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Takai Y, Noda Y, Asano M, Kawai N, Kaga T, Tsuchida Y, Miyoshi T, Hyodo F, Kato H, Matsuo M. Deep-learning image reconstruction for 80-kVp pancreatic CT protocol: Comparison of image quality and pancreatic ductal adenocarcinoma visibility with hybrid-iterative reconstruction. Eur J Radiol 2023; 165:110960. [PMID: 37423016 DOI: 10.1016/j.ejrad.2023.110960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/19/2023] [Accepted: 07/03/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE To evaluate the image quality and visibility of pancreatic ductal adenocarcinoma (PDAC) in 80-kVp pancreatic CT protocol and compare them between hybrid-iterative reconstruction (IR) and deep-learning image reconstruction (DLIR) algorithms. METHOD A total of 56 patients who underwent 80-kVp pancreatic protocol CT for pancreatic disease evaluation from January 2022 to July 2022 were included in this retrospective study. Among them, 20 PDACs were observed. The CT raw data were reconstructed using 40% adaptive statistical IR-Veo (hybrid-IR group) and DLIR at medium- and high-strength levels (DLIR-M and DLIR-H groups, respectively). The CT attenuation of the abdominal aorta, pancreas, and PDAC (if present) at the pancreatic phase and those of the portal vein and liver at the portal venous phase; background noise; signal-to-noise ratio (SNR) of these anatomical structures; and tumor-to-pancreas contrast-to-noise ratio (CNR) were calculated. The confidence scores for the image noise, overall image quality, and visibility of PDAC were qualitatively assigned using a five-point scale. Quantitative and qualitative parameters were compared among the three groups using Friedman test. RESULTS The CT attenuation of all anatomical structures were comparable among the three groups (P = .26-.86), except that of the pancreas (P = .001). Background noise was lower (P <.001) and SNRs (P <.001) and tumor-to-pancreas CNR (P <.001) were higher in the DLIR-H group than those in the other two groups. The image noise, overall image quality, and visibility of PDAC were better in the DLIR-H group than in the other two groups (P <.001-.003). CONCLUSION In 80-kVp pancreatic CT protocol, DLIR at a high-strength level improved image quality and visibility of PDAC.
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Affiliation(s)
- Yukiko Takai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Masashi Asano
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Tetsuro Kaga
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Yuki Tsuchida
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Toshiharu Miyoshi
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Fuminori Hyodo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; Institute for Advanced Study, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
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Prognostic value of tumor-to-parenchymal contrast enhancement ratio on portal venous-phase CT in pancreatic neuroendocrine neoplasms. Eur Radiol 2023; 33:2713-2724. [PMID: 36378252 DOI: 10.1007/s00330-022-09235-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to evaluate the prognostic value of tumor-to-parenchymal contrast enhancement ratio on portal venous-phase CT (CER on PVP) and compare its prognostic performance to prevailing grading and staging systems in pancreatic neuroendocrine neoplasms (PanNENs). METHODS In this retrospective study, data on 465 patients (development cohort) who underwent upfront curative-intent resection for PanNEN were used to assess the performance of CER on PVP and tumor size measured by CT (CT-Size) in predicting recurrence-free survival (RFS) using Harrell's C-index and to determine their optimal cutoffs to stratify RFS using a multi-way partitioning algorithm. External data on 184 patients (test cohort) were used to validate the performance of CER on PVP in predicting RFS and overall survival (OS) and compare its predictive performance with those of CT-Size, 2019 World Health Organization classification system (WHO), and the 8th American Joint Committee on Cancer staging system (AJCC). RESULTS In the test cohort, CER on PVP showed C-indexes of 0.83 (95% confidence interval [CI], 0.74-0.91) and 0.84 (95% CI, 0.73-0.95) for predicting RFS and OS, respectively, which were higher than those for the WHO (C-index: 0.73 for RFS [p = .002] and 0.72 for OS [p = .004]) and AJCC (C-index, 0.67 for RFS [p = .002] and 0.58 for OS [p = .002]). CT-Size obtained C-indexes of 0.71 for RFS and 0.61 for OS. CONCLUSIONS CER on PVP showed superior predictive performance on postoperative survival in PanNEN than current grading and staging systems, indicating its potential as a noninvasive preoperative prognostic tool. KEY POINTS • In pancreatic neuroendocrine neoplasms, the tumor-to-parenchymal enhancement ratio on portal venous-phase CT (CER on PVP) showed acceptable predictive performance of postoperative outcomes. • CER on PVP showed superior predictive performance of postoperative survival over the current WHO classification and AJCC staging system.
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Su J, Wang Y, Shao H, You X, Li S. Value of multi-detector computed tomography combined with serum tumor markers in diagnosis, preoperative, and prognostic evaluation of pancreatic cancer. World J Surg Oncol 2022; 20:323. [PMID: 36175918 PMCID: PMC9520929 DOI: 10.1186/s12957-022-02785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background Multi-detector computed tomography (MDCT) and serum tumor markers are commonly used in the diagnosis of pancreatic cancer (PC). In this article, we focused on the evaluation of the clinical value of MDCT combined with serum tumor markers CA199, CA242, and CEA in diagnosis, preoperative, and prognostic evaluation of PC. Methods Eighty-five PC patients (PC group) and 39 patients with pancreatitis (control group) admitted to our hospital were selected for our present research study. MDCT, CA199, CA242, and CEA examination were examined in all patients, and their value in diagnosis, preoperative, and prognostic evaluation of PC was retrospectively analyzed. Results There were 69 patients whose clinical staging results of MDCT were consistent with the postoperative pathological diagnosis. The coincidence rate was 70.00% in stage I, 62.96% in stage II, 72.72% in stage III, and 80.00% in stage IV, respectively, and the overall coincidence rate was 69.57%The levels of CA199, CA242, and CEA in PC group were remarkably higher than those in control group and were sharply correlated with clinical stage, differentiation degree, and distant metastasis. The sensitivity, accuracy, and negative predictive value of MDCT combined with serum CA199, CA242 and CEA in the diagnosis of PC were significantly improved compared with those of each single test. In PC group, the 2-year event-free survival rate of the group with high CA199, CA242, and CEA expression was remarkably lower than that of the low expression group. Conclusion MDCT combined with CA199, CA242, and CEA notably improved the diagnostic efficiency of PC and had guiding significance for preoperative and prognostic evaluation of PC.
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Affiliation(s)
- Jianli Su
- Department of Clinical Laboratory, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, 266035, China
| | - Yunfeng Wang
- Department of Clinical Laboratory, Chengyang People's Hospital, Qingdao, 266109, China
| | - Hua Shao
- Radiophysics Department, The Affiliated Qingdao Central Hospital of Qingdao University, The Second Affiliated Hospital of Medical College of Qingdao University, Qingdao, 266042, China
| | - Xinting You
- Department of Endoscopic Diagnosis and Treatment, Qingdao Eighth People's Hospital, Qingdao, 266100, China
| | - Shuying Li
- Department of Hepatobiliary Pancreatic Surgery (I), Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, China.
