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Lee HJ, Kim JS, Lee JK, Lee HA, Pak S. Ultra-low-dose hepatic multiphase CT using deep learning-based image reconstruction algorithm focused on arterial phase in chronic liver disease: A non-inferiority study. Eur J Radiol 2023; 159:110659. [PMID: 36584563 DOI: 10.1016/j.ejrad.2022.110659] [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: 10/04/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study determined whether image quality and detectability of ultralow-dose hepatic multiphase CT (ULDCT, 33.3% dose) using a vendor-agnostic deep learning model(DLM) are noninferior to those of standard-dose CT (SDCT, 100% dose) using model-based iterative reconstruction(MBIR) in patients with chronic liver disease focusing on arterial phase. METHODS Sixty-seven patients underwent hepatic multiphase CT using a dual-source scanner to obtain two different radiation dose CT scans (100%, SDCT and 33.3%, ULDCT). ULDCT using DLM and SDCT using MBIR were compared. A margin of -0.5 for the difference between the two protocols was pre-defined as noninferiority of the overall image quality of the arterial phase image. Quantitative image analysis (signal to noise ratio[SNR] and contrast to noise ratio[CNR]) was also conducted. The detectability of hepatic arterial focal lesions was compared using the Jackknife free-response receiver operating characteristic analysis. Non-inferiority was satisfied if the margin of the lower limit of 95%CI of the difference in figure-of-merit was less than -0.1. RESULTS Mean overall arterial phase image quality scores with ULDCT using DLM and SDCT using MBIR were 4.35 ± 0.57 and 4.08 ± 0.58, showing noninferiority (difference: -0.269; 95 %CI, -0.374 to -0.164). ULDCT using DLM showed a significantly superior contrast-to-noise ratio of arterial enhancing lesion (p < 0.05). Figure-of-merit for detectability of arterial hepatic focal lesion was 0.986 for ULDCT using DLM and 0.963 for SDCT using MBIR, showing noninferiority (difference: -0.023, 95 %CI: -0.016 to 0.063). CONCLUSION ULDCT using DLM with 66.7% dose reduction showed non-inferior overall image quality and detectability of arterial focal hepatic lesion compared to SDCT using MBIR.
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Affiliation(s)
- Hyun Joo Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jin Sil Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, Republic of Korea
| | - Seongyong Pak
- Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology,Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Choi ES, Kim JS, Lee JK, Lee HA, Pak S. Prospective evaluation of low-dose multiphase hepatic computed tomography for detecting and characterizing hepatocellular carcinoma in patients with chronic liver disease. BMC Med Imaging 2022; 22:219. [PMID: 36536325 PMCID: PMC9762112 DOI: 10.1186/s12880-022-00947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Knowing the lowest acceptable radiation dose of multiphase hepatic CT may allow us to reduce the radiation dose for detecting HCC. PURPOSE To prospectively assess the image quality and diagnostic performance of low-dose and ultra-low-dose multiphase hepatic computed tomography using a dual-source CT scanner. METHODS Three reconstructed different dose scan images (standard-dose, low-dose, and ultra-low-dose) of hepatic multiphase CT were obtained from 67 patients with a dual-source CT scanner. The image quality and the diagnostic performance of the three radiation dose CT scans of the hepatic focal lesion (≥ 0.5 cm) were analyzed by two independent readers using the Liver Imaging Reporting and Data System. RESULTS Qualitative image quality and signal-to-noise ratio were significantly different among the radiation doses (p < 0.001). In total, 154 lesions comprising 32 hepatocellular carcinomas (HCC) and 122 non-HCC were included. The sensitivities of SDCT, LDCT, and ULDCT were 90.6%(29/32), 81.3%(26/32), and 56.2%(18/32), respectively. The accuracies of SDCT, LDCT, and ULDCT were 98.1%(151/154), 96.1%(148/154), and 89.6%(138/154), respectively. On per-lesion analysis, SDCT and LDCT did not show significantly different sensitivity and accuracy in diagnosing HCC (p = 0.250 and 0.250). CONCLUSIONS The diagnostic performance of dynamic hepatic LDCT with 33% reduced radiation dose in comparison to SDCT would be acceptable even though its image quality was qualitatively and quantitatively inferior. However, few HCCs could be overlooked. Therefore, with caution, radiation dose reduction by one-third could be implemented for follow-up CT scans for patients suspected of having HCC with caution and further studies are needed in the future.
