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Jayamani N, Pothiawala S, Ong HB, Low Choon Seng AS, Mohamed Afif A, Arumugam Z, Sung CT, Teck FC, Liang HC. Clinical audit of the image quality and customised contrast volume using P3T contrast injection software versus standard injection protocol in CT coronary angiography. Radiography (Lond) 2024; 30:1144-1150. [PMID: 38824873 DOI: 10.1016/j.radi.2024.05.009] [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: 01/08/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
INTRODUCTION The implications of shorter scan time and lower tube voltage in the dual-source CT coronary angiography (CTCA) scan protocol necessitate the adaptation of contrast media (CM) injection parameters. This audit evaluates the coronary arteries' vascular attenuation and image quality by comparing the personalised patient protocol technology (P3T) contrast injection software with standard injection protocol. The secondary aim is to determine the relationship between CM volume and the patient's weight. METHODOLOGY A Siemens Somatom Definition Force CT Unit was used to scan 30 sets of patients between August 2020 and October 2020. Patients were selected retrospectively and separated into Standard Injection and P3T injection protocols. An experienced radiologist blinded to the groups reviewed the coronary vessels' contrast enhancement and image quality. RESULTS Overall, the mean HU of all the main coronary artery vessels obtained from P3T injection software reached above 350 HU and was diagnostically sufficient. The mean attenuation at the proximal region of RCA in the 80-99 kg weight category was significantly higher in the P3T injection software than the standard injection protocol (p < 0.001). The CM volume proposed by P3T injection software for 40-59 kg was approximately 57 ± 5 mls, while 75 ml was used for the standard injection protocol. CONCLUSION P3T injection software in CTCA resulted in an adequate diagnostic attenuation of coronary arteries (>350HU) in all weight groups, most effectively in the higher weight group, while maintaining diagnostic image quality. Further, the P3T software reduces CM volumes in lower-weight patients. IMPLICATIONS P3T software enables reducing CM volume in lower-weight patients while improving vascular enhancement in CTCA scans in higher-weight patients.
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Affiliation(s)
- N Jayamani
- Department of Radiography, Singapore General Hospital, Singapore.
| | - S Pothiawala
- Department of Emergency Medicine, Woodlands Health, Singapore
| | - H B Ong
- Department of Radiography, Singapore General Hospital, Singapore
| | | | - A Mohamed Afif
- Department of Radiography, Singapore General Hospital, Singapore
| | - Z Arumugam
- Department of Radiography, Singapore General Hospital, Singapore
| | - C T Sung
- Department of Radiography, Singapore General Hospital, Singapore
| | - F C Teck
- Department of Radiography, Singapore General Hospital, Singapore
| | - H C Liang
- Department of Radiography, Singapore General Hospital, Singapore
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Computed Tomography Techniques, Protocols, Advancements, and Future Directions in Liver Diseases. Magn Reson Imaging Clin N Am 2021; 29:305-320. [PMID: 34243919 DOI: 10.1016/j.mric.2021.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Computed tomography (CT) is often performed as the initial imaging study for the workup of patients with known or suspected liver disease. Our article reviews liver CT techniques and protocols in clinical practice along with updates on relevant CT advances, including wide-detector CT, radiation dose optimization, and multienergy scanning, that have already shown clinical impact. Particular emphasis is placed on optimizing the late arterial phase of enhancement, which is critical to evaluation of hepatocellular carcinoma. We also discuss emerging techniques that may soon influence clinical care.