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Beyer G, Hoffmeister A, Michl P, Gress TM, Huber W, Algül H, Neesse A, Meining A, Seufferlein TW, Rosendahl J, Kahl S, Keller J, Werner J, Friess H, Bufler P, Löhr MJ, Schneider A, Lynen Jansen P, Esposito I, Grenacher L, Mössner J, Lerch MM, Mayerle J. S3-Leitlinie Pankreatitis – Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – September 2021 – AWMF Registernummer 021-003. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:419-521. [PMID: 35263785 DOI: 10.1055/a-1735-3864] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Georg Beyer
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
| | - Albrecht Hoffmeister
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Patrick Michl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Thomas Mathias Gress
- Klinik für Gastroenterologie und Endokrinologie, Universitätsklinikum Gießen und Marburg, Deutschland
| | - Wolfgang Huber
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Hana Algül
- Comprehensive Cancer Center München TUM, II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Albrecht Neesse
- Klinik für Gastroenterologie, gastrointestinale Onkologie und Endokrinologie, Universitätsmedizin Göttingen, Deutschland
| | - Alexander Meining
- Medizinische Klinik und Poliklinik II Gastroenterologie und Hepatologie, Universitätsklinikum Würzburg, Deutschland
| | | | - Jonas Rosendahl
- Universitätsklinik u. Poliklinik Innere Medizin I mit Schwerpunkt Gastroenterologie, Universitätsklinikum Halle, Deutschland
| | - Stefan Kahl
- Klinik für Innere Medizin m. Schwerpkt. Gastro./Hämat./Onko./Nephro., DRK Kliniken Berlin Köpenick, Deutschland
| | - Jutta Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - Jens Werner
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, Deutschland
| | - Helmut Friess
- Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - Philip Bufler
- Klinik für Pädiatrie m. S. Gastroenterologie, Nephrologie und Stoffwechselmedizin, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Deutschland
| | - Matthias J Löhr
- Department of Gastroenterology, Karolinska, Universitetssjukhuset, Stockholm, Schweden
| | - Alexander Schneider
- Klinik für Gastroenterologie und Hepatologie, Klinikum Bad Hersfeld, Deutschland
| | - Petra Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS), Berlin, Deutschland
| | - Irene Esposito
- Pathologisches Institut, Heinrich-Heine-Universität und Universitätsklinikum Duesseldorf, Duesseldorf, Deutschland
| | - Lars Grenacher
- Conradia Radiologie München Schwabing, München, Deutschland
| | - Joachim Mössner
- Bereich Gastroenterologie, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie Pneumologie und Infektiologie, Universitätsklinikum Leipzig, Deutschland
| | - Markus M Lerch
- Klinik für Innere Medizin A, Universitätsmedizin Greifswald, Deutschland.,Klinikum der Ludwig-Maximilians-Universität (LMU) München, Deutschland
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, LMU Klinikum, Ludwig-Maximilians-Universität München, Deutschland
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Fractal analysis improves tumour size measurement on computed tomography in pancreatic ductal adenocarcinoma: comparison with gross pathology and multi-parametric MRI. Eur Radiol 2022; 32:5053-5063. [PMID: 35201407 PMCID: PMC9279218 DOI: 10.1007/s00330-022-08631-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
Objectives Tumour size measurement is pivotal for staging and stratifying patients with pancreatic ductal adenocarcinoma (PDA). However, computed tomography (CT) frequently underestimates tumour size due to insufficient depiction of the tumour rim. CT-derived fractal dimension (FD) maps might help to visualise perfusion chaos, thus allowing more realistic size measurement. Methods In 46 patients with histology-proven PDA, we compared tumour size measurements in routine multiphasic CT scans, CT-derived FD maps, multi-parametric magnetic resonance imaging (mpMRI), and, where available, gross pathology of resected specimens. Gross pathology was available as reference for diameter measurement in a discovery cohort of 10 patients. The remaining 36 patients constituted a separate validation cohort with mpMRI as reference for diameter and volume. Results Median RECIST diameter of all included tumours was 40 mm (range: 18–82 mm). In the discovery cohort, we found significant (p = 0.03) underestimation of tumour diameter on CT compared with gross pathology (Δdiameter3D = −5.7 mm), while realistic diameter measurements were obtained from FD maps (Δdiameter3D = 0.6 mm) and mpMRI (Δdiameter3D = −0.9 mm), with excellent correlation between the two (R2 = 0.88). In the validation cohort, CT also systematically underestimated tumour size in comparison to mpMRI (Δdiameter3D = −10.6 mm, Δvolume = −10.2 mL), especially in larger tumours. In contrast, FD map measurements agreed excellently with mpMRI (Δdiameter3D = +1.5 mm, Δvolume = −0.6 mL). Quantitative perfusion chaos was significantly (p = 0.001) higher in the tumour rim (FDrim = 4.43) compared to the core (FDcore = 4.37) and remote pancreas (FDpancreas = 4.28). Conclusions In PDA, fractal analysis visualises perfusion chaos in the tumour rim and improves size measurement on CT in comparison to gross pathology and mpMRI, thus compensating for size underestimation from routine CT. Key Points • CT-based measurement of tumour size in pancreatic adenocarcinoma systematically underestimates both tumour diameter (Δdiameter = −10.6 mm) and volume (Δvolume = −10.2 mL), especially in larger tumours. • Fractal analysis provides maps of the fractal dimension (FD), which enable a more reliable and size-independent measurement using gross pathology or multi-parametric MRI as reference standards. • FD quantifies perfusion chaos—the underlying pathophysiological principle—and can separate the more chaotic tumour rim from the tumour core and adjacent non-tumourous pancreas tissue.
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Noda Y, Kawai N, Ishihara T, Tsuboi Y, Kaga T, Miyoshi T, Hyodo F, Matsuo M. Optimized scan delay for late hepatic arterial or pancreatic parenchymal phase in dynamic contrast-enhanced computed tomography with bolus-tracking method. Br J Radiol 2021; 94:20210315. [PMID: 33956484 DOI: 10.1259/bjr.20210315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the optimal scan delay corresponding to individual hemodynamic status for pancreatic parenchymal phase in dynamic contrast-enhanced CT of the abdomen. METHODS One hundred and fourteen patients were included in this retrospective study (69 males and 45 females; mean age, 67.9 ± 12.1 years; range, 39-87 years). These patients underwent abdominal dynamic contrast-enhanced CT between November 2019 and May 2020. We calculated and recorded the time from contrast material injection to the bolus-tracking trigger of 100 Hounsfield unit (HU) at the abdominal aorta (s) (TimeTRIG) and scan delay from the bolus-tracking trigger to the initiation of pancreatic parenchymal phase scanning (s) (TimeSD). The scan delay ratio (SDR) was defined by dividing the TimeSD by TimeTRIG. Non-linear regression analysis was conducted to assess the association between CT number of the pancreas and SDR and to reveal the optimal SDR, which was ≥120 HU in pancreatic parenchyma. RESULTS The non-linear regression analysis showed a significant association between CT number of the pancreas and the SDR (p < 0.001). The mean TimeTRIG and TimeSD were 16.1 s and 16.8 s, respectively. The SDR to peak enhancement of the pancreas (123.5 HU) was 1.00. An SDR between 0.89 and 1.18 shows an appropriate enhancement of the pancreas (≥120 HU). CONCLUSION The CT number of the pancreas peaked at an SDR of 1.00, which means TimeSD should be approximately the same as TimeTRIG to obtain appropriate pancreatic parenchymal phase images in dynamic contrast-enhanced CT with bolus-tracking method. ADVANCES IN KNOWLEDGE The hemodynamic state is different in each patient; therefore, scan delay from the bolus-tracking trigger should also vary based on the time from contrast material injection to the bolus-tracking trigger. This is necessary to obtain appropriate late hepatic arterial or pancreatic parenchymal phase images in dynamic contrast-enhanced CT of the abdomen.
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Affiliation(s)
| | | | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Yoshiki Tsuboi
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | - Tetsuro Kaga
- Department of Radiology, Gifu University, Gifu, Japan
| | - Toshiharu Miyoshi
- Department of Radiology Services, Gifu University Hospital, Gifu, Japan
| | - Fuminori Hyodo
- Department of Radiology, Frontier Science for Imaging, Gifu University, Gifu, Japan
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Split-bolus injection protocol with optimized timings of contrast medium injection and CT scanning for 3D CT angio-venography before laparoscopic gastrectomy. Jpn J Radiol 2020; 39:395-403. [PMID: 33222108 DOI: 10.1007/s11604-020-01069-2] [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: 06/07/2020] [Accepted: 10/29/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To propose an optimization method of contrast medium injection for the split-bolus protocol based on the contrast medium pharmacokinetics and investigate the utility of the optimized split-bolus protocol in 3D CT angio-venography for laparoscopic gastrectomy. MATERIALS AND METHODS A pharmacokinetic relationship between injection duration and time to the peak enhancement was taken into account in the protocol design. The first 20 consecutive patients underwent a multi-phase scan with a single-bolus injection (single-bolus protocol), and the next 20 underwent the proposed split-bolus protocol. CT attenuations of the arteries and veins and dose-length products (DLPs) were compared between the two protocols. Two radiologists visually assessed arterial and venous depictions and the misregistrations. RESULTS Mean arterial CT attenuations were not significantly different between the two protocols. Though mean venous CT attenuations for the split-bolus protocol were 7-11% lower than those of the single-bolus protocol, they were visually evaluated as similar. The mean DLP of the split-bolus protocol was 46% lower than that of the single-bolus protocol. Misregistration between the arteries and veins occurred 35-80% during the single-bolus protocol, but was not indicated in the split-bolus protocol. CONCLUSION The split-bolus protocol with optimized timing was more effective for providing improved image quality with reduced radiation dose compared with the single-bolus protocol in 3D CT angio-venography for laparoscopic gastrectomy.