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Affiliation(s)
- Eun Sun Choi
- grid.255649.90000 0001 2171 7754Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jin Sil Kim
- grid.255649.90000 0001 2171 7754Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jeong Kyong Lee
- grid.255649.90000 0001 2171 7754Department of Radiology and Medical Research Institute, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hye Ah Lee
- grid.255649.90000 0001 2171 7754Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul, Korea
| | - Seongyong Pak
- grid.267370.70000 0004 0533 4667Department of Biomedical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Inoue A, Uemura R, Takaki K, Sonoda A, Ota S, Nitta N, Batsaikhan B, Takahashi H, Watanabe Y. Clinical impact of low tube voltage computed tomography during hepatic arteriography with low iodine to detect hepatocellular carcinoma before transarterial chemoembolization. Eur J Radiol 2022; 154:110420. [DOI: 10.1016/j.ejrad.2022.110420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022]
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Zaki IH, Shropshire E, Zhang S, Xiao D, Wildman-Tobriner B, Marin D, Gupta RT, Erkanli A, Nelson RC, Bashir MR. How frequently does hepatocellular carcinoma develop in at-risk patients with a negative liver MRI examination with intravenous Gadobenate dimeglumine? Abdom Radiol (NY) 2021; 46:969-978. [PMID: 32951065 DOI: 10.1007/s00261-020-02771-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the rate of development of clinically significant liver nodules (LR-4, LR-5, LR-M) after a negative MRI in an HCC screening population. METHODS This retrospective study included patients at risk of developing HCC requiring imaging surveillance who had undergone multiphase Gadobenate dimeglumine-enhanced MRI that was negative and had follow up LI-RADS compliant multiphase CTs or MRIs for at least 12 months or positive follow-up within 12 months. Follow-up examinations were classified as negative (no nodules or only LR-1 nodules) or positive (nodule other than LR-1). Time-to-first positive examination, types of nodules, and cumulative incidence of nodule development were recorded. RESULTS 204 patients (mean age 58.9 ± 10.2 years, 128 women), including 172 with cirrhosis, were included. Based CT/MRI follow-up (median 35 months, range 12-80 months), the overall cumulative incidence of developing a nodule was 10.5%. Cumulative incidence of nodule development was: 0.5% at 6-9 months and 2.1% at 12 ± 3 months, including one LR-4 nodule, one LR-M nodule, and two LR-3 nodules. The cumulative incidence of clinically significant nodule development was 1.1% at 9-15 months. 70% (143/204) of patients also underwent at least one US follow-up, and no patient developed a positive US examination following index negative MRI. CONCLUSION Clinically significant liver nodules develop in 1.1% of at-risk patients in the first year following negative MRI. While ongoing surveillance is necessary for at-risk patients, our study suggests than longer surveillance intervals after a negative MRI may be reasonable and that further research is needed to explore this possibility.
