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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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García-Figueiras R, Oleaga L, Broncano J, Tardáguila G, Fernández-Pérez G, Vañó E, Santos-Armentia E, Méndez R, Luna A, Baleato-González S. What to Expect (and What Not) from Dual-Energy CT Imaging Now and in the Future? J Imaging 2024; 10:154. [PMID: 39057725 PMCID: PMC11278514 DOI: 10.3390/jimaging10070154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/09/2024] [Accepted: 06/14/2024] [Indexed: 07/28/2024] Open
Abstract
Dual-energy CT (DECT) imaging has broadened the potential of CT imaging by offering multiple postprocessing datasets with a single acquisition at more than one energy level. DECT shows profound capabilities to improve diagnosis based on its superior material differentiation and its quantitative value. However, the potential of dual-energy imaging remains relatively untapped, possibly due to its intricate workflow and the intrinsic technical limitations of DECT. Knowing the clinical advantages of dual-energy imaging and recognizing its limitations and pitfalls is necessary for an appropriate clinical use. The aims of this paper are to review the physical and technical bases of DECT acquisition and analysis, to discuss the advantages and limitations of DECT in different clinical scenarios, to review the technical constraints in material labeling and quantification, and to evaluate the cutting-edge applications of DECT imaging, including artificial intelligence, qualitative and quantitative imaging biomarkers, and DECT-derived radiomics and radiogenomics.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago, Choupana, 15706 Santiago de Compostela, Spain
| | - Laura Oleaga
- Department of Radiology, Hospital Clinic, C. de Villarroel, 170, 08036 Barcelona, Spain
| | | | - Gonzalo Tardáguila
- Department of Radiology, Hospital Ribera Povisa, Rúa de Salamanca, 5, Vigo, 36211 Pontevedra, Spain
| | | | - Eliseo Vañó
- Department of Radiology, Hospital Universitario Nuestra Señora, del Rosario, C. del Príncipe de Vergara, 53, 28006 Madrid, Spain
| | - Eloísa Santos-Armentia
- Department of Radiology, Hospital Ribera Povisa, Rúa de Salamanca, 5, Vigo, 36211 Pontevedra, Spain
| | - Ramiro Méndez
- Department of Radiology, Hospital Universitario Nuestra Señora, del Rosario, C. del Príncipe de Vergara, 53, 28006 Madrid, Spain
- Department of Radiology, Hospital Universitario Clínico San Carlos, Calle del Prof Martín Lagos, 28040 Madrid, Spain
| | | | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago, Choupana, 15706 Santiago de Compostela, Spain
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Narang M, Singh A, Mahapatra SJ, Gunjan D, Sharma S, Srivastava DN, Yadav R, Dash NR, Bansal VK, Pandey RM, Garg PK, Madhusudhan KS. Utility of dual-energy CT and advanced multiparametric MRI based imaging biomarkers of pancreatic fibrosis in grading the severity of chronic pancreatitis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04443-0. [PMID: 38900324 DOI: 10.1007/s00261-024-04443-0] [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: 02/06/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE To non-invasively quantify pancreatic fibrosis and grade severity of chronic pancreatitis (CP) on dual-energy CT (DECT) and multiparametric MRI (mpMRI). METHODS We included 72 patients (mean age:30years; 59 men) with suspected or confirmed CP from December 2019 to December 2021 graded as equivocal(n = 20), mild(n = 18), and moderate-marked(n = 34) using composite imaging and endoscopic ultrasound criteria. Study patients underwent multiphasic DECT and mpMRI of the abdomen. Normalized iodine concentration(NIC) and fat fraction(FF) on 6-minute delayed DECT, and T1 relaxation time(T1Rt), extracellular volume fraction(ECVf), intravoxel incoherent motion-based perfusion fraction(PF), and magnetization transfer ratio(MTR) on mpMRI of pancreas were compared. 20 renal donors(for DECT) and 20 patients with renal mass(for mpMRI) served as controls. RESULTS NIC of pancreas in controls and progressive grades of CP were 0.24 ± 0.05, 0.80 ± 0.18, 1.06 ± 0.23, 1.40 ± 0.36, FF were 9.28 ± 5.89, 14.19 ± 5.29, 17.31 ± 5.99, 29.32 ± 12.22, T1Rt were 590.11 ± 61.13, 801.93 ± 211.01, 1006.79 ± 352.18, 1388.01 ± 312.23ms, ECVf were 0.07 ± 0.03, 0.30 ± 0.12, 0.41 ± 0.12, 0.53 ± 0.13, PF were 0.38 ± 0.04, 0.28 ± 0.07, 0.25 ± 0.09, 0.21 ± 0.05 and MTR were 0.12 ± 0.03, 0.15 ± 0.06, 0.21 ± 0.07, 0.26 ± 0.06, respectively. There were significant differences for all quantitative parameters between controls and mild CP; for NIC, PF, and ECVf between controls and progressive CP grades (p < 0.05). Area under curve for NIC, FF, T1Rt, ECVf, PF, and MTR in differentiating controls and mild CP were 1.00, 0.86, 0.95, 1.00, 0.90 and 0.84 respectively and for NIC, FF, ECVf and PF in differentiating controls and equivocal CP were 1.00, 0.76, 0.95 and 0.92 respectively. CONCLUSION DECT and mpMRI were useful in quantifying pancreatic fibrosis and grading the severity of CP. NIC was the most accurate marker.