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Noda Y, Goshima S, Kaga T, Ando T, Miyoshi T, Kawai N, Kawada H, Tanahashi Y, Matsuo M. Virtual monochromatic image at lower energy level for assessing pancreatic ductal adenocarcinoma in fast kV-switching dual-energy CT. Clin Radiol 2020; 75:320.e17-320.e23. [DOI: 10.1016/j.crad.2019.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/20/2019] [Indexed: 11/17/2022]
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Nagayama Y, Tanoue S, Inoue T, Oda S, Nakaura T, Utsunomiya D, Yamashita Y. Dual-layer spectral CT improves image quality of multiphasic pancreas CT in patients with pancreatic ductal adenocarcinoma. Eur Radiol 2019; 30:394-403. [DOI: 10.1007/s00330-019-06337-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 12/19/2022]
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Noda Y, Goshima S, Tsuji Y, Tomita H, Hara A, Kawaguchi M, Kawada H, Kawai N, Tanahashi Y, Matsuo M. Prognostic evaluation of pancreatic ductal adenocarcinoma: Associations between molecular biomarkers and CT imaging findings. Pancreatology 2019; 19:331-339. [PMID: 30718187 DOI: 10.1016/j.pan.2019.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate association between molecular biomarkers and computed tomography (CT) imaging findings in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS Fifty-three consecutive patients with PDAC (34 men and 19 women; mean age, 70.6 ± 8.1 years; range, 56-86 years) who underwent dynamic contrast-enhanced CT prior to pancreatectomy were included. The Ki-67 index and expressions of E-cadherin, Vimentin, and TWIST were immunohistochemically evaluated. Qualitative image analysis and histogram analysis of CT numbers were conducted. Clinical and molecular biomarkers were tested as possible prognostic factors for overall survival (OS) using Kaplan-Meier method and Cox proportional hazards regression. In addition, associations between CT imaging findings and significant molecular biomarkers were investigated. RESULTS The TNM stage (P = 0.018) and E-cadherin expression status (P = 0.018) were independently associated with OS. E-cadherin-negative PDACs had a worse prognosis than E-cadherin-positive PDACs (hazard ratio: 2.21). Irregular tumor margin was observed more frequently in E-cadherin-negative PDACs (54.7%) than in E-cadherin-positive PDACs (45.3%) (P = 0.00054). The kurtosis of CT number during the pancreatic parenchymal phase was significantly higher in E-cadherin-negative PDACs than in E-cadherin-positive PDACs (P = 0.035). CONCLUSIONS E-cadherin suppression was found to be a prognostic factor for OS in patients with PDAC, and irregular tumor margin and kurtosis of CT numbers during the pancreatic parenchymal phase could be indicators for E-cadherin suppression.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Satoshi Goshima
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yusuke Tsuji
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Akira Hara
- Department of Tumor Pathology, Gifu University, Gifu, Japan
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
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Kim SS. Pancreas Neuroendocrine Tumor and Its Mimics: Review of Cross-Sectional Imaging Findings for Differential Diagnosis. ACTA ACUST UNITED AC 2018. [DOI: 10.15746/sms.18.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Noda Y, Goshima S, Fujimoto K, Kawada H, Kawai N, Tanahashi Y, Matsuo M. Utility of the portal venous phase for diagnosing pancreatic necrosis in acute pancreatitis using the CT severity index. Abdom Radiol (NY) 2018; 43:3035-3042. [PMID: 29632992 DOI: 10.1007/s00261-018-1579-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the value of portal venous phase (PVP) images in the diagnosis of pancreatic necrosis in patients with acute pancreatitis using computed tomography severity index (CTSI). METHODS This retrospective study was approved by our Institutional Review Board, and written informed consent was waived. Dynamic contrast-enhanced CT images, with the pancreatic parenchymal phase (PPP) and the PVP, were obtained from 56 consecutive patients with acute pancreatitis. Two radiologists reviewed two sets of images, namely PPP images alone (image set A) and combined PPP and PVP images (image set B) to evaluate the CTSI. Cases were categorized as necrotizing pancreatitis if ensuing walled-off necrosis formation was identified 4 weeks after onset of symptoms. The relationship between pancreatic necrosis and CTSI was compared between image sets A and B. Logistic regression analysis was performed to evaluate the significance of clinical and radiological factors associated with the diagnosis of pancreatic necrosis. RESULTS Pancreatic necrosis was confirmed in 14 out of 56 (25%) patients. The area under the receiver-operating-characteristic curve (AUC) for the diagnosis of pancreatic necrosis was 0.70 and 0.78 for image sets A and B, respectively. The AUC for image set B was significantly greater than that for image set A (P = 0.0002). Logistic regression analysis demonstrated that among clinical and radiological factors tested, CTSI for image set B was independently correlated with pancreatic necrosis (P = 0.025). CONCLUSIONS Combined PPP and PVP images significantly improved the diagnostic accuracy of pancreatic necrosis following acute pancreatitis.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Satoshi Goshima
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Keita Fujimoto
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yukichi Tanahashi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
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Assessing Chemotherapeutic Response in Pancreatic Ductal Adenocarcinoma: Histogram Analysis of Iodine Concentration and CT Number in Single-Source Dual-Energy CT. AJR Am J Roentgenol 2018; 211:1221-1226. [PMID: 30332288 DOI: 10.2214/ajr.18.19791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the feasibility of histographic analysis of iodine concentration (IC) and CT number on single-source dual-energy CT (DECT) to assess response to first-line chemotherapy in patients with pancreatic ductal adenocarcinoma (PDAC) who received first-line chemotherapy but not radiation therapy. SUBJECTS AND METHODS This prospective study was approved by our institutional review board, and patients gave written informed consent. Sixty consecutive patients with PDAC undergoing first-line chemotherapy underwent DECT during the pancreatic parenchymatous phase (PPP) and the equilibrium phase (EP). The IC and CT number of PDAC were measured using PPP and EP iodine-based material decomposition and monochromatic images (65 keV), respectively. Histographic parameters for the IC and CT number of PDACs were obtained, and differences in mean IC (ΔIC) and CT number (ΔHU) between the PPP and the EP were calculated. These parameters were then compared between the response (partial response or stable disease) and nonresponse (progressive disease) groups. RESULTS Among the histographic parameters, the kurtosis of IC during the PPP (p = 0.018) and ΔIC (p = 0.0004) were identified as significant for differentiating between the two groups. IC diagnostic factor was calculated using the following coefficients of logistic regression analysis: 0.52 - (1.45 × kurtosis of IC during PPP) + (0.69 × ΔIC). The sensitivity, specificity, and area under the ROC curve for differentiating between the two groups were 97.7%, 70.6%, and 0.889, respectively. CONCLUSION The IC diagnostic factor is a potential biomarker for assessing chemotherapeutic response in patients with PDAC.
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Modified National Comprehensive Cancer Network Criteria for Assessing Resectability of Pancreatic Ductal Adenocarcinoma. AJR Am J Roentgenol 2018; 210:1252-1258. [PMID: 29629801 DOI: 10.2214/ajr.17.18595] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of our study was to assess the preoperative resectability of pancreatic ductal adenocarcinoma (PDAC) using the National Comprehensive Cancer Network (NCCN) guideline, the general rules of the Japan Pancreas Society (JPS), and both of them combined. MATERIALS AND METHODS Eighty-six consecutive patients with PDAC (50 men and 36 women; mean age ± SD, 70.8 ± 9.0 years; age range, 49-86 years) underwent dynamic contrast-enhanced CT. Following the NCCN guideline, the degree of vascular invasion was evaluated to determine the NCCN score: 0 points for absence of vascular invasion, 1 point for tumor contact ≤ 180°, and 2 points for tumor contact > 180°. Direct invasion to adjacent structures was rated according to the general rules of JPS to determine the JPS score: 0 points for absence and 1 point for presence. The NCCN score, JPS score, and sum of the two scores, which we refer to as the "combined score," were compared with histopathologic or intraoperative findings as well as for the differentiation of R0 resection (negative resection margins) from R1 (microscopic tumor infiltration) and R2 (macroscopic residual tumor) using ROC curve analysis. RESULTS The sensitivities, specificities, and areas under the ROC curves (AUCs) for the differentiation of R0 from R1 and R2 were 100.0%, 40.0%, and 0.725, respectively, with the NCCN score; 63.9%, 84.0%, and 0.824 with the JPS score; and 86.9%, 68.0%, and 0.874 with the combined score. The AUC of the combined score was significantly greater than that of the NCCN score (p = 0.0059). CONCLUSION The assessment of resectability of PDAC based on the combined criteria of the NCCN guideline and general rules of JPS was superior to that based on either criterion alone.