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Time to peak enhancement of malignant hypervascular hepatic tumors versus that of the aorta evaluating by test bolus sequence of magnetic resonance imaging. Eur J Radiol 2020; 131:109211. [DOI: 10.1016/j.ejrad.2020.109211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/12/2020] [Accepted: 08/05/2020] [Indexed: 11/21/2022]
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Yeh BM, FitzGerald PF, Edic PM, Lambert JW, Colborn RE, Marino ME, Evans PM, Roberts JC, Wang ZJ, Wong MJ, Bonitatibus PJ. Opportunities for new CT contrast agents to maximize the diagnostic potential of emerging spectral CT technologies. Adv Drug Deliv Rev 2017; 113:201-222. [PMID: 27620496 PMCID: PMC5344792 DOI: 10.1016/j.addr.2016.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/15/2022]
Abstract
The introduction of spectral CT imaging in the form of fast clinical dual-energy CT enabled contrast material to be differentiated from other radiodense materials, improved lesion detection in contrast-enhanced scans, and changed the way that existing iodine and barium contrast materials are used in clinical practice. More profoundly, spectral CT can differentiate between individual contrast materials that have different reporter elements such that high-resolution CT imaging of multiple contrast agents can be obtained in a single pass of the CT scanner. These spectral CT capabilities would be even more impactful with the development of contrast materials designed to complement the existing clinical iodine- and barium-based agents. New biocompatible high-atomic number contrast materials with different biodistribution and X-ray attenuation properties than existing agents will expand the diagnostic power of spectral CT imaging without penalties in radiation dose or scan time.
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Affiliation(s)
- Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States.
| | - Paul F FitzGerald
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Peter M Edic
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Jack W Lambert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Robert E Colborn
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Michael E Marino
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Paul M Evans
- GE Healthcare Life Sciences, The Grove Centre, White Lion Road, Amersham, Buckinghamshire HP7 9LL, United Kingdom
| | - Jeannette C Roberts
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Margaret J Wong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Peter J Bonitatibus
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
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Saade C, Deeb IA, Mohamad M, Al-Mohiy H, El-Merhi F. Contrast medium administration and image acquisition parameters in renal CT angiography: what radiologists need to know. Diagn Interv Radiol 2016; 22:116-24. [PMID: 26728701 PMCID: PMC4790062 DOI: 10.5152/dir.2015.15219] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/06/2015] [Accepted: 07/20/2015] [Indexed: 12/12/2022]
Abstract
Over the last decade, exponential advances in computed tomography (CT) technology have resulted in improved spatial and temporal resolution. Faster image acquisition enabled renal CT angiography to become a viable and effective noninvasive alternative in diagnosing renal vascular pathologies. However, with these advances, new challenges in contrast media administration have emerged. Poor synchronization between scanner and contrast media administration have reduced the consistency in image quality with poor spatial and contrast resolution. Comprehensive understanding of contrast media dynamics is essential in the design and implementation of contrast administration and image acquisition protocols. This review includes an overview of the parameters affecting renal artery opacification and current protocol strategies to achieve optimal image quality during renal CT angiography with iodinated contrast media, with current safety issues highlighted.
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Affiliation(s)
- Charbel Saade
- From the Department of Radiology (C.S., I.A.D., M.M., F.E.M. ), American University of Beirut, Beirut, Lebanon; the Department of Radiology (H.A.M.), King Khalid University, Abha, Saudi Arabia
| | - Ibrahim Alsheikh Deeb
- From the Department of Radiology (C.S., I.A.D., M.M., F.E.M. ), American University of Beirut, Beirut, Lebanon; the Department of Radiology (H.A.M.), King Khalid University, Abha, Saudi Arabia
| | - Maha Mohamad
- From the Department of Radiology (C.S., I.A.D., M.M., F.E.M. ), American University of Beirut, Beirut, Lebanon; the Department of Radiology (H.A.M.), King Khalid University, Abha, Saudi Arabia
| | - Hussain Al-Mohiy
- From the Department of Radiology (C.S., I.A.D., M.M., F.E.M. ), American University of Beirut, Beirut, Lebanon; the Department of Radiology (H.A.M.), King Khalid University, Abha, Saudi Arabia
| | - Fadi El-Merhi
- From the Department of Radiology (C.S., I.A.D., M.M., F.E.M. ), American University of Beirut, Beirut, Lebanon; the Department of Radiology (H.A.M.), King Khalid University, Abha, Saudi Arabia
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Inter- and intra-individual comparative study of two gadolinium-based agents: A pilot study. ACTA ACUST UNITED AC 2014; 40:865-74. [DOI: 10.1007/s00261-014-0248-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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7
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Romanini L, Passamonti M, Navarria M, Lanzarotto F, Villanacci V, Grazioli L, Calliada F, Maroldi R. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease. Eur J Radiol 2014; 83:1317-23. [PMID: 24908589 DOI: 10.1016/j.ejrad.2014.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 04/15/2014] [Accepted: 05/06/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity. MATERIALS AND METHODS This prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated. RESULTS High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p<.0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min). CONCLUSION Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and specificity.