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Affiliation(s)
- Mohak Narang
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology, Hauz Khas, New Delhi, 10029, India
| | - Soumya Jagannath Mahapatra
- Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Deepak Gunjan
- Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Sanjay Sharma
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Deep Narayan Srivastava
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Rajni Yadav
- Departments of Pathology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Nihar Ranjan Dash
- Departments of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Virinder Kumar Bansal
- Departments of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Ravindra Mohan Pandey
- Departments of Biostatistics, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Pramod Kumar Garg
- Departments of Gastroenterology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India
| | - Kumble Seetharama Madhusudhan
- Departments of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, Ansari Nagar, 10029, India.
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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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Calzadilla N, Zilberstein N, Hanscom M, Al Rashdan HT, Chacra W, Gill RK, Alrefai WA. Serum metabolomic analysis in cirrhotic alcohol-associated liver disease patients identified differentially altered microbial metabolites and novel potential biomarkers for disease severity. Dig Liver Dis 2024; 56:923-931. [PMID: 37923598 PMCID: PMC11061266 DOI: 10.1016/j.dld.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/10/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Alcohol-Associated Liver Disease (ALD) is a leading cause of liver mortality. Mechanisms responsible for severe ALD and the roles of gut microbiota are not fully understood. Multi-omics tools have enabled a better understanding of metabolic alterations and can aid in identifying metabolites as biomarkers for severe ALD. AIMS Examine differences between cirrhotic and non-cirrhotic ALD, investigate microbial contributions to such changes, and identify potential diagnostic and prognostic metabolites for severe ALD. METHODS Untargeted metabolomics were performed on the serum of 11 non-cirrhotic and 11 cirrhotic ALD patients. Data were analyzed using MetOrigin and Metaboanalyst to identify enriched pathways. RESULTS Increased methylated nucleotides, gamma-glutamyl amino acids, bile acids, and specific metabolites kynurenine and campesterol were increased in ALD cirrhosis, whereas branched-chain amino acids, serotonin, and xanthurenate were decreased. Microbial contributions included increases in the short-chain fatty acid indolebutyrate and methionine sulfoxide in ALD cirrhosis. The analysis also identified the potential for serum levels of 3-ureidopropionate, cis-3,3-methyleneheptanoylglycine, retinol, and valine to be used as biomarkers for clinical assessment of alcohol-associated cirrhosis. CONCLUSION We have identified a set of metabolites that are differentially altered in cirrhotic compared to non-cirrhotic ALD that can potentially be used as biomarkers for the severity of the disease.
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Affiliation(s)
- Nathan Calzadilla
- Department of Biomedical Engineering, University of Illinois Chicago, Chicago, IL, United States
| | - Netanel Zilberstein
- Division of Gastroenterology & Hepatology, Rush University, Chicago, IL, United States
| | - Mark Hanscom
- Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, United States
| | - Haya T Al Rashdan
- Division of Gastroenterology & Hepatology, University of Illinois Chicago, Chicago, IL, United States
| | - Wadih Chacra
- Division of Gastroenterology & Hepatology, University of Illinois Chicago, Chicago, IL, United States
| | - Ravinder K Gill
- Division of Gastroenterology & Hepatology, University of Illinois Chicago, Chicago, IL, United States
| | - Waddah A Alrefai
- Division of Gastroenterology & Hepatology, University of Illinois Chicago, Chicago, IL, United States; Jesse Brown VA Medical Center, Chicago, IL, United States.
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Asmundo L, Rizzetto F, Srinivas Rao S, Sgrazzutti C, Vicentin I, Kambadakone A, Catalano OA, Vanzulli A. Dual-energy CT applications on liver imaging: what radiologists and radiographers should know? A systematic review. Abdom Radiol (NY) 2024:10.1007/s00261-024-04380-y. [PMID: 38811447 DOI: 10.1007/s00261-024-04380-y] [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: 03/05/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE This review aims to provide a comprehensive summary of DECT techniques, acquisition workflows, and post-processing methods. By doing so, we aim to elucidate the advantages and disadvantages of DECT compared to conventional single-energy CT imaging. METHODS A systematic search was conducted on MEDLINE/EMBASE for DECT studies in liver imaging published between 1980 and 2024. Information regarding study design and endpoints, patient characteristics, DECT technical parameters, radiation dose, iodinated contrast agent (ICA) administration and postprocessing methods were extracted. Technical parameters, including DECT phase, field of view, pitch, collimation, rotation time, arterial phase timing (from injection), and venous timing (from injection) from the included studies were reported, along with formal narrative synthesis of main DECT applications for liver imaging. RESULTS Out of the initially identified 234 articles, 153 met the inclusion criteria. Extensive variability in acquisition parameters was observed, except for tube voltage (80/140 kVp combination reported in 50% of articles) and ICA administration (1.5 mL/kg at 3-4 mL/s, reported in 91% of articles). Radiation dose information was provided in only 40% of articles (range: 6-80 mGy), and virtual non-contrast imaging (VNC) emerged as a common strategy to reduce the radiation dose. The primary application of DECT post-processed images was in detecting focal liver lesions (47% of articles), with predominance of study focusing on hepatocellular carcinoma (HCC) (27%). Furthermore, a significant proportion of the articles (16%) focused on enhancing DECT protocols, while 15% explored metastasis detection. CONCLUSION Our review recommends using 80/140 kVp tube voltage with 1.5 mL/kg ICA at 3-4 mL/s flow rate. Post-processing should include low keV-VMI for enhanced lesion detection, IMs for tumor iodine content evaluation, and VNC for dose reduction. However, heterogeneous literature hinders protocol standardization.