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Shamul N, Joskowicz L. Radon Space Dose Optimization in Repeat CT Scanning. IEEE TRANSACTIONS ON MEDICAL IMAGING 2017; 36:2436-2448. [PMID: 28880162 DOI: 10.1109/tmi.2017.2747520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a new method for on-line radiation dose optimization in repeat computer tomography (CT) scanning. Our method uses the information of the baseline scan during the repeat scanning to significantly reduce the radiation dose without compromising the repeat scan quality. It automatically registers the patient to the baseline scan using fractional scanning and detects in sinogram space the patient regions where changes have occurred without having to reconstruct the repeat scan image. It scans only these regions in the patient, thereby considerably reducing the necessary radiation dose. It then completes the missing values of the sparsely sampled repeat scan sinogram with those of the fully sampled baseline sinogram in regions where no changes were detected and computes the repeat scan image by standard filtered backprojection reconstruction. Experiments on a patient scan with simulated changes yield a mean recall of 98% using <19% of a full dose. Experiments on real CT scans of an abdomen phantom produce similar results, with a mean recall of 94.5% and only 14.4% of a full dose more than the theoretical optimum. As hardly any changed rays are missed, the reconstructed images are practically indistinguishable from a full dose scan. Our method successfully detects small, low contrast changes and produces an accurate repeat scan reconstruction using three times less radiation than an image space baseline method.
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Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation. Pract Radiat Oncol 2017; 7:e489-e497. [DOI: 10.1016/j.prro.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/08/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023]
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Choi SY, Lee I, Seo JW, Park HY, Choi HJ, Lee YW. Optimal scan delay depending on contrast material injection duration in abdominal multi-phase computed tomography of pancreas and liver in normal Beagle dogs. J Vet Sci 2017; 17:555-561. [PMID: 27297414 PMCID: PMC5204034 DOI: 10.4142/jvs.2016.17.4.555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/22/2016] [Accepted: 05/12/2016] [Indexed: 11/20/2022] Open
Abstract
This study was conducted to establish the values for optimal fixed scan delays and diagnostic scan delays associated with the bolus-tracking technique using various contrast material injection durations in canine abdominal multi-phase computed tomography (CT). This study consisted of two experiments employing the crossover method. In experiment 1, three dynamic scans at the porta hepatis were performed using 5, 10 and 15 sec injection durations. In experiment 2, two CT scans consisting of five multi-phase series with different scan delays of 5 sec intervals for bolus-tracking were performed using 5, 10 and 15 sec injection duration. Mean arrival times to aortic enhancement peak (12.0, 15.6, and 18.6 sec for 5, 10, and 15 sec, respectively) and pancreatic parenchymal peak (17.8, 25.1, and 29.5 sec) differed among injection durations. The maximum mean attenuation values of aortas and pancreases were shown at the scan section with 0 and 5, 0 and 10 and 5 and 10 sec diagnostic scan delays during each injection duration, respectively. The optimal scan delays of the arterial and pancreatic parenchymal phase in multi-phase CT scan using fixed scan delay or bolus-tracking should be determined with consideration of the injection duration.
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Affiliation(s)
| | - In Lee
- Ian Animal Diagnostic Center, Seoul 06014, Korea
| | - Ji-Won Seo
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Hyun-Young Park
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Ho-Jung Choi
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
| | - Young-Won Lee
- College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Korea
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Granata V, Fusco R, Catalano O, Setola SV, de Lutio di Castelguidone E, Piccirillo M, Palaia R, Grassi R, Granata F, Izzo F, Petrillo A. Multidetector computer tomography in the pancreatic adenocarcinoma assessment: an update. Infect Agent Cancer 2016; 11:57. [PMID: 27891175 PMCID: PMC5111267 DOI: 10.1186/s13027-016-0105-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 11/03/2016] [Indexed: 02/07/2023] Open
Abstract
Ductal adenocarcinoma of the pancreas is one of the most aggressive forms of cancer, with only a minority of cases being resectable at the moment of their diagnosis. The accurate detection and characterization of pancreatic carcinoma is very important for patient management. Multidetector-row computed tomography (MDCT) has become the cross-sectional modality of choice in the diagnosis, staging, treatment planning, and follow-up of patients with pancreatic tumors. However, approximately 11% of ductal adenocarcinomas still remain undetected at MDCT because of the lack of attenuation gradient between the lesion and the adjacent pancreatic parenchyma. In this systematic literature review we investigate the current evolution of the CT technique, limitations, and perspectives in the evaluation of pancreatic carcinoma.
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Affiliation(s)
- Vincenza Granata
- Department of Diagnostic Imaging, radiant and metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Roberta Fusco
- Department of Diagnostic Imaging, radiant and metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Orlando Catalano
- Department of Diagnostic Imaging, radiant and metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Sergio Venanzio Setola
- Department of Diagnostic Imaging, radiant and metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | | | - Mauro Piccirillo
- Department of Hepato-Biliary Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Raffaele Palaia
- Department of Hepato-Biliary Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Roberto Grassi
- Departement of Radiology, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Francesco Granata
- Departement of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Lazio, Italy
| | - Francesco Izzo
- Department of Hepato-Biliary Surgery, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Department of Diagnostic Imaging, radiant and metabolic Therapy, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
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Noda Y, Goshima S, Miyoshi T, Watanabe H, Kawada H, Kawai N, Koyasu H, Kanematsu M, Matsuo M, T Bae K. Determination of the least amount of iodine load required for the detection of pancreatic adenocarcinoma at 80-kVp CT. Eur J Radiol 2016; 85:901-5. [DOI: 10.1016/j.ejrad.2016.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/08/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Quantitative and Qualitative Comparison of Single-Source Dual-Energy Computed Tomography and 120-kVp Computed Tomography for the Assessment of Pancreatic Ductal Adenocarcinoma. J Comput Assist Tomogr 2016; 39:907-13. [PMID: 26295192 DOI: 10.1097/rct.0000000000000295] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study was to compare contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) between pancreatic-phase dual-energy computed tomography (DECT) and 120-kVp CT for pancreatic ductal adenocarcinoma (PDA). MATERIALS AND METHODS Seventy-eight patients underwent multiphasic pancreatic imaging protocols for PDA (40, DECT; 38, 120-kVp CT [control]). Using pancreatic phase, CNR and SNR for PDA were obtained for DECT at monochromatic energies 50 through 80 keV, iodine material density images, and 120-kVp images. Using a 5-point scale (1, excellent; 5, markedly limited), images were qualitatively assessed by 2 radiologists in consensus for PDA detection, extension, vascular involvement, and noise. Wilcoxon signed rank and 2-sample tests were used to compare the qualitative measures, CNR and SNR, for DECT and 120-kVp images. Bonferroni correction was applied. RESULTS Iodine material density image had significantly higher CNR and SNR for PDA than any monochromatic energy images (P < 0.0001) and the 120-kVp images. Qualitatively, 70-keV images were rated highest in the categories of tumor extension and vascular invasion and were similar to 120-kVp images. CONCLUSIONS Our results indicate that DECT improves PDA lesion conspicuity compared with routine 120-kVp CT, which may allow for better detection of PDA.
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Abstract
Currently, ultrasound (US), computed tomography (CT) and Magnetic Resonance imaging (MRI) represent the mainstay in the evaluation of pancreatic solid and cystic tumors affecting pancreas in 80-85% and 10-15% of the cases respectively. Integration of US, CT or MR imaging is essential for an accurate assessment of pancreatic parenchyma, ducts and adjacent soft tissues in order to detect and to stage the tumor, to differentiate solid from cystic lesions and to establish an appropriate treatment. The purpose of this review is to provide an overview of pancreatic tumors and the role of imaging in their diagnosis and management. In order to a prompt and accurate diagnosis and appropriate management of pancreatic lesions, it is crucial for radiologists to know the key findings of the most frequent tumors of the pancreas and the current role of imaging modalities. A multimodality approach is often helpful. If multidetector-row CT (MDCT) is the preferred initial imaging modality in patients with clinical suspicion for pancreatic cancer, multiparametric MRI provides essential information for the detection and characterization of a wide variety of pancreatic lesions and can be used as a problem-solving tool at diagnosis and during follow-up.
