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Nishii T, Horinouchi H, Namboku T, Sofue K, Asano R, Kotoku A, Ohta Y, Ogo T, Fukuda T. Laterality of CT-measured hepatic extracellular volume fraction in patients with chronic thromboembolic pulmonary hypertension. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1423-1434. [PMID: 38796803 DOI: 10.1007/s10554-024-03119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE This study examines the hepatic extracellular volume fraction (ECV) disparity between the left and right lobes (ECV_left and ECV_right) in patients with chronic thromboembolic pulmonary hypertension (CTEPH), its association with right heart catheterization (RHC) metrics, and with intolerance to increased pulmonary hypertension (PH)-targeted medication dosages. METHODS We retrospectively analyzed 72 CTEPH-diagnosed patients who underwent equilibrium-phase abdominal dual-energy CT (DECT) and RHC. Hepatic ECVs, derived from DECT's iodine maps using circular regions of interest in the liver and aorta, were correlated with RHC parameters via Spearman's rank correlation and lobe differences through the Wilcoxon signed-rank test. Logistic regression assessed cases with ECV_left exceeding ECV_right by > 0.05, while receiver operating characteristic curve analysis gauged ECVs' predictive power for medication intolerance. RESULTS Of the 72 patients (57 females; median age 69), ECV_total (0.24, IQR 0.20-0.27) moderately correlated with RHC parameters (rs = 0.28, -0.24, 0.3 for mean pulmonary arterial pressure, cardiac index [CI], and pulmonary vascular resistance index, respectively). ECV_left significantly surpassed ECV_right (0.25 vs. 0.22, p < 0.001), with a greater ECV_left by > 0.05 indicating notably lower CI (p < 0.001). In 27 patients on PH medication, ECV_left effectively predicted medication intolerance (AUC = 0.84). CONCLUSION In CTEPH patients, hepatic ECV correlated with RHC metrics, where elevated left lobe ECV suggested reduced CI and potential medication intolerance.
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Affiliation(s)
- Tatsuya Nishii
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Hiroki Horinouchi
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takara Namboku
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Keitaro Sofue
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryotaro Asano
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Akiyuki Kotoku
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takeshi Ogo
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsuya Fukuda
- Department of Radiology, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Kutaiba N, Chung W, Goodwin M, Testro A, Egan G, Lim R. The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review. Insights Imaging 2024; 15:146. [PMID: 38886297 PMCID: PMC11183036 DOI: 10.1186/s13244-024-01727-3] [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: 08/17/2023] [Accepted: 05/26/2024] [Indexed: 06/20/2024] Open
Abstract
Chronic liver disease is responsible for significant morbidity and mortality worldwide. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) can fully visualise the liver and adjacent structures in the upper abdomen providing a reproducible assessment of the liver and biliary system and can detect features of portal hypertension. Subjective interpretation of CT and MRI in the assessment of liver parenchyma for early and advanced stages of fibrosis (pre-cirrhosis), as well as severity of portal hypertension, is limited. Quantitative and reproducible measurements of hepatic and splenic volumes have been shown to correlate with fibrosis staging, clinical outcomes, and mortality. In this review, we will explore the role of volumetric measurements in relation to diagnosis, assessment of severity and prediction of outcomes in chronic liver disease patients. We conclude that volumetric analysis of the liver and spleen can provide important information in such patients, has the potential to stratify patients' stage of hepatic fibrosis and disease severity, and can provide critical prognostic information. CRITICAL RELEVANCE STATEMENT: This review highlights the role of volumetric measurements of the liver and spleen using CT and MRI in relation to diagnosis, assessment of severity, and prediction of outcomes in chronic liver disease patients. KEY POINTS: Volumetry of the liver and spleen using CT and MRI correlates with hepatic fibrosis stages and cirrhosis. Volumetric measurements correlate with chronic liver disease outcomes. Fully automated methods for volumetry are required for implementation into routine clinical practice.
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Affiliation(s)
- Numan Kutaiba
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
- The University of Melbourne, Parkville, Melbourne, VIC, Australia.