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Affiliation(s)
- Luigi Asmundo
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Francesco Rizzetto
- Postgraduate School of Diagnostic and Interventional Radiology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy.
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Shravya Srinivas Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristiano Sgrazzutti
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Ilaria Vicentin
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Vanzulli
- Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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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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9
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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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Chen Y, Shi K, Li Z, Wang H, Liu N, Zhan P, Liu X, Shang B, Hou P, Gao J, Lyu P. Survival prediction of hepatocellular carcinoma by measuring the extracellular volume fraction with single-phase contrast-enhanced dual-energy CT imaging. Front Oncol 2023; 13:1199426. [PMID: 37538109 PMCID: PMC10394647 DOI: 10.3389/fonc.2023.1199426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
Purpose This study aimed to investigate the value of quantified extracellular volume fraction (fECV) derived from dual-energy CT (DECT) for predicting the survival outcomes of patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). Materials and methods A total of 63 patients with HCC who underwent DECT before treatment were retrospectively included. Virtual monochromatic images (VMI) (70 keV) and iodine density images (IDI) during the equilibrium phase (EP) were generated. The tumor VMI-fECV and IDI-fECV were measured and calculated on the whole tumor (Whole) and maximum enhancement of the tumor (Maximum), respectively. Univariate and multivariate Cox models were used to evaluate the effects of clinical and imaging predictors on overall survival (OS) and progression-free survival (PFS). Results The correlation between tumor VMI-fECV and IDI-fECV was strong (both p< 0.001). The Bland-Altman plot between VMI-fECV and IDI-fECV showed a bias of 5.16% for the Whole and 6.89% for the Maximum modalities, respectively. Increasing tumor VMI-fECV and IDI-fECV were positively related to the effects on OS and PFS (both p< 0.05). The tumor IDI-fECV-Maximum was the only congruent independent predictor in patients with HCC after TACE in the multivariate analysis on OS (p = 0.000) and PFS (p = 0.028). Patients with higher IDI-fECV-Maximum values had better survival rates above the optimal cutoff values, which were 35.42% for OS and 29.37% for PFS. Conclusion The quantified fECV determined by the equilibrium-phase contrast-enhanced DECT can potentially predict the survival outcomes of patients with HCC following TACE treatment.
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Affiliation(s)
- Yan Chen
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Kexin Shi
- Department of Clinical Medicine, Henan Medical School of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen Li
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Huixia Wang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Nana Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Pengchao Zhan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xing Liu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Bo Shang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ping Hou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Peijie Lyu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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11
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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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12
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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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13
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Ozaki K, Ohtani T, Ishida S, Higuchi S, Ishida T, Takahashi K, Matta Y, KImura H, Gabata T. Extracellular volume fraction obtained by dual-energy CT depicting the etiological differences of liver fibrosis. Abdom Radiol (NY) 2023; 48:1975-1986. [PMID: 36939910 DOI: 10.1007/s00261-023-03873-6] [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: 12/28/2022] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE To assess etiological differences in extracellular volume fraction (ECV) and evaluate its influence on staging performance. METHODS A total of 166 patients with normal liver (n = 14) and chronic liver disease related to viral hepatitis (n = 71), alcohol (n = 44), and nonalcoholic steatohepatitis (NASH) (n = 37) underwent dual-energy CT (DECT) of the liver (5-min equilibrium-phase images) between January 2020 and July 2022. The iodine densities of the parenchyma and aorta were measured and ECV was calculated. Comparisons of ECV between each etiology and METAVIR fibrosis stage were statistically analyzed (p < 0.05). RESULTS ECV in each etiology and all patients significantly increased with higher fibrosis stage (p < 0.001) and showed a strong or moderate correlation with fibrosis stage (Spearman's ρ; all patients, 0.701; viral hepatitis, 0.638; alcoholic, 0.885; NASH, 0.791). In stages F2-F4, ECV in alcoholic liver disease was significantly larger than those for viral hepatitis and NASH (p < 0.05); however, no significant difference in stage F1 was found among the three etiologies. The cutoff values and areas under the receiver operating characteristic curve (AUC-ROCs) for discriminating fibrosis stage (≥ F1- ≥ F4) were higher for alcohol (cutoff values and AUC-ROC; 20.1% and 0.708 for ≥ F1, 23.8% and 0.990 for ≥ F2, 24.3% and 0.968 for ≥ F3, and 26.6% and 0.961 for ≥ F4, respectively) compared with those for the others. CONCLUSION ECV in alcoholic liver disease is higher than that in other etiologies in the advanced stages of fibrosis, and etiological differences in ECV affect the staging performance of fibrosis.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan. .,Department of Radiology, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-Ku, Hamamatsu, 431-3192, Japan.