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ZHANG QING, GUO MUJIE, WU YUFEN. Correlation of abdominal fat ratio with hepatic CT enhancement. Exp Ther Med 2015; 10:285-288. [DOI: 10.3892/etm.2015.2474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/27/2015] [Indexed: 11/06/2022] Open
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Abstract
OBJECTIVES To investigate the feasibility of low-dose whole pancreas CT perfusion in the clinical practice. METHODS Sixty-one patients suspected pancreatic disease underwent low-dose whole pancreas CT perfusion scan (by body weight, group A: 70 kV, 120 mAs; group B: 80 kV, 100 mAs) and the individualized pancreas scan. Forty-six patients were enrolled. Perfusion characteristics, such as, blood flow, blood volume and permeability, were analyzed. The effective radiation dose of the whole pancreas CT perfusion and the total CT scan protocol were recorded. CT findings were histologically confirmed by surgical intervention or diagnostic puncture. RESULTS Of the 46 cases, 33 were pancreatic adenocarcinoma, 5 were solid-pseudo-papillary tumors of pancreas, 8 cases of pancreatic endocrine tumors on the perfusion study. There was significant interobserver agreement on the measurement of normal pancreatic CT perfusion parameters of group A (n = 28)and group B (n = 18), respectively (p > 0.05). For the normal pancreas, there was no significant difference on CT perfusion parameters between group A and group B (p > 0.05). There were significant differences on blood flow as well as blood volume between the pancreatic adenocarcinomas and the normal pancreas (p < 0.001), whereas no difference on the permeability (p > 0.05). The time to peak of the normal pancreas is 28.94 ± 4.37 s (range from 24 to 38 s). Different pancreatic tumors had different types of time attenuation curve (TAC). TACs were different between pancreatic adenocarcinomas and normal pancreas. The effective radiation dose of the whole pancreas CT perfusion of Group A and Group B were 3.60 and 4.88 mSv (DLP 246 and 325 mGy cm), respectively, and the total radiation dose was around 8.01-16.22 mSv. CONCLUSIONS Low-dose whole pancreatic CT perfusion can effectively reduce radiation dose, and provide the best phase for the individualized pancreas scan, which has great value in the clinical practice.
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Choi SY, Choi HJ, Lee KJ, Lee YW. Establishment of optimal scan delay for multi-phase computed tomography using bolus-tracking technique in canine pancreas. J Vet Med Sci 2015; 77:1049-54. [PMID: 25843155 PMCID: PMC4591144 DOI: 10.1292/jvms.14-0693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
To establish a protocol for a multi-phase computed tomography (CT) of the
canine pancreas using the bolus-tracking technique, dynamic scan and multi-phase CT were
performed in six normal beagle dogs. The dynamic scan was performed for 60 sec at 1-sec
intervals after the injection (4 ml/sec) of a contrast medium, and
intervals from aortic enhancement appearance to aortic, pancreatic parenchymal and portal
vein peaks were measured. The multi-phase CT with 3 phases was performed three times using
a bolus-tracking technique. Scan delays were 0, 15 and 30 in first multi-phase scan; 5, 20
and 35 in second multi-phase scan; and 10, 25 and 40 sec in third multi-phase scan,
respectively. Attenuation values and contrast enhancement pattern were analyzed from the
aorta, pancreas and portal vein. The intervals from aortic enhancement appearance to
aortic, pancreatic parenchymal and portal vein peaks were 3.8 ± 0.7, 8.7 ± 0.9 and 13.3 ±
1.5 sec, respectively. The maximum attenuation values of the aorta, pancreatic parenchyma
and portal vein were present at scan sections with no scan delay, a 5-sec delay and a
10-sec delay, respectively. When a multi-phase CT of the canine pancreas is triggered at
aortic enhancement appearance using a bolus-tracking technique, the recommended optimal
delay times of the arterial and pancreatic parenchymal phases are no scan delay and 5 sec,
respectively.
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Affiliation(s)
- Soo-Young Choi
- College of Veterinary Medicine and Research Institute of Veterinary Medicine, Chungnam National University, Daejeon 305-764, South Korea
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Reduction of iodine load in CT imaging of pancreas acquired with low tube voltage and an adaptive statistical iterative reconstruction technique. J Comput Assist Tomogr 2014; 38:714-20. [PMID: 24834887 DOI: 10.1097/rct.0000000000000106] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To prospectively assess the contrast enhancement, image quality, radiation dose, and detectability of malignant pancreatic tumors with pancreatic computed tomography (CT) obtained at an 80-kilovolt (peak) (kV[p]) tube voltage setting and reduced iodine dose. METHODS Institutional review board approval and written informed consent were obtained. During a recent 10-month period, 136 patients (66 men and 70 women; age range, 21-86 years; mean ± SD age, 65.9 ± 11.0 years) with suspected pancreatic disease were randomized into 3 groups according to the following iodine-load and tube-voltage protocols: 600 mg of iodine per kilogram body weight (mg/kg) and 120 kV(p) (600-120 group), 500 mg/kg and 80 kV(p) (500-80 group), and 400 mg/kg and 80 kV(p) (400-80 group). Analysis of variance was conducted to evaluate differences in CT number, background noise, signal-to-noise ratio, effective dose, lesion-to-pancreas contrast-to-noise ratio, and figure of merit. Sensitivity, specificity, and area under the receiver-operating-characteristic curve were compared to assess the detectability of malignant pancreatic tumors. RESULTS The signal-to-noise ratios in vessels were greater (P < 0.05) in the 400-80 and 500-80 groups than in the 600-120 group, and those in pancreas were comparable between the 400-80 and 600-120 groups. No significant difference was found in effective dose, image quality, lesion-to-pancreas contrast-to-noise ratio, or figure of merit between the groups. Sensitivity, specificity, and area under the receiver-operating-characteristic curve for detecting malignant pancreatic tumors were comparable between the groups. CONCLUSIONS Pancreatic CT with an 80-kV(p) setting and 400-mg iodine per kilogram contrast material load facilitates the reduction of iodine dose while maintaining image quality and the detectability of malignant pancreatic tumors.
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Noda Y, Kanematsu M, Goshima S, Kondo H, Watanabe H, Kawada H, Kawai N, Tanahashi Y, Miyoshi TRT, Bae KT. Reducing iodine load in hepatic CT for patients with chronic liver disease with a combination of low-tube-voltage and adaptive statistical iterative reconstruction. Eur J Radiol 2014; 84:11-18. [PMID: 25455414 DOI: 10.1016/j.ejrad.2014.10.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 10/09/2014] [Accepted: 10/12/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE To prospectively assess the effect of reduced iodine load to contrast enhancement, image quality, and detectability of hepatocellular carcinomas (HCCs) in hepatic CT with a combination of 80 kVp tube voltage setting and adaptive statistical iterative reconstruction (ASIR) technique in patients with chronic liver disease. MATERIALS AND METHODS This HIPAA-compliant study was approved by our institutional review board and written informed consent was obtained in all patients. During a recent 9-month period, 170 consecutive patients (114 men and 56 women; age range, 40-85 years; mean, 67.7 years) with suspected chronic liver diseases were randomized into three CT groups according to the following iodine-load and tube-voltage protocols: 600 milligram per kilogram body weight (mg/kg) iodine load and 120 peak kilovolt (kVp) tube voltage setting (600-120 group), 500 mg/kg and 80 kVp (500-80 group), and 400mg/kg and 80 kVp (400-80 group). Analysis of variance was conducted to evaluate differences in CT number, background noise, signal-to-noise ratio (SNR), effective dose, HCC-to-liver contrast-to-noise ratio (CNR), and figure of merit (FOM). Sensitivity, specificity, and area under the receiver-operating-characteristic curve (AUC) were compared to assess the detectability of HCCs. RESULTS Vascular and hepatic enhancement in the 400-80 and 500-80 groups was comparable to or greater than that in the 600-120 group (P<.05). Subjective image quality was comparable among the three groups. Sensitivity, specificity, and AUC for detecting HCCs were comparable among the groups. The effective dose was kept low (3.3-4.1 mSv) in all three groups. CONCLUSION Iodine load can be reduced by 33% in CT of the liver with a combination of 80 kVp tube voltage setting and ASIR technique, without compromising the contrast enhancement, image quality, and detection of HCCs.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Masayuki Kanematsu
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan; Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan.