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Affiliation(s)
- Laura Romanini
- Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.
| | - Matteo Passamonti
- Department of Radiology-AO Provincia di Lodi, Via Fissiraga, 15, 26900 Lodi, Italy.
| | - Mario Navarria
- Department of Radiology-ASL Vallecamonica-Sebino, Via Manzoni 142, 25040 Esine, BS, Italy.
| | - Francesco Lanzarotto
- Department of Gastroenterology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.
| | - Vincenzo Villanacci
- Department of Pathology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.
| | - Luigi Grazioli
- Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.
| | - Fabrizio Calliada
- Department of Radiology, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy.
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.
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Patient-Tailored Scan Delay for Multiphase Liver CT: Improved Scan Quality and Lesion Conspicuity With a Novel Timing Bolus Method. AJR Am J Roentgenol 2014; 202:318-23. [DOI: 10.2214/ajr.12.9676] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Marin D, Nelson RC, Guerrisi A, Barnhart H, Schindera ST, Passariello R, Catalano C. 64-section multidetector CT of the upper abdomen: optimization of a saline chaser injection protocol for improved vascular and parenchymal contrast enhancement. Eur Radiol 2011; 21:1938-47. [DOI: 10.1007/s00330-011-2139-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/19/2011] [Accepted: 04/04/2011] [Indexed: 11/30/2022]
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Cardiothoracic CT angiography: current contrast medium delivery strategies. AJR Am J Roentgenol 2011; 196:W260-72. [PMID: 21343473 DOI: 10.2214/ajr.10.5814] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Over the last decade, rapid technologic evolution in CT has resulted in improved spatial and temporal resolution and acquisition speed, enabling cardiothoracic CT angiography to become a viable and effective noninvasive alternative in the diagnostic algorithm. These new technologic advances have imposed new challenges for the optimization of contrast medium delivery and image acquisition strategies. CONCLUSION Thorough understanding of contrast medium dynamics is essential for the design of effective acquisition and injection protocols. This article provides an overview of the fundamentals affecting contrast enhancement, emphasizing the modifications to contrast material delivery protocols required to optimize cardiothoracic CT angiography.
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Improving image quality in portal venography with spectral CT imaging. Eur J Radiol 2011; 81:1677-81. [PMID: 21444170 DOI: 10.1016/j.ejrad.2011.02.063] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 02/28/2011] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate the effect of energy spectral CT on the image quality of CT portal venography in cirrhosis patients. MATERIALS AND METHODS 30 portal hypertension patients underwent spectral CT examination using a single-tube, fast dual tube voltage switching technique. 101 sets of monochromatic images were generated from 40keV to 140keV. Image noise and contrast-to-noise ratio (CNR) for portal veins from the monochromatic images were measured. An optimal monochromatic image set was selected for obtaining the best CNR for portal veins. The image noise and CNR of the intra-hepatic portal vein and extra-hepatic main stem at the selected monochromatic level were compared with those from the conventional polychromatic images. Image quality was also assessed and compared. RESULTS The monochromatic images at 51keV were found to provide the best CNR for both the intra-hepatic and extra-hepatic portal veins. At this energy level, the monochromatic images had about 100% higher CNR than the polychromatic images with a moderate 30% noise increase. The qualitative image quality assessment was also statistically higher with monochromatic images at 51keV. CONCLUSION Monochromatic images at 51keV for CT portal venography could improve CNR for displaying hepatic portal veins and improve the overall image quality.
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Bae KT. Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 2010; 256:32-61. [PMID: 20574084 DOI: 10.1148/radiol.10090908] [Citation(s) in RCA: 646] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The continuing advances in computed tomographic (CT) technology in the past decades have provided ongoing opportunities to improve CT image quality and clinical practice and discover new clinical CT imaging applications. New CT technology, however, has introduced new challenges in clinical radiology practice. One of the challenges is with intravenous contrast medium administration and scan timing. In this article, contrast medium pharmacokinetics and patient, contrast medium, and CT scanning factors associated with contrast enhancement and scan timing are presented and discussed. Published data from clinical studies of contrast medium and physiology are reviewed and interpreted. Computer simulation data are analyzed to provide an in-depth analysis of various factors associated with contrast enhancement and scan timing. On the basis of basic principles and analysis of the factors, clinical considerations and modifications to protocol design that are necessary to optimize contrast enhancement for common clinical CT applications are proposed.