| | - Takashi Ohtani
- Radiological Center, University of Fukui Hospital, Eiheiji, Japan
| | - Shota Ishida
- Radiological Center, University of Fukui Hospital, Eiheiji, Japan.,Department of Radiological Technology, Faculty of Medical Science, Kyoto College of Medical Science, Kyoto, Japan
| | - Shohei Higuchi
- Department of Pathology, Faculty of Medical Sciences, University of Fukui, Eiheiji, Japan
| | - Tomokazu Ishida
- Radiological Center, University of Fukui Hospital, Eiheiji, Japan
| | - Kouki Takahashi
- Radiological Center, University of Fukui Hospital, Eiheiji, Japan
| | - Yuki Matta
- Radiological Center, University of Fukui Hospital, Eiheiji, Japan
| | - Hirohiko KImura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji, Fukui, 910-1193, Japan
| | - Toshifumi Gabata
- Department of Radiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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14
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Fujita N, Ushijima Y, Itoyama M, Okamoto D, Ishimatsu K, Wada N, Takao S, Murayama R, Fujimori N, Nakata K, Nakamura M, Yamamoto T, Oda Y, Ishigami K. Extracellular volume fraction determined by dual-layer spectral detector CT: Possible role in predicting the efficacy of preoperative neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma. Eur J Radiol 2023; 162:110756. [PMID: 36907069 DOI: 10.1016/j.ejrad.2023.110756] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/12/2023] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To clarify the relationship between extracellular volume (ECV) measured by dual-energy CT (DECT) and efficacy of preoperative neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC), as compared with single-energy CT (SECT). METHODS We enrolled 67 patients with PDAC who underwent dynamic contrast-enhanced CT with a dual-energy CT system prior to NAC. Attenuation values were measured on unenhanced and the equilibrium-phase 120-kVp equivalent CT images for PDAC and the aorta. ΔHU-tumor, ΔHU-tumor/ΔHU-aorta, and SECT-ECV were calculated. Iodine densities of the tumor and aorta were measured in the equilibrium phase, and DECT-ECV of the tumor was calculated. Response to NAC was evaluated and the correlation between imaging parameters and response to NAC was statistically assessed. RESULTS Tumor DECT-ECVs were significantly lower in the response group (n = 7) than in the non-response group (n = 60), with most significant difference (p = 0.0104). DECT-ECV showed highest diagnostic value with an Az value of 0.798. When using the optimal cut off value of DECT-ECV (<26.0 %), sensitivity, specificity, accuracy, positive predictive value, and negative value for predicting response group were 71.4 %, 85.0 %, 83.6 %, 35.7 % and 96.2 %, respectively. CONCLUSION PDAC with lower DECT-ECV can potentially show better response to NAC. DECT-ECV might be a useful biomarker for predicting response to NAC in patients with PDAC.
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Affiliation(s)
- Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masahiro Itoyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Keisuke Ishimatsu
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Noriaki Wada
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Seiichiro Takao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryo Murayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Nao Fujimori
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takeo Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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15
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Oostveen LJ, Boedeker KL, Balta C, Shin D, de Lange F, Prokop M, Sechopoulos I. Technical performance of a dual-energy CT system with a novel deep-learning based reconstruction process: Evaluation using an abdomen protocol. Med Phys 2023; 50:1378-1389. [PMID: 36502496 DOI: 10.1002/mp.16151] [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: 03/31/2022] [Revised: 11/16/2022] [Accepted: 12/02/2002] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND A new tube voltage-switching dual-energy (DE) CT system using a novel deep-learning based reconstruction process has been introduced. Characterizing the performance of this DE approach can help demonstrate its benefits and potential drawbacks. PURPOSE To evaluate the technical performance of a novel DECT system and compare it to that of standard single-kV CT and a rotate/rotate DECT, for abdominal imaging. METHODS DE and single-kV images of four different phantoms were acquired on a kV-switching DECT system, and on a rotate/rotate DECT. The dose for the acquisitions of each phantom was set to that selected for the kV-switching DE mode by the automatic tube current modulation (ATCM) at manufacturer-recommended settings. The dose that the ATCM would have selected in single-kV mode was also recorded. Virtual monochromatic images (VMIs) from 40 to 130 keV, as well as iodine maps, were reconstructed from the DE data. Single-kV images, acquired at 120 kV, were reconstructed using body hybrid iterative reconstruction. All reconstructions were made at 0.5 mm section thickness. Task transfer functions (TTFs) were determined for a Teflon and LDPE rod. Noise magnitude (SD), and noise power spectrum (NPS) were calculated using 240 and 320 mm diameter water phantoms. Iodine quantification accuracy and contrast-to-noise ratios (CNRs) relative to water for 2, 5, 10, and 15 mg I/ml were determined using a multi-energy CT (MECT) phantom. Low-contrast visibility was determined and the presence of beam-hardening artifacts and inhomogeneities were evaluated. RESULTS The TTFs of the kV-switching DE VMIs were higher than