| | - William Chung
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
- Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Mark Goodwin
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Adam Testro
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
- Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Gary Egan
- Monash Biomedical Imaging, Monash University, Clayton, VIC, 3800, Australia
| | - Ruth Lim
- Department of Radiology, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
- The University of Melbourne, Parkville, Melbourne, VIC, Australia
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Kutaiba N, Tran A, Ashraf S, Con D, Lokan J, Goodwin M, Testro A, Egan G, Lim R. Computed Tomography-Derived Extracellular Volume Fraction and Splenic Size for Liver Fibrosis Staging. J Comput Assist Tomogr 2024:00004728-990000000-00328. [PMID: 38858799 DOI: 10.1097/rct.0000000000001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVE Extracellular volume fraction (fECV) and liver and spleen size have been correlated with liver fibrosis stages and cirrhosis. The purpose of the current study was to determine the predictive value of fECV alone and in conjunction with measurement of liver and spleen size for severity of liver fibrosis. METHODS This was a retrospective study of 95 subjects (65 with liver biopsy and 30 controls). Spearman rank correlation coefficient was used to assess correlation between radiological markers and fibrosis stage. Receiver operating characteristic analysis was performed to assess the discriminative ability of radiological markers for significant (F2+) and advanced (F3+) fibrosis and cirrhosis (F4), by reporting the area under the curve (AUC). RESULTS The cohort had a mean age of 51.4 ± 14.4 years, and 52 were female (55%). There were 36, 5, 6, 9, and 39 in fibrosis stages F0, F1, F2, F3, and F4, respectively. Spleen volume alone showed the highest correlation (r = 0.552, P < 0.001) and AUCs of 0.823, 0.807, and 0.785 for identification of significant and advanced fibrosis and cirrhosis, respectively. Adding fECV to spleen length improved AUCs (0.764, 0.745, and 0.717 to 0.812, 0.781, and 0.738, respectively) compared with splenic length alone. However, adding fECV to spleen volume did not improve the AUCs for significant or advanced fibrosis or cirrhosis. CONCLUSIONS Spleen size (measured in length or volume) showed better correlation with liver fibrosis stages compared with fECV. The combination of fECV and spleen length had higher accuracy compared with fECV alone or spleen length alone.
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Affiliation(s)
| | - Anthony Tran
- From the Department of Radiology, Austin Health, Heidelberg, Victoria
| | - Saad Ashraf
- From the Department of Radiology, Austin Health, Heidelberg, Victoria
| | | | - Julie Lokan
- Anatomical Pathology, Austin Health, Heidelberg
| | | | | | - Gary Egan
- Monash Biomedical Imaging, Monash University, Clayton, Victoria, Australia
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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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Chen H, Fang Y, Gu J, Sun P, Yang L, Pan F, Wu H, Ye T. Dual-Layer Spectral Detector Computed Tomography Quantitative Parameters: A Potential Tool for Lymph Node Activity Determination in Lymphoma Patients. Diagnostics (Basel) 2024; 14:149. [PMID: 38248026 PMCID: PMC10814325 DOI: 10.3390/diagnostics14020149] [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: 11/23/2023] [Revised: 01/01/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Dual-energy CT has shown promising results in determining tumor characteristics and treatment effectiveness through spectral data by assessing normalized iodine concentration (nIC), normalized effective atomic number (nZeff), normalized electron density (nED), and extracellular volume (ECV). This study explores the value of quantitative parameters in contrast-enhanced dual-layer spectral detector CT (SDCT) as a potential tool for detecting lymph node activity in lymphoma patients. A retrospective analysis of 55 lymphoma patients with 289 lymph nodes, assessed through 18FDG-PET/CT and the Deauville five-point scale, revealed significantly higher values of nIC, nZeff, nED, and ECV in active lymph nodes compared to inactive ones (p < 0.001). Generalized linear mixed models showed statistically significant fixed-effect parameters for nIC, nZeff, and ECV (p < 0.05). The area under the receiver operating characteristic curve (AUROC) values of nIC, nZeff, and ECV reached 0.822, 0.845, and 0.811 for diagnosing lymph node activity. In conclusion, the use of g nIC, nZeff, and ECV as alternative imaging biomarkers to PET/CT for identifying lymph node activity in lymphoma holds potential as a reliable diagnostic tool that can guide treatment decisions.
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Affiliation(s)
- Hebing Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Yuxiang Fang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Jin Gu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Peng Sun
- Clinical & Technical Support, Philips Healthcare, Floor 7, Building 2, World Profit Center, Beijing 100000, China;
| | - Lian Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Feng Pan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Hongying Wu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
| | - Tianhe Ye
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan 430022, China; (H.C.); (Y.F.); (J.G.); (L.Y.); (F.P.)