| | - Satoshi Goshima
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroshi Kondo
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Haruo Watanabe
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroshi Kawada
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Nobuyuki Kawai
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Yukichi Tanahashi
- Department of Radiology and Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Toshiharu R T Miyoshi
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kyongtae T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Tang A, Billiard JS, Chagnon DO, Rizk F, Olivié D, Turcotte S, Chagnon M, Lepanto L. Optimal Pancreatic Phase Delay with 64-Detector CT Scanner and Bolus-tracking Technique. Acad Radiol 2014; 21:977-85. [PMID: 25018069 DOI: 10.1016/j.acra.2014.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/03/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the optimal pancreatic phase delay in terms of parenchymal enhancement and tumor-to-pancreas contrast with a bolus-tracking method. MATERIALS AND METHODS Patients referred for suspicion of pancreatic tumor and undergoing 64-detector computed tomography scanner were randomized to an individualized scan delay of 10, 20, or 30 seconds of nonionic contrast material (370 mg I/mL) after aortic enhancement above 150 Hounsfield units. The volume of contrast was adjusted to patient weight. Pancreatic and tumor enhancements were measured. Statistical analysis included analysis of variance and post hoc Tukey tests. RESULTS One hundred and fifty patients were randomized to individualized scan delays of 10, 20, or 30 seconds. Pancreatic parenchymal enhancement in all patients (n = 150) was significantly higher with a delay of 20 or 30 seconds than that with 10 seconds (P < .001 for both). Tumor-to-pancreas contrast for solid tumors (n = 59) was significantly higher with a delay of 30 seconds than that with 10 seconds (P = .015). Adenocarcinoma-to-pancreas contrast during pancreatic phase was significantly higher for a 20- or 30-second delay than for a 10-second delay (P = .027 and .011, respectively) for one reader. CONCLUSIONS With a flow rate of 4 mL/s and weight-adjusted contrast volume, an individualized scan delay of 30 seconds after aortic transit time revealed higher pancreatic enhancement and tumor-to-pancreas contrast than that with a delay of 10 seconds.
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Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: A state-of-the-art review. World J Gastroenterol 2014; 20:7864-7877. [PMID: 24976723 PMCID: PMC4069314 DOI: 10.3748/wjg.v20.i24.7864] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/13/2013] [Accepted: 01/05/2014] [Indexed: 02/06/2023] Open
Abstract
Pancreatic cancer (PC) remains one of the deadliest cancers worldwide, and has a poor, five-year survival rate of 5%. Although complete surgical resection is the only curative therapy for pancreatic cancer, less than 20% of newly-diagnosed patients undergo surgical resection with a curative intent. Due to the lack of early symptoms and the tendency of pancreatic adenocarcinoma to invade adjacent structures or to metastasize at an early stage, many patients with pancreatic cancer already have advanced disease at the time of their diagnosis and, therefore, there is a high mortality rate. To improve the patient survival rate, early detection of PC is critical. The diagnosis of PC relies on computed tomography (CT) and/or magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP), or biopsy or fine-needle aspiration using endoscopic ultrasound (EUS). Although multi-detector row computed tomography currently has a major role in the evaluation of PC, MRI with MRCP facilitates better detection of tumors at an early stage by allowing a comprehensive analysis of the morphological changes of the pancreas parenchyma and pancreatic duct. The diagnosis could be improved using positron emission tomography techniques in special conditions in which CT and EUS are not completely diagnostic. It is essential for clinicians to understand the advantages and disadvantages of the various pancreatic imaging modalities in order to be able to make optimal treatment and management decisions. Our study investigates the current role and innovative techniques of pancreatic imaging focused on the detection of pancreatic cancer.
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Türkvatan A, Erden A, Türkoğlu MA, Seçil M, Yener Ö. Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis. Diagn Interv Imaging 2014; 96:151-60. [PMID: 24512896 DOI: 10.1016/j.diii.2013.12.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical setting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.
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Affiliation(s)
- A Türkvatan
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey.
| | - A Erden
- Department of Radiology, Ankara University School of Medicine, Talatpaşa Street, 06100 Sıhhiye, Ankara, Turkey
| | - M A Türkoğlu
- Department of General Surgery, Akdeniz University School of Medicine, Dumlupınar street, Antalya, Turkey
| | - M Seçil
- Department of Radiology, Dokuz Eylul University School of Medicine, Cumhuriyet street, İzmir, Turkey
| | - Ö Yener
- Department of Radiology, Türkiye Yüksek İhtisas Hospital, Kızılay street, No 4, 06100 Sıhhiye, Ankara, Turkey
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SHERIDAN MB, MANOHARAN P. Neoplasms of the pancreas. IMAGING 2013. [DOI: 10.1259/imaging/20369618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chu AJ, Lee JM, Lee YJ, Moon SK, Han JK, Choi BI. Dual-source, dual-energy multidetector CT for the evaluation of pancreatic tumours. Br J Radiol 2012; 85:e891-8. [PMID: 22972978 DOI: 10.1259/bjr/26129418] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate the potential diagnostic value of dual-energy CT (DECT) with virtual non-enhanced (VNE) and iodine-only images, and to determine the optimal mixed ratio of blended images for evaluation of pancreatic diseases. METHODS Multiphasic DECT was performed in 44 patients with focal pancreatic disease. DECT was used during the pancreatic and hepatic venous phases, and a peak kilovoltage of 120 kVp was used for both non-contrast phases. For qualitative analysis of the CT images, two radiologists assessed three image sets (VNE, iodine-only and blended images) in order to determine the acceptability of VNE in replacing true non-enhanced (TNE) images, the added value of iodine-only images and the preferred blending ratio. For quantitative analyses, the CT numbers and image noise of the pancreatic parenchyma, lesions, aorta and psoas muscle were measured. The contrast-to-noise ratio of the lesion was calculated on the pancreatic phase images. The effective radiation dose for DECT and TNE images was calculated. Statistical comparisons were made using the Friedman test, the Wilcoxon test, the paired t-test and repeated measures of analysis of variation with Bonferroni correction for multiple comparisons. RESULTS The level of acceptance of the VNE images in replacing TNE images was 90.9%. Regarding the iodine-only images, 50% of the cases were found to have an added value. The linear-blended images with a weighting factor of 0.5 were preferred. CONCLUSIONS DECT was able to provide high-quality VNE images that could replace TNE images and iodine-only images showing an added value. Blended images with a weighting factor of 0.5 were preferred by the reviewers.
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Affiliation(s)
- A J Chu
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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Stuber T, Brambs HJ, Freund W, Juchems MS. Sixty-four MDCT achieves higher contrast in pancreas with optimization of scan time delay. World J Radiol 2012; 4:324-7. [PMID: 22900134 PMCID: PMC3419869 DOI: 10.4329/wjr.v4.i7.324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 06/16/2012] [Accepted: 06/23/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare different multidetector computed tomography (MDCT) protocols to optimize pancreatic contrast enhancement.
METHODS: Forty consecutive patients underwent contrast-enhanced biphasic MDCT (arterial and portal-venous phase) using a 64-slice MDCT. In 20 patients, the scan protocol was adapted from a previously used 40-channel MDCT scanner with arterial phase scanning initiated 11.1 s after a threshold of 150 HU was reached in the descending aorta, using automatic bolus tracking (Protocol 1). The 11.1-s delay was changed to 15 s in the other 20 patients to reflect the shorter scanning times on the 64-channel MDCT compared to the previous 40-channel system (Protocol 2). HU values were measured in the head and tail of the pancreas in the arterial and portal-venous phase.
RESULTS: Using an 11.1-s delay, 74.2 HU (head) were measured on average in the arterial phase and 111.2 HU (head) were measured using a 15-s delay (P < 0.0001). For the pancreatic tail, the average attenuation level was 76.73 HU (11.1 s) and 99.89 HU (15 s) respectively (P = 0.0002). HU values were also significantly higher in the portal-venous phase [pancreatic head: 70.5 HU (11.1 s) vs 84.0 HU (15 s) (P = 0.0014); pancreatic tail: 67.45 HU (11.1 s) and 77.18 HU (15 s) using Protocol 2 (P = 0.0071)].