that of the single-kV images for Teflon (20% TTF: 6.8 lp/cm at 40 keV, 6.2 lp/cm for single-kV), while for LDPE the DE TTFs at 70 keV and above were equivalent or higher than the single-kV TTF. All TTFs of the kV-switching DECT were higher than for the rotate/rotate DECT. The SD was lowest in the 70 keV VMI (12.0 HU), which was lower than that of single-kV (18.3 HU). The average NPS frequency varied between 2.3 lp/cm and 4.2 lp/cm for the kV-switching VMIs and was 2.2 lp/cm for single-kV. The error in iodine quantification was at maximum 1 mg I/ml (at 5 mg I/ml). The highest CNR for all iodine concentrations was at 60 keV, 2.5 times higher than the CNR for single-kV. At 70-90 keV, the number of visible low contrast objects was comparable to that in single-kV, while other VMIs showed fewer objects. At manufacturer-recommended ATCM settings, the CTDIvol for the DE acquisitions of the water and MECT phantoms were 12.6 and 15.4 mGy, respectively, and higher than that for single-kV. The 70 keV VMI had less severe beam hardening artifacts than single-kV images. Hyper- and hypo-dense blotches may appear in VMIs when object attenuation exceeds manufacturer recommended limits. CONCLUSIONS At manufacturer-recommended ATCM settings for abdominal imaging, this DE implementation results in higher CTDIvol compared to single-kV acquisitions. However, it can create sharper, lower noise VMIs with up to 2.5 times higher iodine CNR compared to single-kV images acquired at the same dose.
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Affiliation(s)
- Luuk J Oostveen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Daniel Shin
- Canon Medical Systems Europe, Zoetermeer, The Netherlands
| | - Frank de Lange
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
- Technical Medicine Center, University of Twente, Enschede, The Netherlands
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16
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Fujita S, Sano K, Cruz G, Fukumura Y, Kawasaki H, Fukunaga I, Morita Y, Yoneyama M, Kamagata K, Abe O, Ikejima K, Botnar RM, Prieto C, Aoki S. MR Fingerprinting for Liver Tissue Characterization: A Histopathologic Correlation Study. Radiology 2023; 306:150-159. [PMID: 36040337 DOI: 10.1148/radiol.220736] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Liver MR fingerprinting (MRF) enables simultaneous quantification of T1, T2, T2*, and proton density fat fraction (PDFF) maps in single breath-hold acquisitions. Histopathologic correlation studies are desired for its clinical use. Purpose To compare liver MRF-derived metrics with separate reference quantitative MRI in participants with diffuse liver disease, evaluate scan-rescan repeatability of liver MRF, and validate MRF-derived measurements for histologic grading of liver biopsies. Materials and Methods This prospective study included participants with diffuse liver disease undergoing MRI from July 2021 to January 2022. Participants underwent two-dimensional single-section liver MRF and separate reference quantitative MRI. Linear regression, Bland-Altman plots, and coefficients of variation were used to assess the bias and repeatability of liver MRF measurements. For participants undergoing liver biopsy, the association between mapping and histologic grading was evaluated by using the Spearman correlation coefficient. Results Fifty-six participants (mean age, 59 years ± 15 [SD]; 32 women) were included to compare mapping techniques and 23 participants were evaluated with liver biopsy (mean age, 52.7 years ± 12.7; 14 women). The linearity of MRF with reference measurements in participants with diffuse liver disease (R2 value) for T1, T2, T2*, and PDFF maps was 0.86, 0.88, 0.54, and 0.99, respectively. The overall coefficients of variation for repeatability in the liver were 3.2%, 5.5%, 7.1%, and 4.6% for T1, T2, T2*, and PDFF maps, respectively. MRF-derived metrics showed high diagnostic performance in differentiating moderate or severe changes from mild or no changes (area under the receiver operating characteristic curve for fibrosis, inflammation, steatosis, and siderosis: 0.62 [95% CI: 0.52, 0.62], 0.92 [95% CI: 0.88, 0.92], 0.97 [95% CI: 0.96, 0.97], and 0.74 [95% CI: 0.57, 0.74], respectively). Conclusion Liver MR fingerprinting provided repeatable T1, T2, T2*, and proton density fat fraction maps in high agreement with reference quantitative mapping and may correlate with pathologic grades in participants with diffuse liver disease. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Shohei Fujita
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Katsuhiro Sano
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Gastao Cruz
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Yuki Fukumura
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Hideo Kawasaki
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Issei Fukunaga
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Yuichi Morita
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Masami Yoneyama
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Koji Kamagata
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Osamu Abe
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Kenichi Ikejima
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - René M Botnar
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Claudia Prieto
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
| | - Shigeki Aoki
- From the Departments of Radiology (S.F., K.S., H.K., I.F., Y.M., K.K., S.A.), Human Pathology (Y.F.), and Gastroenterology (K.I.), Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom (G.C., R.M.B., C.P.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.M.B., C.P.)