- Hubei Province Key Laboratory of Molecular Imaging, Jiefang Avenue #1277, Wuhan 430022, China
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Peng Y, Tang G, Sun M, Yu S, Cheng Y, Wang Y, Deng W, Li Y, Guan J. Feasibility of spectral CT-derived extracellular volume fraction for differentiating aldosterone-producing from nonfunctioning adrenal nodules. Eur Radiol 2024; 34:50-59. [PMID: 37566275 DOI: 10.1007/s00330-023-10077-5] [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: 12/14/2022] [Revised: 07/04/2023] [Accepted: 07/15/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To assess the feasibility of spectral CT-derived extracellular volume (ECV) for differentiating aldosterone-producing nodules (APN) from nonfunctioning adrenal nodules (NFN). METHODS Sixty-nine patients with biochemically and histologically confirmed unilateral APN (34) and NFN (35) as well as 23 patients with bilateral APN (19) and NFN (27) confirmed biochemically and by adrenal vein sampling (AVS) were enrolled in this retrospective study from October 2020 to April 2022. All patients underwent contrast-enhanced spectral CT of the adrenal glands with a 10-min delayed phase. The haematocrit level was measured within 2 days of CT. An iodine density map was derived from the delayed CT. The ECV fractions of the APN and NFN were calculated and compared in the test cohort of 69 patients with unilateral adrenal nodules. The optimal cut-off value was determined to evaluate the diagnostic efficacy of the ECV fraction for differentiating APN from NFN in the validation cohort of 23 patients with bilateral adrenal nodules. RESULTS The ECV fractions of the APN (11.17 ± 4.57%) were significantly lower (p < 0.001) than that of the NFN (24.79 ± 6.01%) in the test cohort. At cut-off ECV value of 17.16%, the optimal area under the receiver operating characteristic curve was 0.974 (95% confidence interval: 0.942-1) with 91.4% sensitivity, 93.9% specificity, and 92.8% accuracy in the test cohort and 89.5% sensitivity, 96.3% specificity, and 93.5% accuracy in the validation cohort for differentiating APN from NFN. CONCLUSION The spectral CT-derived ECV fraction can differentiate APN from NFN with high diagnostic performance. CLINICAL RELEVANCE STATEMENT Spectral CT-derived extracellular volume fraction could accurately differentiate between adrenal aldosterone-producing nodules and nonfunctioning nodules. It might serve as a noninvasive alternative to adrenal vein sampling in primary aldosteronism patients with bilateral adrenal nodules. KEY POINTS • Conventional CT cannot differentiate aldosterone-producing adrenal nodules from nonfunctioning nodules. • Extracellular volume of adrenal aldosterone-producing nodules was significantly lower than that of nonfunctioning nodules and normal adrenal glands. It can accurately differentiate between aldosterone-producing and nonfunctioning adrenal nodules. • Extracellular volume may be a novel, noninvasive biomarker alternative to adrenal vein sampling for determining the functional status of bilateral adrenal nodules in patients with primary aldosteronism.
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Affiliation(s)
- Yang Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Guanglei Tang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Mengya Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Shuang Yu
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Yanglei Cheng
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Weiwei Deng
- Clinical & Technical Support, Philips Healthcare, China, 200072, Shanghai, People's Republic of China
| | - Yanbing Li
- Department of Endocrinology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China.
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China.
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Bing X, Wang N, Li Y, Sun H, Yao J, Li R, Li Z, Ouyang A. The Value of Dual-Energy Computed Tomography-Based Radiomics in the Evaluation of Interstitial Fibers of Clear Cell Renal Carcinoma. Technol Cancer Res Treat 2024; 23:15330338241235554. [PMID: 38404055 PMCID: PMC10896050 DOI: 10.1177/15330338241235554] [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: 08/17/2023] [Revised: 12/27/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE We investigated the potential of dual-energy computed tomography (DECT) radiomics in assessing cancer-associated fibroblasts in clear cell renal carcinoma (ccRCC). METHODS A retrospective analysis was conducted on 132 patients with ccRCC. The arterial and venous phase iodine-based material decomposition images (IMDIs), virtual non-contrast images, 70 keV, 100 keV, and 150 keV virtual monoenergetic images, and mixed energy images (MEIs) were obtained from the DECT datasets. On the Radcloud platform, radiomics feature extraction, feature selection, and model establishment were performed. Seven radiomics models were established using the support vector machine. The predictive performance was evaluated by utilizing receiver operating characteristic and the area under the curve (AUC) was calculated. Nomograms were constructed. RESULTS The combined model demonstrated high efficiency in evaluating pseudocapsule thickness with AUC, specificity, and sensitivity of 0.833, 0.870, and 0.750, respectively in the validation set, surpassing those of other models. The precision, F1-score, and Youden index were also higher for the combined model. For evaluating the number of collagen fibers, the combined model exhibited the highest AUC (0.741) among all models, with a specificity of 0.830 and a sensitivity of 0.330. The AUC in the 150 kv model and IMDI model were slightly lower than those in the combined model (0.728 and 0.710, respectively), with corresponding sensitivity and specificity of 0.560/0.780 and 0.670/0.830. The nomogram exhibited that Rad-score had good prediction efficiency. CONCLUSION DECT radiomics features have significant value in evaluating the interstitial fibers of ccRCC. The combined model of IMDI + MEI exhibits superior performance in assessing the thickness of the pseudocapsule, while the combined, 150 keV, and IMDI models demonstrate higher efficacy in evaluating collagen fiber number. Radiomics, combined with imaging features and clinical features, has excellent predictive performance. These findings offer crucial support for the clinical diagnosis, treatment, and prognosis of ccRCC and provide valuable insights into the application of DECT.