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Affiliation(s)
- Islam H Zaki
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
- Center for Advanced Magnetic Resonance Development (CAMRD), Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Erin Shropshire
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Shuaiqi Zhang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC, 27710, USA
| | - Dong Xiao
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC, 27710, USA
| | | | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Alaattin Erkanli
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, 2424 Erwin Road, Suite 1102 Hock Plaza, Box 2721, Durham, NC, 27710, USA
| | - Redon C Nelson
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
- Center for Advanced Magnetic Resonance Development (CAMRD), Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
- Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
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An C, Kim DY, Choi JY, Han KH, Roh YH, Kim MJ. Noncontrast magnetic resonance imaging versus ultrasonography for hepatocellular carcinoma surveillance (MIRACLE-HCC): study protocol for a prospective randomized trial. BMC Cancer 2018; 18:915. [PMID: 30249190 PMCID: PMC6154402 DOI: 10.1186/s12885-018-4827-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 09/17/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Biannual ultrasound (US)-with or without alpha-fetoprotein (AFP)-is recommended by current guidelines for the surveillance of hepatocellular carcinoma (HCC). However, the inadequate sensitivity of US has been a concern. Magnetic resonance imaging (MRI) is known to have high sensitivity in detecting hepatic malignancies, even without contrast enhancement. The purpose of our study is to compare US with noncontrast (unenhanced) MRI for HCC surveillance of high-risk patients. METHODS/DESIGN MIRACLE-HCC (usefulness of noncontrast MagnetIc Resonance imAging versus nonContrast ultrasonography for surveiLlancE of HepatoCellular Carcinoma) is a prospective, single-center, nonblinded, balanced-randomized, parallel-group study. This study was approved by our institutional review board, and informed consent will be obtained from all participating patients. All patients with compensated liver cirrhosis will undergo noncontrast US or MRI, with serum AFP testing every 6 months. If a suspicious lesion is newly detected, or if the serum AFP level is elevated in an increasing trend for two consecutive tests, dynamic contrast-enhanced imaging will be performed to confirm the diagnosis. The primary endpoints are detection rates of very early or early stage HCC, stage distribution at the initial diagnosis, and false positive referral rates, which will be compared using Fisher's exact or chi-square tests. The study will include 416 patients in a tertiary academic medical center in South Korea. DISCUSSION MIRACLE-HCC is the first prospective randomized trial to compare the effectiveness of noncontrast MRI and noncontrast US in the surveillance of HCC in at-risk patients. The results of this trial will show whether noncontrast MRI surveillance is superior to noncontrast US surveillance in the early detection of HCC. The trial will also determine whether there are fewer false referrals with noncontrast MRI than with noncontrast US and, eventually, whether there is improvement in the overall survival of HCC patients. TRIAL REGISTRATION The date of trial registration (ClincalTrials.gov: NCT02514434 ) for this study is July 23, 2015. Enrollment of participants was finished in November 2017. No authors have relationships, conditions, or circumstances that present potential conflicts of interest.
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Affiliation(s)
- Chansik An
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Do Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Young Choi
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Kwang Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Roh
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Kim JW, Seong J, Park MS, Kim KS, Park YN, Han KH, Keum KC, Lee IJ. Radiological-pathological correlation study of hepatocellular carcinoma undergoing local chemoradiotherapy and surgery. J Gastroenterol Hepatol 2016; 31:1619-27. [PMID: 26969151 DOI: 10.1111/jgh.13334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS Optimal response criteria and assessment timing were investigated through radiologic-pathologic correlation in hepatocellular carcinoma (HCC) treated with localized chemoradiotherapy (CRT). METHODS We reviewed 19 consecutive HCC patients who underwent surgical resection after radiotherapy and concurrent hepatic arterial infusion chemotherapy. Patients who received transarterial chemoembolization before RT or surgery were excluded from evaluation. Tumor diameters and total and enhancing tumor volumes were measured from CT images obtained 1, 3, 6, and 9 months after CRT. Percent changes calculated using size (RECIST and WHO) and enhancement criteria (mRECIST and EASL) were correlated with percent changes in total and enhancing tumor volumes, and with percent viable tumor in surgical specimens. RESULTS Median time between CRT and resection was 4.1 months (range, 1.5-15.4 months). CR and PR rates were 0 and 68% by RECIST, 0 and 63% by WHO, 53% and 37% by mRECIST, and 53% and 42% by EASL. Pathologic CR (pCR) rate was 52.6%. Radiologic criteria showed strong correlation with tumor volumes at 1 and 3 months after CRT; at 6 months, however, size and enhancement criteria showed strong correlation only with total and enhancing tumor volumes, respectively. Enhancement criteria were better predictors of pathologic response at all times including preoperative evaluation (RECIST: R(2) = 0.303, P = 0.015 and WHO: R(2) = 0.366, P = 0.006 vs. mRECIST: R(2) = 0.760, P < 0.0001 and EASL: R(2) = 0.768, P < 0.0001). Time interval >6 months before resection showed significant correlation with pCR (P = 0.013). CONCLUSIONS We recommend using enhancement criteria in assessing tumor viability, especially if the tumor was to be resected <6 months after CRT.
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Affiliation(s)
- Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Sook Park
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Jae Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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