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17
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Toia GV, Mileto A, Wang CL, Sahani DV. Quantitative dual-energy CT techniques in the abdomen. Abdom Radiol (NY) 2022; 47:3003-3018. [PMID: 34468796 DOI: 10.1007/s00261-021-03266-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 02/06/2023]
Abstract
Advances in dual-energy CT (DECT) technology and spectral techniques are catalyzing the widespread implementation of this technology across multiple radiology subspecialties. The inclusion of energy- and material-specific datasets has ushered overall improvements in CT image contrast and noise as well as artifacts reduction, leading to considerable progress in radiologists' ability to detect and characterize pathologies in the abdomen. The scope of this article is to provide an overview of various quantitative clinical DECT applications in the abdomen and pelvis. Several of the reviewed applications have not reached mainstream clinical use and are considered investigational. Nonetheless awareness of such applications is critical to having a fully comprehensive knowledge base to DECT and fostering future clinical implementation.
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Affiliation(s)
- Giuseppe V Toia
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Mailbox 3252, Madison, WI, 53792, USA.
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Carolyn L Wang
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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18
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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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19
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Li Z, Xian M, Guo J, Wang CS, Zhang L, Xian J. Dynamic contrast-enhanced MRI can quantitatively identify malignant transformation of sinonasal inverted papilloma. Br J Radiol 2022; 95:20211374. [PMID: 35234501 PMCID: PMC10996421 DOI: 10.1259/bjr.20211374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To investigate the diagnostic performance of quantitative and semi-quantitative parameters derived from dynamic contrast-enhanced MRI (DCE-MRI) in differentiating sinonasal inverted papilloma (SIP) from SIP with coexisting malignant transformation into squamous cell carcinoma (MT-SIP). METHODS This retrospective study included 122 patients with 88 SIP and 34 MT-SIP. Quantitative and semi-quantitative parameters derived from DCE-MRI were compared between SIP and MT-SIP. The multivariate logistic regression analysis was performed to identify independent indicators and construct regression model for distinguishing MT-SIP and SIP. Diagnostic performance of independent indicators and regression model were evaluated using receiver operating coefficient (ROC) analysis and compared using DeLong test. RESULTS There were significant differences in maximum slope of increase, contrast-enhancement ratio, bolus arrival time, volume of extravascular extracellular space (Ve), and rate constant (Kep) between SIP and MT-SIP (p < 0.05). There were no significant differences in initial area under the gadolinium curve (p = 0.174) and volume transfer constant (p = 0.105) between two groups. Multivariate analysis results showed that Ve and Kep were identified as the independent indicators for differentiating MT-SIP from SIP (p < 0.001). Areas under the ROC curves (AUCs) for predicting MT-SIP were 0.779 for Ve and 0.766 for Kep. The AUC of the combination of Ve and Kep was 0.831, yielding 83% specificity and 76.5% sensitivity. CONCLUSION DCE-MRI can quantitatively differentiate between MT-SIP and SIP. The combination of Ve and Kep yielded an optimal performance for discriminating SIP from its malignant mimics. ADVANCES IN KNOWLEDGE DCE-MRI with quantitative and semi-quantitative parameters can provide valuable evidences for quantitatively identifying MT-SIP.
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Affiliation(s)
- Zheng Li
- Department of Radiology, Beijing Tongren Hospital, Capital
Medical University, Beijing,
China
| | - Mu Xian
- Department of Otolaryngology Head and Neck Surgery, Beijing
Tongren Hospital, Capital Medical University,
Beijing, China
| | - Jian Guo
- Department of Radiology, Beijing Tongren Hospital, Capital
Medical University, Beijing,
China
| | - Cheng shuo Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing
Tongren Hospital, Capital Medical University,
Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing
Tongren Hospital, Capital Medical University,
Beijing, China
| | - Junfang Xian
- Department of Radiology, Beijing Tongren Hospital, Capital
Medical University, Beijing,
China
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20
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Shi HY, Lu ZP, Li MN, Ge YQ, Jiang KR, Xu Q. Dual-Energy CT Iodine Concentration to Evaluate Postoperative Pancreatic Fistula after Pancreatoduodenectomy. Radiology 2022; 304:65-72. [PMID: 35315715 DOI: 10.1148/radiol.212173] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Pancreatic fibrosis and fatty infiltration are associated with postoperative pancreatic fistula (POPF), but accurate preoperative assessment remains a challenge. Iodine concentration (IC) and fat fraction derived from dual-energy CT (DECT) may reflect the amount of fibrosis and steatosis, potentially enabling the preoperative prediction of POPF. Purpose To identify multiphasic DECT-derived IC and fat fraction that improve the prediction of POPF risks compared with contrast-enhanced CT attenuation values and to evaluate the underlying histopathologic changes. Materials and Methods This retrospective study included patients who underwent pancreatoduodenectomy and DECT (including pancreatic parenchymal, portal venous, and delayed phase scanning) between January 2020 and December 2020. The relationships of the quantitative DECT-derived IC and fat fraction, along with CT attenuation values from enhanced images with POPF risk, were analyzed with logistic regression analysis. The predictive performance of the IC was compared with that of the CT values. The histopathologic underpinnings of IC were evaluated with multivariable linear regression analysis. Results A total of 107 patients (median age, 65 years; interquartile range, 57-70 years; 56 men) were included. Of these, 23 (21%) had POPF. The pancreatic parenchymal-to-portal venous phase IC ratio (adjusted odds ratio [OR], 13; 95% CI: 2, 162; P < .001) was an independent predictor of POPF occurrence. The accuracy of the pancreatic parenchymal-to-portal venous phase IC ratio in predicting POPF was higher than that of the CT value ratio in the same phases (78% vs 65%, P < .001). The pancreatic parenchymal-to-portal venous phase IC ratio was independently associated with pancreatic fibrosis (β = -1.04; 95% CI: -0.44, -1.64; P = .001). Conclusion A higher pancreatic parenchymal-to-portal venous phase IC ratio was associated with less histologic fibrosis and greater risk of POPF. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Yoon in this issue.