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Affiliation(s)
- Xue Bing
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Ning Wang
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Yuhan Li
- Department of Radiology, Longkou Traditional Chinese Medicine Hospital, Yantai, P.R. China
| | - Haitao Sun
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Jian Yao
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
| | - Ruobing Li
- Department of Radiology, Shandong First Medical University, Jinan, P.R. China
| | - Zhongyuan Li
- School of Medical Imaging, Weifang Medical University, Weifang, P.R. China
| | - Aimei Ouyang
- Department of Radiology, Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital, Jinan, P.R. China
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Hu N, Yan G, Tang M, Wu Y, Song F, Xia X, Chan LWC, Lei P. CT-based methods for assessment of metabolic dysfunction associated with fatty liver disease. Eur Radiol Exp 2023; 7:72. [PMID: 37985560 PMCID: PMC10661153 DOI: 10.1186/s41747-023-00387-0] [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: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 11/22/2023] Open
Abstract
Metabolic dysfunction-associated fatty liver disease (MAFLD), previously called metabolic nonalcoholic fatty liver disease, is the most prevalent chronic liver disease worldwide. The multi-factorial nature of MAFLD severity is delineated through an intricate composite analysis of the grade of activity in concert with the stage of fibrosis. Despite the preeminence of liver biopsy as the diagnostic and staging reference standard, its invasive nature, pronounced interobserver variability, and potential for deleterious effects (encompassing pain, infection, and even fatality) underscore the need for viable alternatives. We reviewed computed tomography (CT)-based methods for hepatic steatosis quantification (liver-to-spleen ratio; single-energy "quantitative" CT; dual-energy CT; deep learning-based methods; photon-counting CT) and hepatic fibrosis staging (morphology-based CT methods; contrast-enhanced CT biomarkers; dedicated postprocessing methods including liver surface nodularity, liver segmental volume ratio, texture analysis, deep learning methods, and radiomics). For dual-energy and photon-counting CT, the role of virtual non-contrast images and material decomposition is illustrated. For contrast-enhanced CT, normalized iodine concentration and extracellular volume fraction are explained. The applicability and salience of these approaches for clinical diagnosis and quantification of MAFLD are discussed.Relevance statementCT offers a variety of methods for the assessment of metabolic dysfunction-associated fatty liver disease by quantifying steatosis and staging fibrosis.Key points• MAFLD is the most prevalent chronic liver disease worldwide and is rapidly increasing.• Both hardware and software CT advances with high potential for MAFLD assessment have been observed in the last two decades.• Effective estimate of liver steatosis and staging of liver fibrosis can be possible through CT.
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Affiliation(s)
- Na Hu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Gang Yan
- Department of Nuclear Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Maowen Tang
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuhui Wu
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Fasong Song
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xing Xia
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lawrence Wing-Chi Chan
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
| | - Pinggui Lei
- Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China.
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.
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Ozaki K, Ohtani T, Ishida T, Takahashi K, Ishida S, Takata K, Sakai T, Higuchi S, Gabata T. Liver fibrosis estimated using extracellular volume fraction obtained from dual-energy CT as a risk factor for hepatocellular carcinoma after sustained virologic response: A preliminary case-control study. Eur J Radiol 2023; 168:111112. [PMID: 37783146 DOI: 10.1016/j.ejrad.2023.111112] [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: 08/01/2023] [Revised: 09/11/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To assess hepatocellular carcinoma (HCC) risk after sustained virologic response (SVR) through clinical data analyses, including evaluation of liver fibrosis using the extracellular volume fraction (ECV) obtained from dual-energy computed tomography (DECT). METHODS Ninety-two patients (52 men and 40 women; mean age, 69.9 years) with hepatitis C virus infection after SVR underwent DECT of the liver (3-minute equilibrium-phase images) between January 2020 and March 2022. The ECV was calculated by measuring iodine density; fibrous markers, including ECV, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, and platelet count, were statistically analyzed (p < 0.05). The risk factors associated with HCC were analyzed using univariate and multivariate logistic regression analyses. RESULTS The ECV (26.1 ± 4.6 %) in patients with HCC (n,21) was significantly larger than the ECV (20.7 ± 3.3 %) in patients without HCC (n = 71) (p < 0.001). The cutoff value for the ECV was 24.3 %. The area under the operating characteristic curve of the ECV was 0.857, which was higher than that of the serum fibrosis markers. Older age, SVR achieved with interferon, alpha-fetoprotein level (>5 ng/mL), advanced fibrosis before treatment (>F3), and ECV were associated with HCC according to the univariate analysis. Multivariate analyses showed that ECV was the only factor independently associated with HCC (odds ratio 0.619, 95 % confidence interval 0.482-0.795, p < 0.001). CONCLUSION Liver fibrosis estimated using ECV can be a predictive marker in patients with HCC after SVR.