CONCLUSION: Sixty-four MDCT may yield a higher contrast in pancreatic study with (appropriate) optimization of scan delay time.
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Incidentally discovered solid pancreatic masses: imaging and clinical observations. ACTA ACUST UNITED AC 2012; 37:91-7. [PMID: 21394600 DOI: 10.1007/s00261-011-9720-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to review the CT findings and clinical outcome in patients with incidentally discovered solid pancreatic masses. MATERIALS AND METHODS Over an 8-year period, from 2001 to 2009, we identified 24 patients with solid pancreatic masses incidentally detected by CT. There were 13 females and 11 males, with a mean age of 67 years. We determined the indication for initial CT, analyzed the CT features, and ascertained the clinical follow-up in all the patients. RESULTS All of the solid masses were malignant. There were 14 adenocarcinomas and 10 neuroendocrine tumors. The most common indications for the initial CT were surveillance of an extrapancreatic malignancy (n = 10) and evaluation for hematuria (n = 6). On the initial CT, 16 of the patients (67%) had a clearly visible pancreatic mass. In eight patients isoattenuating masses were identified, only recognized by subtle signs including unexplained dilatation of the pancreatic duct (n = 5) or minimal contour deformity or density of the pancreas (n = 3). The mean survival time for the patients with adenocarcinoma was 21.6 months, and 42 months for the patients with neuroendocrine tumors. CONCLUSION Although uncommon, incidentally discovered solid pancreatic masses are malignant neoplasms, either ductal adenocarcinomas or neuroendocrine tumors. Unlike incidentally discovered small cystic lesions, solid pancreatic lesions are often biologically aggressive.
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Pancreatic dual-source dual-energy CT: Is it time to discard unenhanced imaging? Clin Radiol 2012; 67:334-9. [DOI: 10.1016/j.crad.2011.09.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 09/06/2011] [Accepted: 09/14/2011] [Indexed: 12/12/2022]
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Correlation between dual-phase dynamic multi-detector CT findings and fibrosis within lung adenocarcinoma tumors. Eur J Radiol 2011; 80:e470-5. [DOI: 10.1016/j.ejrad.2010.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 08/30/2010] [Accepted: 09/03/2010] [Indexed: 11/21/2022]
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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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Yitta S, Hecht EM, Mausner EV, Bennett GL. Normal or Abnormal? Demystifying Uterine and Cervical Contrast Enhancement at Multidetector CT. Radiographics 2011; 31:647-61. [DOI: 10.1148/rg.313105057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Long XY, Sun WJ, Zou YY, Li YX. Imaging evaluation of therapeutic response in patients with pancreatic cancer: recent advances. Shijie Huaren Xiaohua Zazhi 2011; 19:1211-1218. [DOI: 10.11569/wcjd.v19.i12.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Chemoradiotherapy is the primary choice of non-surgical treatment of advanced pancreatic cancer, and diagnostic imaging plays an important role in objectively assessing early therapeutic response. This article systematically reviews the criteria for evaluation of therapeutic response in solid tumors and their application in pancreatic cancer, highlighting some key contents in imaging evaluation of therapeutic response in patients with pancreatic cancer.
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Heller MT, Johnson N, Fargiano A. Pancreatic neoplasia: a practical cross-sectional imaging primer for the nonradiologist. J Gastrointest Cancer 2011; 43:148-56. [PMID: 21221845 DOI: 10.1007/s12029-010-9250-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this article is to provide a practical review of basic pancreatic imaging protocols and key cross-sectional imaging findings of the more common pancreatic neoplasms. METHODS We performed a literature search and reviewed numerous cases archived in the radiology department of a large university hospital to find examples which illustrate the key cross-sectional imaging findings of pancreatic neoplasms. RESULTS We reviewed the literature and provided several practical examples of common cross-sectional imaging findings in patients with pancreatic neoplasms. CONCLUSIONS Cross-sectional imaging plays a pivotal role in the evaluation of pancreatic neoplasms and allows proper triage of patients for conservative, medical or surgical management due to its ability to reliably detect and characterize pancreatic lesions, determine involvement of local structures, and assess metastatic disease. Familiarity with the key imaging findings will allow the clinician to better implement imaging data into daily practice.
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Affiliation(s)
- Matthew T Heller
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
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An optimal contrast dose indicator for the determination of hepatic enhancement in abdominal multidetector computed tomography: comparison of patient attenuation indicator with total body weight and body mass index. J Comput Assist Tomogr 2010; 34:874-8. [PMID: 21084903 DOI: 10.1097/rct.0b013e3181ed2f72] [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 evaluate a patient attenuation indicator (PAI) as compared with traditional patient-related factors of total body weight and body mass index (BMI) as a predictor of hepatic enhancement in contrast-enhanced abdominal multidetector computed tomography (MDCT). MATERIALS AND METHODS Institutional review board approval was obtained, and the study was Health Insurance Portability and Accountability Act compliant. A total of 77 patients (mean age, 53 years; male-female ratio, 32:45) underwent routine contrast-enhanced abdominal CT on a 16-slice multidetector CT (LightSpeed 16; GE Medical Systems, Milwaukee, Wis). Contrast enhancement was achieved by administering a 120-mL iodine contrast medium (350-mg iodine per milliliter) at an injection rate of 3 mL/s followed by an injection of 40-mL saline at 3 mL/s. Computed tomographic attenuation values (Hounsfield units [HU]) of liver parenchyma, main portal vein, and abdominal aorta were measured in each patient. Statistical analysis was performed with linear regression to determine the correlation of PAI, total body weight, and BMI with abdominal organ enhancement. RESULTS The mean of PAI, total body weight, and BMI were 28.0 (range, 22.1-34.2), 79.0 kg (range, 49.6-112.2 kg), and 27.5 kg/m (range, 16.8-43 kg/m), respectively. Mean hepatic enhancement was 128.2 HU (range, 73.6-175 HU), mean main portal vein enhancement was 214.2 HU (range, 118-327 HU), and mean abdominal aorta enhancement was 208.9 HU (range, 116-395 HU). Patient attenuation indicator, total body weight, and BMI showed a negative correlation with liver enhancement (r = -0.55, r = -0.4, and r = -0.3, respectively). Patient attenuation indicator exhibited a significantly higher correlation with hepatic enhancement than total body weight and BMI (P < 0.01, respectively). CONCLUSIONS Patient attenuation indicator exhibits a moderately inverse correlation with liver enhancement that is greater than those of total body weight and BMI. Patient attenuation indicator may be reliable in predicting the hepatic enhancement degree for a given dose of contrast material and has a potential use in customizing individual patient contrast medium dose during contrast-enhanced abdominal CT.
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Marin D, Nelson RC, Barnhart H, Schindera ST, Ho LM, Jaffe TA, Yoshizumi TT, Youngblood R, Samei E. Detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase: effect of a low-tube-voltage, high-tube-current CT technique--preliminary results. Radiology 2010; 256:450-9. [PMID: 20656835 DOI: 10.1148/radiol.10091819] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To intraindividually compare a low-tube-voltage (80 kVp), high-tube-current (675 mA) computed tomographic (CT) technique with a high-tube-voltage (140 kVp) CT protocol for the detection of pancreatic tumors, image quality, and radiation dose during the pancreatic parenchymal phase. MATERIALS AND METHODS This prospective, single-center, HIPAA-compliant study was approved by the institutional review board, and written informed consent was obtained. Twenty-seven patients (nine men, 18 women; mean age, 64 years) with 23 solitary pancreatic tumors underwent dual-energy CT. Two imaging protocols were used: 140 kVp and 385 mA (protocol A) and 80 kVp and 675 mA (protocol B). For both protocols, the following variables were compared during the pancreatic parenchymal phase: contrast enhancement for the aorta, the pancreas, and the portal vein; pancreas-to-tumor contrast-to-noise ratio (CNR); noise; and effective dose. Two blinded, independent readers qualitatively scored the two data sets for tumor detection and image quality. Random-effect analysis of variance tests were used to compare differences between the two protocols. RESULTS Compared with protocol A, protocol B yielded significantly higher contrast enhancement for the aorta (508.6 HU vs 221.5 HU, respectively), pancreas (151.2 HU vs 67.0 HU), and portal vein (189.7 HU vs 87.3 HU), along with a greater pancreas-to-tumor CNR (8.1 vs 5.9) (P < .001 for all comparisons). No statistically significant difference in tumor detection was observed between the two protocols. Although standard deviation of image noise increased with protocol B (11.5 HU vs 18.6 HU), this protocol significantly reduced the effective dose (from 18.5 to 5.1 mSv; P < .001). CONCLUSION A low-tube-voltage, high-tube-current CT technique has the potential to improve the enhancement of the pancreas and peripancreatic vasculature, improve tumor conspicuity, and reduce patient radiation dose during the pancreatic parenchymal phase.