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Affiliation(s)
- Hong-Yuan Shi
- From the Department of Radiology (H.Y.S., Q.X.), Pancreas Center (Z.P.L., K.R.J.), and Department of Pathology (M.N.L.), The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, P.R. China; and Siemens Healthineers, Shanghai, P.R. China (Y.Q.G.)
| | - Zi-Peng Lu
- From the Department of Radiology (H.Y.S., Q.X.), Pancreas Center (Z.P.L., K.R.J.), and Department of Pathology (M.N.L.), The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, P.R. China; and Siemens Healthineers, Shanghai, P.R. China (Y.Q.G.)
| | - Ming-Na Li
- From the Department of Radiology (H.Y.S., Q.X.), Pancreas Center (Z.P.L., K.R.J.), and Department of Pathology (M.N.L.), The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, P.R. China; and Siemens Healthineers, Shanghai, P.R. China (Y.Q.G.)
| | - Ying-Qian Ge
- From the Department of Radiology (H.Y.S., Q.X.), Pancreas Center (Z.P.L., K.R.J.), and Department of Pathology (M.N.L.), The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, P.R. China; and Siemens Healthineers, Shanghai, P.R. China (Y.Q.G.)
| | - Kui-Rong Jiang
- From the Department of Radiology (H.Y.S., Q.X.), Pancreas Center (Z.P.L., K.R.J.), and Department of Pathology (M.N.L.), The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, P.R. China; and Siemens Healthineers, Shanghai, P.R. China (Y.Q.G.)
| | - Qing Xu
- From the Department of Radiology (H.Y.S., Q.X.), Pancreas Center (Z.P.L., K.R.J.), and Department of Pathology (M.N.L.), The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, P.R. China; and Siemens Healthineers, Shanghai, P.R. China (Y.Q.G.)
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21
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Marri UK, Madhusudhan KS. Dual-Energy Computed Tomography in Diffuse Liver Diseases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1742432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractDual-energy computed tomography (DECT) is an advancement in the field of CT, where images are acquired at two energies. Materials are identified and quantified based on their attenuation pattern at two different energy beams using various material decomposition algorithms. With its ability to identify and quantify materials such as fat, calcium, iron, and iodine, DECT adds great value to conventional CT and has innumerable applications in body imaging. Continuous technological advances in CT scanner hardware, material decomposition algorithms, and image reconstruction software have led to considerable growth of these applications. Among all organs, the liver is the most widely investigated by DECT, and DECT has shown promising results in most liver applications. In this article, we aim to provide an overview of the role of DECT in the assessment of diffuse liver diseases, mainly the deposition of fat, fibrosis, and iron and review the most relevant literature.
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Affiliation(s)
- Uday Kumar Marri
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble Seetharama Madhusudhan
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
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22
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Hong S, Kim JE, Cho JM, Choi HC, Won JH, Na JB, Choi DS, Park MJ, Choi HY, Shin HS, Cho HC, Kim HO. Quantification of liver extracellular volume using dual-energy CT for ruling out high-risk varices in cirrhosis. Eur J Radiol 2022; 148:110151. [PMID: 35032849 DOI: 10.1016/j.ejrad.2022.110151] [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: 11/09/2021] [Revised: 12/10/2021] [Accepted: 01/03/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the performance of quantification of liver extracellular volume fraction (fECV) using dual-energy CT (DECT) compared with CT imaging for ruling out high-riskesophageal varices(HRV) in cirrhotic patients. METHODS We retrospectively analyzed 229 cirrhotic patients (training [n = 159] and internal validation cohorts [n = 70]) who underwent dual-source DECT, serum marker assessment, and esophagogastroduodenoscopy (EGD) from 2017 to 2020. The fECV score was measured using iodine maps from 3-minute delayed, equilibrium-phase images at 100/140 Sn kVp. The association of CT parameters and serum markers with HRV was investigated. Criteria combining the fECV score (≤ 25.1%) or CT imaging with platelet count (> 150,000/mm3) were created and compared to rule out HRV. RESULTS In the training cohort, the fECV score (odds ratio (OR), 1.20; 95% confidence interval (CI), 1.09, 1.32) and CT imaging (OR, 28.21; 95% CI, 9.31, 85.93) were independent predictors of HRV, along with platelet count (OR, 0.85 and 0.78). Criteria combining the fECV score with platelet count showed significantly better performance than those combining CT imaging with platelet count in ruling out HRV (p < 0.001). Applying the criteria could have safely avoided an additional 10.7% and 8.6% of EGDs in the training and validation cohorts, respectively, achieving a final value of 36.5% and 35.7% spared EGDs (0 HRV missed) compared to CT imaging with platelet count. CONCLUSIONS The combined DECT-based fECV score with platelet count is useful for ruling out HRV and can safely avoid more EGDs than CT imaging with platelet count.