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Affiliation(s)
- Kumi Ozaki
- Departments of Radiology, Faculty of Medical Sciences, University of Fukui, Japan; Department of Radiology, Hamamatsu University School of Medicine, Japan.
| | - Takashi Ohtani
- Radiological Center, University of Fukui Hospital, Japan
| | | | | | - Shota Ishida
- Radiological Center, University of Fukui Hospital, Japan; Department of Radiological Technology, Faculty of Medical Science, Kyoto College of Medical Science, Japan
| | - Kenji Takata
- Departments of Radiology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Toyohiko Sakai
- Departments of Radiology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Shohei Higuchi
- Departments of Pathology, Faculty of Medical Sciences, University of Fukui, Japan
| | - Toshifumi Gabata
- Department of Radiology, Kanazawa University Graduate School of Medicine, Japan
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10
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Peng Y, Tang H, Huang Y, Yuan X, Wang X, Ran Z, Deng W, Liu R, Lan X, Shen H, Zhang J. CT-derived extracellular volume and liver volumetry can predict posthepatectomy liver failure in hepatocellular carcinoma. Insights Imaging 2023; 14:145. [PMID: 37697217 PMCID: PMC10495294 DOI: 10.1186/s13244-023-01496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/08/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVES Posthepatectomy liver failure (PHLF) is a severe complication of liver resection. We aimed to develop and validate a model based on extracellular volume (ECV) and liver volumetry derived from computed tomography (CT) for preoperative predicting PHLF in resectable hepatocellular carcinoma (HCC) patients. METHODS A total of 393 resectable HCC patients from two hospitals were enrolled and underwent multiphasic contrast-enhanced CT before surgery. A total of 281 patients from our hospital were randomly divided into a training cohort (n = 181) and an internal validation cohort (n = 100), and 112 patients from another hospital formed the external validation cohort. CT-derived ECV was measured on nonenhanced and equilibrium phase images, and liver volumetry was measured on portal phase images. The model is composed of independent predictors of PHLF. The under the receiver operator characteristic curve (AUC) and calibration curve were used to reflect the predictive performance and calibration of the model. Comparison of AUCs used the DeLong test. RESULTS CT-derived ECV, measured future liver remnant (mFLR) ratio, and serum albumin were independent predictors for PHLF in resectable HCC patients. The AUC of the model was significantly higher than that of the ALBI score in the training cohort, internal validation cohort, and external validation cohort (all p < 0.001). The calibration curve of the model showed good consistency in the training cohort and the internal and external validation cohorts. CONCLUSIONS The novel model contributes to the preoperative prediction of PHLF in resectable HCC patients. CRITICAL RELEVANCE STATEMENT The novel model combined CT-derived extracellular volume, measured future liver remnant ratio, and serum albumin outperforms the albumin-bilirubin score for predicting posthepatectomy liver failure in patients with resectable hepatocellular carcinoma. KEY POINTS • CT-derived ECV correlated well with the fibrosis stage of the background liver. • CT-derived ECV and mFLR ratio were independent predictors for PHLF in HCC. • The AUC of the model was higher than the CT-derived ECV and mFLR ratio. • The model showed a superior predictive performance than that of the ALBI score.
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Affiliation(s)
- Yangling Peng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Hao Tang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Yuanying Huang
- Department of Hematology, Chongqing General Hospital, University of the Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Xiaoqian Yuan
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Xing Wang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Zijuan Ran
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Wei Deng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Renwei Liu
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Hesong Shen
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China.