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Affiliation(s)
- Daniele Marin
- Department of Radiology, Duke University Medical Center, Erwin Rd, Durham, NC 27710, USA
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Perez-Johnston R, Lenhart DK, Sahani DV. CT Angiography of the Hepatic and Pancreatic Circulation. Radiol Clin North Am 2010; 48:311-30, viii. [DOI: 10.1016/j.rcl.2010.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Dual-Source Dual-Energy MDCT of Pancreatic Adenocarcinoma: Initial Observations With Data Generated at 80 kVp and at Simulated Weighted-Average 120 kVp. AJR Am J Roentgenol 2010; 194:W27-32. [DOI: 10.2214/ajr.09.2737] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Boraschi P, Donati F, Gigoni R, Salemi S, Faggioni L, Del Chiaro M, Boggi U, Bartolozzi C, Falaschi F. Secretin-stimulated multi-detector CT versus mangafodipir trisodium-enhanced MR imaging plus MRCP in characterization of non-metastatic solid pancreatic lesions. Dig Liver Dis 2009; 41:829-37. [PMID: 19303825 DOI: 10.1016/j.dld.2009.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 01/26/2009] [Accepted: 02/10/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM Our study was aimed to compare multiphasic multi-detector computed tomography after secretin stimulation and mangafodipir trisodium-enhanced magnetic resonance imaging plus MR cholangiopancreatography in the characterization of solid pancreatic lesions. PATIENTS AND METHODS Forty patients with ultrasound diagnosis of solid pancreatic lesion prospectively underwent both multi-detector computed tomography and magnetic resonance imaging. Three minutes after intravenous administration of secretin, post-contrast computed tomography scans were performed 40, 80, and 180 s after contrast medium injection. MR protocol included axial/coronal, thin/thick-slab, single-shot T2 w sequences and axial/coronal T1 w breath-hold spoiled gradient-echo images before and 30-40 min after intravenous infusion of manganese dipyri-doxal diphosphate. Different observers blindly evaluated the ability of computed tomography and magnetic resonance imaging to characterize focal pancreatic lesions. Surgery, biopsy, and/or follow-up were considered as our diagnostic gold standard. RESULTS Thirty-five focal pancreatic lesions (adenocarcinoma, n=18; focal chronic pancreatitis, n=4; endocrine tumor, n=6; metastasis, n=1; cystic tumor, n=3; indeterminate cystic lesions, n=3) were present in 34 patients since the remaining 6 subjects showed no pathological finding. Both multi-detector computed tomography and magnetic resonance imaging showed a statistically significant correlation with the gold standard and between themselves in the characterization of 29 solid lesions of the pancreas (p<0.05). CONCLUSION Both imaging techniques well correlate to final diagnosis of non-metastatic solid pancreatic lesions and particularly of adenocarcinomas with a slight advantage for mangafodipir trisodium-enhanced magnetic resonance imaging plus MR cholangiopancreatography.
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Affiliation(s)
- P Boraschi
- 2nd Department of Radiology, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy.
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Pancreatic adenocarcinoma: a comparison of automatic bolus tracking and empirical scan delay. ACTA ACUST UNITED AC 2009; 35:548-55. [DOI: 10.1007/s00261-009-9560-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2008] [Revised: 04/13/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
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The Bloody Pancreas: MDCT and MRI Features of Hypervascular and Hemorrhagic Pancreatic Conditions. AJR Am J Roentgenol 2009; 192:923-35. [PMID: 19304696 DOI: 10.2214/ajr.08.1602] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, Gualdi GF. Imaging assessment of acute pancreatitis: a review. Semin Ultrasound CT MR 2009; 29:322-40. [PMID: 18853839 DOI: 10.1053/j.sult.2008.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis is one of the more commonly encountered etiologies in the emergency setting. While in the majority of cases it is a self-limiting disease which responds rapidly to conservative management, in some cases acute pancreatitis may present with a more pronounced, sometimes dramatic, clinical picture and requires immediate medical care to avoid fatal complication. In this context, imaging plays a significant role because it enables identification of the development of the disease and local/systemic complications. The purpose of this article is to offer an overview of the disease and a spectrum of imaging findings in patients with acute pancreatitis, emphasizing the role of ultrasound, computed tomography, and magnetic resonance imaging according to the appropriate clinical context and advantages and limitations of each imaging modality are examined.
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Affiliation(s)
- Mariano Scaglione
- Department of Diagnostic Imaging, Clinica Pineta Grande, Castel Volturno, Caserta, Italy.
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Fleischmann D, Kamaya A. Optimal Vascular and Parenchymal Contrast Enhancement: The Current State of the Art. Radiol Clin North Am 2009; 47:13-26. [DOI: 10.1016/j.rcl.2008.10.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kondo H, Kanematsu M, Goshima S, Tomita Y, Miyoshi T, Hatcho A, Moriyama N, Onozuka M, Shiratori Y, Bae KT. Abdominal Multidetector CT in Patients with Varying Body Fat Percentages: Estimation of Optimal Contrast Material Dose. Radiology 2008; 249:872-7. [DOI: 10.1148/radiol.2492080033] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Optimal arterial phase imaging for detection of hypervascular hepatocellular carcinoma determined by continuous image capture on 16-MDCT. AJR Am J Roentgenol 2008; 191:772-7. [PMID: 18716108 DOI: 10.2214/ajr.07.3452] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study is to estimate the optimal time delay before the initiation of arterial phase scanning for detection of hypervascular hepatocellular carcinoma (HCC) on 16-MDCT when a rapid bolus injection of contrast medium is administered. SUBJECTS AND METHODS In this prospective study, 25 patients (19 men and six women; mean age, 63.5 years; age range, 50-81 years) with pathologically confirmed HCC were included. Dynamic 16-MDCT imaging was performed in cine mode using 70 mL of nonionic iodinated contrast medium (300 mg I/mL) at an injection rate of 7 mL/s. Four consecutive 5-mm-thick slices at the maximum diameter of the HCC were selected as the region of interest. Time-attenuation curves were generated by region of interest drawn on the aorta, tumor, and liver. Qualitative assessments of conspicuity for contrast medium wash-in, peak, and wash-out of aorta and tumor were performed. RESULTS There were 108 arterial phase enhancing lesions (mean [+/-SD], 4.9 +/- 2.4 cm; range, 0.7-12.9 cm) in the 25 patients. The maximum Hounsfield value of aorta, tumor, and background liver parenchyma were 463.8 +/- 98 HU, 106.5 +/- 19 HU, and 98.3 +/- 14 HU, respectively. At the time of onset of peak tumor enhancement, the difference between tumor density and background liver density was 38.2 +/- 19 HU. The time-attenuation curve showed that the mean times of contrast enhancement start, peak, and end were 9.2 +/- 2.7 seconds, 19.4 +/- 2.1 seconds, and 38 +/- 13.5 seconds, respectively, for the aorta, and 15.5 +/- 2.6 seconds, 26.3 +/- 2.9 seconds, and 57.7 +/- 14.4 seconds, respectively, for 25 pathologically confirmed hepatocellular carcinomas. Qualitatively, the mean times of contrast enhancement wash-in, peak, and washout were 10.2 +/- 2.8 seconds, 19.9 +/- 3 seconds, and 39.9 +/- 9.2 seconds, respectively for the aorta, and 18 +/- 4.2 seconds, 27 +/- 3 seconds, and 55.7 +/- 21 seconds, respectively, for tumor. There were no differences between quantitative and qualitative measurements of wash-in and peak time for the aorta (p = 0.00017, p = 0.00016) and tumor (p = 0.00163, p = 0.00040). CONCLUSION When using 70 mL of 300 mg I/mL of contrast medium with an injection rate of 7 mL/s in 16-MDCT scanning, the optimal time to initiate scanning for HCC is 26.3 +/- 2.9 seconds (range, 24.0-34.5 seconds) after contrast medium administration.
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