver cirrhosis. Eur Radiol 2015; 25:3123-32. [PMID: 25903707 DOI: 10.1007/s00330-015-3732-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of dynamic perfusion CT (P-CT) for detection of hepatocellular carcinoma (HCC) in the cirrhotic liver. MATERIALS AND METHODS Twenty-six cirrhotic patients (19 men, aged 69 ± 10 years) with suspicion of HCC prospectively underwent P-CT of the liver using the 4D spiral-mode (100/80 kV; 150/175mAs/rot) of a dual-source system. Two readers assessed: (1) arterial liver-perfusion (ALP), portal-venous liver-perfusion (PLP) and hepatic perfusion-index (HPI) maps alone; and (2) side-by-side with maximum-intensity-projections of arterial time-points (art-MIP) for detection of HCC using histopathology and imaging follow-up as standard of reference. Another reader quantitatively assessed perfusion maps of detected lesions. RESULTS A total of 48 HCCs in 21/26 (81%) patients with a mean size of 20 ± 10 mm were detected by histopathology (9/48, 19%) or imaging follow-up (39/48, 81%). Detection rates (Reader1/Reader2) of HPI maps and side-by-side analysis of HPI combined with arterial MIP were 92/88% and 98/96%, respectively. Positive-predictive values were 63/63% and 68/71%, respectively. A cut-off value of ≥85% HPI and ≥99% HPI yielded a sensitivity and specificity of 100%, respectively, for detection of HCC. CONCLUSION P-CT shows a high sensitivity for detection of HCC in the cirrhotic liver. Quantitative assessment has the potential to reduce false-positive findings improving the specificity of HCC diagnosis. KEY POINTS • Visual analysis of perfusion maps shows good sensitivity for detection of HCC. • Additional assessment of anatomical arterial MIPs further improves detection rates of HCC. • Quantitative perfusion analysis has the potential to reduce false-positive findings. • In cirrhotic livers, a hepatic-perfusion-index ≥ 9 9% might be specific for HCC.
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Affiliation(s)
- Michael A Fischer
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden. .,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden.
| | - Nikolaos Kartalis
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Aristeidis Grigoriadis
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Louiza Loizou
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Per Stål
- Department of Hepatology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Bertil Leidner
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Peter Aspelin
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Division of Medical Imaging and Technology, Karolinska Institute, 14186, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, 14186, Stockholm, Sweden
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Guo M, Yu Y. Application of 128 Slice 4D CT Whole Liver Perfusion Imaging in Hepatic Tumor. Cell Biochem Biophys 2014; 70:173-8. [DOI: 10.1007/s12013-014-9877-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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