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11
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Doi S, Yanagawa M, Matsui T, Hata A, Kikuchi N, Yoshida Y, Yamagata K, Ninomiya K, Kido S, Tomiyama N. Usefulness of Three-Dimensional Iodine Mapping Quantified by Dual-Energy CT for Differentiating Thymic Epithelial Tumors. J Clin Med 2023; 12:5610. [PMID: 37685677 PMCID: PMC10488564 DOI: 10.3390/jcm12175610] [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: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Background: Dual-energy CT has been reported to be useful for differentiating thymic epithelial tumors. The purpose is to evaluate thymic epithelial tumors by using three-dimensional (3D) iodine density histogram texture analysis on dual-energy CT and to investigate the association of extracellular volume fraction (ECV) with the fibrosis of thymic carcinoma. Methods: 42 patients with low-risk thymoma (n = 20), high-risk thymoma (n = 16), and thymic carcinoma (n = 6) were scanned by dual-energy CT. 3D iodine density histogram texture analysis was performed for each nodule on iodine density mapping: Seven texture features (max, min, median, average, standard deviation [SD], skewness, and kurtosis) were obtained. The iodine effect (average on DECT180s-average on unenhanced DECT) and ECV on DECT180s were measured. Tissue fibrosis was subjectively rated by one pathologist on a three-point grade. These quantitative data obtained by examining associations with thymic carcinoma and high-risk thymoma were analyzed with univariate and multivariate logistic regression models (LRMs). The area under the curve (AUC) was calculated by the receiver operating characteristic curves. p values < 0.05 were significant. Results: The multivariate LRM showed that ECV > 21.47% in DECT180s could predict thymic carcinoma (odds ratio [OR], 11.4; 95% confidence interval [CI], 1.18-109; p = 0.035). Diagnostic performance was as follows: Sensitivity, 83.3%; specificity, 69.4%; AUC, 0.76. In high-risk thymoma vs. low-risk thymoma, the multivariate LRM showed that the iodine effect ≤1.31 mg/cc could predict high-risk thymoma (OR, 7; 95% CI, 1.02-39.1; p = 0.027). Diagnostic performance was as follows: Sensitivity, 87.5%; specificity, 50%; AUC, 0.69. Tissue fibrosis significantly correlated with thymic carcinoma (p = 0.026). Conclusions: ECV on DECT180s related to fibrosis may predict thymic carcinoma from thymic epithelial tumors, and the iodine effect on DECT180s may predict high-risk thymoma from thymoma.
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Affiliation(s)
- Shuhei Doi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Akinori Hata
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Noriko Kikuchi
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Yuriko Yoshida
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Kazuki Yamagata
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Keisuke Ninomiya
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Shoji Kido
- Department of Artificial Intelligence Diagnostic Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-City 565-0871, Osaka, Japan
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12
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Zheng S, He K, Zhang L, Li M, Zhang H, Gao P. Conventional and artificial intelligence-based computed tomography and magnetic resonance imaging quantitative techniques for non-invasive liver fibrosis staging. Eur J Radiol 2023; 165:110912. [PMID: 37290363 DOI: 10.1016/j.ejrad.2023.110912] [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: 03/13/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Chronic liver disease (CLD) ultimately develops into liver fibrosis and cirrhosis and is a major public health problem globally. The assessment of liver fibrosis is important for patients with CLD for prognostication, treatment decisions, and surveillance. Liver biopsies are traditionally performed to determine the stage of liver fibrosis. However, the risks of complications and technical limitations restrict their application to screening and sequential monitoring in clinical practice. CT and MRI are essential for evaluating cirrhosis-associated complications in patients with CLD, and several non-invasive methods based on them have been proposed. Artificial intelligence (AI) techniques have also been applied to stage liver fibrosis. This review aimed to explore the values of conventional and AI-based CT and MRI quantitative techniques for non-invasive liver fibrosis staging and summarized their diagnostic performance, advantages, and limitations.
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Affiliation(s)
- Shuang Zheng
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Kan He
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Lei Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Mingyang Li
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Huimao Zhang
- Department of Radiology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
| | - Pujun Gao
- Department of Hepatology, the First Hospital of Jilin University, No. 71 Xinmin Street, Changchun, Jilin, China.