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Affiliation(s)
- Kyongtae T Bae
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Goncalves Neto JA, Altun E, Elazzazi M, Vaidean GD, Chaney M, Semelka RC. Enhancement of abdominal organs on hepatic arterial phase: quantitative comparison between 1.5- and 3.0-T magnetic resonance imaging. Magn Reson Imaging 2010; 28:47-55. [DOI: 10.1016/j.mri.2009.05.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2008] [Revised: 03/19/2009] [Accepted: 05/10/2009] [Indexed: 10/20/2022]
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Value of customized scan timing determined by tracking liver enhancement in oncology patients. J Comput Assist Tomogr 2009; 33:253-8. [PMID: 19346855 DOI: 10.1097/rct.0b013e318177e5c7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the value of liver parenchyma enhancement tracking for liver multidetector computed tomography (CT) in patients with potential hypoattenuating liver metastases. MATERIALS AND METHODS Institutional review board approved this Health Insurance Portability and Accountability Act-compliant study. We reviewed the chest-abdomen-pelvis CTs of 120 consecutive patients scanned on 16-/64-row multidetector CT after receiving 52 g I in 50 seconds. Liver scanning started 65 seconds after injection-start in 59 patients, whereas in 61 patients, scanning started automatically when liver enhancement reached 50 Hounsfield units on low-dose continuous attenuation tracking. Enhancement of liver parenchyma, aorta, portal, and hepatic veins was measured. Two readers graded conspicuity and recorded attenuation of hypoattenuating lesions. RESULTS We identified 663 metastases in 74 patients. Scan-delay range in the triggered group was 53 to 83 seconds. Compared with the fixed-delay group, in the triggered group, mean number of metastases per patient with metastases was larger, liver attenuation and enhancement were higher, and median metastasis conspicuity grade was higher (all P < 0.05). CONCLUSIONS Automatic scan triggering based on liver parenchyma enhancement tracking produces consistently higher liver parenchymal enhancement and increased metastasis conspicuity than fixed delay.
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Goncalves Neto JA, Altun E, Vaidean G, Elazzazi M, Troy J, Ramachandran S, Semelka RC. Early contrast enhancement of the liver: exact description of subphases using MRI. Magn Reson Imaging 2009; 27:792-800. [PMID: 19121908 DOI: 10.1016/j.mri.2008.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 10/14/2008] [Accepted: 11/10/2008] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to describe the subphases of early post-contrast enhancement of the liver, using vessel enhancement patterns, and correlate these findings with enhancement patterns of abdominal organs. MATERIALS AND METHODS A total of 114 patients who underwent gadolinium-enhanced abdominal magnetic resonance imaging examinations constituted the final study group, of which 56 were women (age range, 3-94 years; mean, 50 years) and 58 were men (age range, 6-85 years; mean, 54 years). Early post-contrast sequences in all patients were evaluated retrospectively by two reviewers for the determination of the presence of contrast enhancement in predetermined major vessels of the abdomen and qualitative and quantitative extent of enhancement of the renal cortex, spleen, pancreas and liver. Based on the overall findings, subphases of early contrast enhancement of the liver were described and quantitative extent of enhancement of organs was correlated with subphases of early contrast enhancement of the liver. Mann-Whitney U test and one-way unbalanced analysis of variance tests were used for the comparisons. RESULTS Early hepatic arterial phase was observed in 14/114 patients, mid-hepatic arterial phase in 23/114 patients, late hepatic arterial phase in 33/114 patients, splenic vein only hepatic arterial dominant phase in 20/114 patients and hepatic arterial dominant phase in 24/114 patients. There was an overall association between the subphases of enhancement and the quantitative extent of enhancement for all studied organs (P<.0001). CONCLUSION The evaluation of vessel and organ enhancement patterns has allowed the characterization of five different subphases in early post-contrast enhancement of the liver. The quantitative extent of enhancement of abdominal organs also demonstrated significant correlation with these five subphases.
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Affiliation(s)
- Jose A Goncalves Neto
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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