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Affiliation(s)
- Seokjin Hong
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ji Eun Kim
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.
| | - Jae Min Cho
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ho Cheol Choi
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung Ho Won
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jae Beom Na
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Dae Seob Choi
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Mi Jung Park
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hye Young Choi
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hwa Seon Shin
- Department of Radiology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyun Chin Cho
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Hyun Ok Kim
- Department of Internal Medicine, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Assessing the progression of segmental fibrosis in chronic liver disease using extracellular volume fractions. Eur J Radiol 2021; 145:110033. [PMID: 34808581 DOI: 10.1016/j.ejrad.2021.110033] [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: 07/28/2021] [Revised: 10/02/2021] [Accepted: 11/12/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the segmental difference of liver fibrosis during the progression of chronic liver disease (CLD) using hepatic extracellular volume fractions (fECVs) obtained by dual-energy CT. METHODS A total of 218 patients (92 men and 126 women; mean age, 67.8 ± 11.7 years) with CLD and 85 patients (44 men and 41 women; mean age, 62.8 ± 13.7 years) without CLD as a control underwent dual-energy computed tomography (CT) of the liver (5-min equilibrium phase images). The iodine densities of the lateral, medial, anterior, and posterior segments and the aorta were measured, and fECVs were calculated. Comparisons of the fECV of each segment and for each albumin-bilirubin (ALBI) grade were then statistically analyzed. RESULTS In the control group and ALBI grades 1 and 3, no significant difference in fECV was found between each segment, whereas in ALBI grade 2, the fECVs were significantly larger in the medial and anterior than in the other segments (p < 0.001). The fECVs of the lateral and posterior segments significantly increased with higher ALBI grade (p < 0.001). The fECVs of the medial and anterior segments were significantly increased with higher ALBI grade, up to grade 2 (p < 0.001), but no significant difference was found between ALBI grades 2 and 3. CONCLUSION During the progression of CLD, fibrosis antecedently progressed in the medial and anterior segments, followed by the other liver segments.
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Yoon JH, Lee JM, Kim JH, Lee KB, Kim H, Hong SK, Yi NJ, Lee KW, Suh KS. Hepatic fibrosis grading with extracellular volume fraction from iodine mapping in spectral liver CT. Eur J Radiol 2021; 137:109604. [PMID: 33618210 DOI: 10.1016/j.ejrad.2021.109604] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/28/2021] [Accepted: 02/11/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine whether hepatic extracellular volume fraction (ECV) obtained from iodine density map (ECV-iodine) can be used to estimate hepatic fibrosis grade and to compare performance with ECV measured using Hounsfield units (ECV-HU). METHODS From December 2016 to March 2019, patients who underwent liver resection or biopsy within four weeks after spectral liver CT were included. ECV-iodine and ECV-HU were calculated using the equilibrium phase. Within each of these, comparison of ECVs was made for different fibrosis grades (F0 - 1 vs. F2 - 3 vs. F4) and also for patients with compensated and decompensated cirrhosis. The diagnostic performance of ECVs in detecting clinically significant fibrosis (≥ F2) and cirrhosis (F4) was assessed using ROC analysis. RESULTS A total of 144 patients (men = 98, mean age 58.1 ± 11.5 years) were included. The ECV-iodine value was significantly higher in cirrhosis (33.6 ± 6.8 %) than those with F0 - 1 (25.0 ± 3.7 %) or F2 - 3 (28.3 ± 3.4 %, P < 0.001 for all). It was significantly higher in decompensated cirrhosis than those with compensated cirrhosis (36.5 ± 7.2 % vs. 30.7 ± 5.0 %, respectively; P < 0.001). The AUC of ECV-iodine was 0.82 for detecting F2 or above (cut-off value, > 26.9 %) and 0.81 for detecting cirrhosis (cut-off value, > 29 %). ECV-iodine had a significantly higher AUC than ECV-HU for detecting F2 or above (AUC: 0.69, P < 0.001) and cirrhosis (AUC: 0.74, P = 0.04). CONCLUSIONS ECV-iodine from spectral CT was able to detect clinically significant hepatic fibrosis and cirrhosis.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea.
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Kyoung-Bun Lee
- Department of Pathology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
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25
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Chandarana H, Shanbhogue K. Noninvasive Staging of Liver Fibrosis with Dual-Energy CT: Close but No Cigar. Radiology 2021; 298:609-610. [PMID: 33404360 DOI: 10.1148/radiol.2021204315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hersh Chandarana
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, Room 406, New York, NY 10016
| | - Krishna Shanbhogue
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, Room 406, New York, NY 10016
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