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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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14
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Xu Y, Li Y, Li S, Xue S, Liu J. Dual-energy CT quantification of extracellular liver volume predicts short-term disease progression in patients with hepatitis B liver cirrhosis-acute decompensation. Insights Imaging 2023; 14:51. [PMID: 36977956 PMCID: PMC10050608 DOI: 10.1186/s13244-023-01393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/19/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Liver cirrhosis-acute decompensation (LC-AD) has rapid short-term disease progression and difficult early risk stratification. The purpose is to develop and validate a model based on dual-energy CT quantification of extracellular liver volume (ECVIC-liver) for predicting the occurrence of acute-on-chronic liver failure (ACLF) within 90 days in patients with hepatitis B (HBV) LC-AD. METHODS The retrospective study included patients with HBV LC-AD who underwent dual-energy CT scans of the liver from January 2018 to March 2022 and were randomized to training group (215 patients) and validation group (92 patients). The primary outcome was the need for readmission within 90 days due to ACLF. Based on the training group data, independent risk factors for disease progression in clinical and dual-energy CT parameters were identified and modeled by logistic regression analysis. Based on the training and validation groups data, receiver operating characteristic (ROC) curves, calibration curves, and decision analysis curves (DCA) were used to verify the discrimination, calibration, and clinical validity of the nomogram. RESULTS Chronic liver failure consortium-acute decompensation score (CLIF-C ADs) (p = 0.008) and ECVIC-liver (p < 0.001) were independent risk factors for ACLF within 90 days. The AUC of the model combined ECVIC-liver and CLIF-C ADs were 0.893 and 0.838 in the training and validation groups, respectively. The calibration curves show good agreement between predicted and actual risks. The DCA indicates that the model has good clinical application. CONCLUSION The model combined ECVIC-liver and CLIF-C ADs can early predict the occurrence of ACLF within 90 days in HBV LC-AD patients.
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Affiliation(s)
- Yuan Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Yufeng Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Shouxiao Xue
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianli Liu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.
- Second Clinical School, Lanzhou University, Lanzhou, China.
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou University Second Hospital, Lanzhou, China.
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15
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Luo Y, Liu L, Liu D, Shen H, Wang X, Fan C, Zeng Z, Zhang J, Tan Y, Zhang X, Wu J, Zhang J. Extracellular volume fraction determined by equilibrium contrast-enhanced CT for the prediction of the pathological complete response to neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Eur Radiol 2022; 33:4042-4051. [PMID: 36462046 DOI: 10.1007/s00330-022-09307-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To determine the extracellular volume (ECV) fraction derived from equilibrium contrast-enhanced CT for predicting pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) in locally advanced rectal cancer (LARC). METHODS The ECV fraction before NCRT (ECVpre) and/or ECV after NCRT (ECVpost) of rectal tumors was assessed, and ECVΔ was calculated as ECVpost - ECVpre. The histopathologic tumor regression grading (TRG) was assessed. pCR (TRG 0 grade) was defined as the absence of viable tumor cells in the primary tumor and lymph nodes. Demographic and clinicopathological characteristics and ECV fraction were compared between the pCR and non-pCR groups. A mixed model was constructed by logistic regression. The performance for predicting pCR was assessed with the area under the receiver-operator curve (AUC). The AUCs of the different methods were compared by the method proposed by DeLong et al. RESULTS: Seventy-five patients were included; 17 achieved pCR, and 58 achieved non-pCR. The ECVpost (17.05 ± 2.36% vs. 29.94 ± 1.20%; p < 0.001) and ECVΔ (- 17.01 ± 3.01% vs. 0.44 ± 1.45%; p < 0.001) values in the pCR group were significantly lower than those in the non-pCR group. The mixed model that combined ECVpost with ECVΔ achieved an AUC of 0.92 (95% confidence interval (CI) = 0.81-0.98), which was higher than that of ECVpost (AUC, 0.91 (95% CI = 0.80-0.97); p = 0.60) or ECVΔ (AUC, 0.90 (95% CI = 0.79-0.97); p = 0.61). CONCLUSIONS ECVpost and ECVΔ determined by using equilibrium contrast-enhanced CT were useful in distinguishing between pCR and non-pCR patients with LARC who received NCRT. KEY POINTS • ECVpost and ECVΔ (ECVpost - ECVpre) differed significantly between the non-pCR and pCR groups. • ECVpre cannot be used to predict the efficacy of neoadjuvant chemoradiotherapy. • ECVpost combined with ECVΔ had the best performance with an AUC of 0.92 for predicting pCR after NCRT in LARC.
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Wada N, Fujita N, Ishimatsu K, Takao S, Yoshizumi T, Miyazaki Y, Oda Y, Nishie A, Ishigami K, Ushijima Y. A novel fast kilovoltage switching dual-energy computed tomography technique with deep learning: Utility for non-invasive assessments of liver fibrosis. Eur J Radiol 2022; 155:110461. [DOI: 10.1016/j.ejrad.2022.110461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/22/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
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17
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Peng Y, Shen H, Tang H, Huang Y, Lan X, Luo X, Zhang X, Zhang J. Nomogram based on CT-derived extracellular volume for the prediction of post-hepatectomy liver failure in patients with resectable hepatocellular carcinoma. Eur Radiol 2022; 32:8529-8539. [PMID: 35678856 DOI: 10.1007/s00330-022-08917-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/19/2022] [Accepted: 05/30/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to develop and validate a nomogram based on extracellular volume (ECV) derived from computed tomography (CT) for predicting post-hepatectomy liver failure (PHLF) in patients with resectable hepatocellular carcinoma (HCC). METHODS A total of 202 patients with resectable HCC from two hospitals were enrolled and underwent multiphasic contrast-enhanced CT before surgery. One hundred twenty-one patients from our hospital and 81 patients from another hospital were assigned to the training cohort and the validation cohort, respectively. CT-derived ECV was measured using nonenhanced and equilibrium-phase-enhanced CT images. The nomogram was developed with independent predictors of PHLF. Predictive performance and calibration were assessed by receiver operator characteristic (ROC) analysis and Hosmer-Lemeshow test, respectively. The Delong test was used to compare the areas under the curve (AUCs). RESULTS CT-derived ECV had a strong correlation with the postoperative pathological fibrosis stage of the background liver (p < 0.001, r = 0.591). The nomogram combining CT-derived ECV, serum albumin (Alb), and serum total bilirubin (Tbil) obtained higher AUCs than the albumin-bilirubin (ALBI) score for predicting PHLF in both the training cohort (0.828 vs. 0.708; p = 0.004) and the validation cohort (0.821 vs. 0.630; p < 0.001). The nomogram showed satisfactory goodness of fit for PHLF prediction in the training and validation cohorts (p = 0.621 and 0.697, respectively). CONCLUSIONS The nomogram contributes to the preoperative prediction of PHLF in patients with resectable HCC. KEY POINTS • CT-derived ECV had a strong correlation with the postoperative pathological fibrosis stage of the background liver. • CT-derived ECV was an independent predictor of PHLF in patients with resectable HCC. • The nomogram based on CT-derived ECV showed a superior prediction efficacy than that of clinical models (including Child-Pugh stage, MELD score, and ALBI score).
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Affiliation(s)
- Yangling Peng
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Hesong Shen
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Hao Tang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Yuanying Huang
- Department of Hematology, Chongqing General Hospital, University of the Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Xiaosong Lan
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China
| | - Xianzhang Luo
- Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, People's Republic of China
| | - Xiaoyue Zhang
- Siemens Healthineers, Xi'an, People's Republic of China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People's Republic of China.
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Lee JM, Yoon JH. Dual-Energy CT for Risk of Postoperative Pancreatic Fistula. Radiology 2022; 304:73-74. [PMID: 35315723 DOI: 10.1148/radiol.220320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeong Min Lee
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.M.L., J.H.Y.); and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.)
| | - Jeong Hee Yoon
- From the Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (J.M.L., J.H.Y.); and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (J.M.L.)
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Synthetic extracellular volume fraction without hematocrit sampling for hepatic applications. Abdom Radiol (NY) 2021; 46:4637-4646. [PMID: 34109447 PMCID: PMC8435519 DOI: 10.1007/s00261-021-03140-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/03/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023]
Abstract
Purpose Calculation of extracellular volume fraction (ECV) currently receives increasing interest as a potential biomarker for non-invasive assessment of liver fibrosis. ECV calculation requires hematocrit (Hct) sampling, which might be difficult to obtain in a high-throughput radiology department. The aim of this study was to generate synthetic ECV for hepatic applications without the need for Hct sampling. Methods In this prospective study participants underwent liver MRI. T1 mapping was performed before and after contrast administration. Blood Hct was obtained prior to MRI. We hypothesized that the relationship between Hct and longitudinal relaxation rate of blood (R1 = 1/T1blood) could be calibrated and used to generate the equation for synthetic Htc and ECV calculation. Conventional and synthetic ECV were calculated. Pearson correlation, linear regression and Bland–Altman method were used for statistical analysis. Results 180 consecutive patients were divided into derivation (n = 90) and validation (n = 90) cohorts. In the derivation cohort, native R1blood and Hct showed a linear relationship (HctMOLLI = 98.04 × (1/T1blood) − 33.17, R2 = 0.75, P < 0.001), which was used to calculate synthetic ECV in the validation and whole study cohorts. Synthetic and conventional ECV showed significant correlations in the derivation, validation and in the whole study cohorts (r = 0.99, 0.97 and 0.99, respectively, P < 0.001, respectively) with minimal bias according to the Bland–Altman analysis. Conclusion Synthetic ECV seems to offer an alternative method for non-invasive quantification of the hepatic ECV. It may potentially overcome an important barrier to clinical implementation of ECV and thus, enable broader use of hepatic ECV in routine clinical practice.
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